Hansard, Wednesday, 9 July 2014

1 Ms Irene Ng Phek Hoong asked the Deputy Prime Minister and Minister for Home Affairs in view of the growing number of extremists from various countries travelling to Syria to fight (a) whether the Government shares the concerns expressed by Britain, France and Australia that these militants will pose a security threat to their home countries upon their return; (b) if so, what are the implications for Singapore; and (c) what measures are being taken to counter this security threat given that terrorist groups are using social media to recruit militants in various parts of the world to their cause.

Mdm Speaker, the conflict in Syria is into its third year. It is a security concern for many countries, including Singapore. As many as 12,000 foreigners may already have gone to fight in Syria. This is even more than the number of foreign fighters in the Soviet-Afghan war, and the number is still growing. Many of the foreigners have joined terrorist groups at the forefront of the violence, such as the Al-Qaeda-linked Jabhat Al-Nusra or the Al-Nusra Front and the former Al-Qaeda affiliate Islamic State of Iraq and the Levant (ISIL), which has now renamed itself the Islamic State (IS).

The Government knows of a handful of Singaporeans who have gone to Syria to take part in the conflict. One of them is Haja Fakkurudeen Usman Ali (Haja), a naturalised Singapore citizen of India origin. He brought his wife and three children then aged between two and 11 with him. Another female Singaporean is believed to have gone to Syria with her foreign husband and two teenaged children. The whole family is taking part in the conflict in various ways, either fighting in the terrorist groups, or providing aid and support to the fighters.

Several Singaporeans intended to travel to Syria or other conflict zones to engage in the jihadist violence there, but were detected before they could proceed with their plans. One was Abdul Basheer s/o Abdul Kader (Basheer), the self-radicalised Singaporean lawyer who was detained under the Internal Security Act (ISA) from 2007 to 2010. He was re-detained in October 2012 when he was found to have been looking for ways to travel to places like Syria

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to engage in armed jihad.

Another was Zakaria bin Rosdan, who tried to establish contact with foreign militant groups online in order to join them and engage in the violence in Syria. A third Singaporean, Khairul Sofri bin Osman, was interested to carry out militant jihad overseas in places like Syria, and had also abetted Zakaria in his plans. Both Zakaria and Khairul were issued with Restriction Orders (RO) under the ISA in December 2013.

There are others who have expressed interest to go to Syria to join in the fighting, and are presently under investigation. We have established that they were radicalised by videos, articles and social media postings online. They subscribed to the sectarian-religious or ideological rhetoric that calls for engaging in militant jihad in Syria.

Mdm Speaker, Singapore is concerned about the flow of foreign fighters into Syria for two reasons.

First, we worry about the terrorism threat from these foreign fighters after they leave Syria. There are parallels between the Syrian crisis and the Soviet-Afghan war of the 1980s, which drew in several thousand foreign fighters and led to the creation of the Al-Qaeda terrorist organisation.

Al-Qaeda had, among other things, planned terrorist attacks in Singapore through the Jemaah Islamiyah (JI) group. Several Singaporean JI members involved had trained in Afghanistan with Al-Qaeda. JI planned suicide truck bomb attacks against a number of diplomatic missions in Singapore, in collaboration with Al-Qaeda. Fortunately, their plans were foiled by ISD's operation in December 2001.

The foreign fighters in Syria may similarly return from the conflict, proficient in terrorist skills. They may undertake terrorist activities in their home countries or overseas, or at the very least provide logistical and operational help to terrorists whom they befriended in Syria. Mdm Speaker, this has already happened. UK and French nationals who returned from fighting in Syria have already targeted Central London and the French Riviera.

Let me cite a recent example of how foreign fighters in Syria can threaten our security here in Singapore. A French national who had fought in Syria recently attacked the Jewish Museum in Brussels in Belgium on 24 May 2014, killing four persons. He was subsequently arrested in France. This French national, whose identity we had not previously known, had in fact, travelled through Thailand, Malaysia and Singapore en-route from Syria back to Europe. Most likely, he did this to mask the fact that he was a returnee from Syria.

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Of more direct concern is if there are foreign fighters in Syria who have come from our region. The Indonesian authorities have said that some 56 Indonesians have joined in the armed violence in Syria and Iraq. Most belong to militant groups like the Indonesian JI and the Jemaah Anshorut Tauhid (JAT) which was founded by Abu Bakar Bashir, the former Spiritual Leader of the JI. More than 30 Malaysians have gone to fight in Syria and Iraq, with some reports citing as many as 100. Some 15 of them have reportedly died while fighting in Syria, while another undertook a suicide mission on behalf of IS in Iraq on 26 May 2014 which killed 25 persons. Meanwhile, the Malaysian authorities had arrested at least 18 people who were involved in activities related to fighting in Syria, including two servicemen in the Malaysian Navy.

The presence of former foreign fighters in our region – whether they originate from Southeast Asia or elsewhere – is a security threat to us. This threat is magnified if these returnee fighters are Singaporeans. Indeed, any Singaporean who assists violent organisations like the Al-Nusra Front, IS or any other violent group, have demonstrated a dangerous tendency to support, or resort to, violence to pursue a political or ideological cause. They would thus pose a real threat to Singapore's national security.

Our second concern over the Syrian conflict is its potential to damage our social cohesion. If we find more Singaporeans fighting or supporting the fighting in Syria, or harbouring intentions of doing so, it will cause disquiet on the ground, and mistrust and tension between our communities. This was the situation in the aftermath of the September 11, 2001 attacks in the US, and the arrests of the Singapore JI members shortly thereafter in December 2001. The Government puts in considerable effort to work with the communities to protect ethnic relations and social harmony. Our Muslim community also played a key role, acknowledging the danger and taking responsibility for countering violent extremist ideology and rehabilitating those who had gone down the terrorist pathway. We also formed the Inter-Racial and Religious Confidence Circles and launched the Community Engagement Programme to build good social relations, so that our society can weather similar social stresses. These efforts are ongoing. They stand us in good stead when we encounter new incidents, for example, in 2010 when we detained a National Serviceman who was planning to fight in Iraq or Afghanistan.

Mdm Speaker, the Syrian crisis has increased the terrorism threat to Singapore. I assure Members that the Government will maintain vigilance in counter-terrorism measures. We will continue to investigate persons who intend to engage in violence overseas, so as to prevent them from posing a security threat to Singapore and their fellow citizens.

A key challenge is to counter the radical propaganda used by the terrorists and radical ideologues to recruit foreign fighters. At the core of the issue is an ideological battle, between those who distort Islam for their violent political ends, and those who uphold the

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tenets of Islam as a religion of peace. We have discussed the security concerns arising from the Syrian conflict with our religious leaders, who are looking at ways to expand and build on their ongoing efforts to counter radical ideology.

A related challenge, which the Member has rightly identified, is the use of social media and the Internet for recruitment. The Soviet-Afghan conflict in the 1980s was in the pre-Internet age. Social media and the Internet have been a game-changer in the Syrian conflict. Some foreigners have been lured by the sense of "adventure" marketed by the extremists online. Others are attracted by the "jihad cool" factor, with "selfies" of fighters posing with weapons. Youths, who are the primary users of social media, are particularly vulnerable to such propaganda.

Mdm Speaker, it is not possible to insulate Singaporeans from the radical rhetoric that is so prevalent online. Singaporeans therefore must play their part in preventing loved ones and friends from becoming radicalised and embarking on a path of violence and self-destruction. They should seek help by bringing such individuals to the attention of the authorities early, rather than let the individual go deeper down the path towards violence, and causing the death of others, and of themselves. As one of my Middle Eastern counterparts explained to me, by intervening early, family members, friends, the community and the authorities would be "saving" these individuals from taking a course of action that would have caused them and others harm.

Singaporeans who wish to help the Syrian civilians who have been victims of the violence should not go to Syria and run the risk of getting involved in the violence. They can help by giving humanitarian aid through bona fide local organisations. They are strongly advised to check with MUIS before making any donations, because some foreign humanitarian organisations are, in fact, covers used by radical elements to raise money or recruit fighters.

Ms Irene Ng.

Madam, the Syrian conflict has been described by counter terrorism experts as "an incubator of new terrorists" with combat skills. Can I ask the Deputy Prime Minister, given the serious threat to national security, whether he is disturbed that there has already been a handful of Singaporeans who have answered the call for militant jihad, and how we can take steps to ensure that the numbers are kept down, and whether new measures will be taken to enhance surveillance of radical Islamist websites that recruit fighters, and to track Singaporeans and also those in this region travelling to Syria or who plan to?

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My second question is: what efforts will be taken to sensitise the wider community to alert the authorities early of those who plan to travel to Syria or who are influenced by the recruitment videos online?

My third question is: what is MHA's assessment of Singapore's readiness to tackle the potential fallout from the Syrian conflict?

Mdm Speaker, once again, we have to look at this issue from two aspects. One is the security aspect and the other is the community resilience aspect.

From the security aspect, it requires vigilance. We take the matter very seriously. It requires vigilance – both locally, but also in cooperation with other countries. Our security agencies are working closely with their regional and international counterparts to exchange intelligence and cooperate in investigations. We are all concerned about the cross-border flows and the potential interactions between foreign fighters who may have gone to Syria, and form networks among themselves. We will investigate anyone, whether local or foreign, who poses a terrorism threat to Singapore and Singaporeans.

There is also the community resilience aspect. To counter the threat of extremism and terrorism holistically, the Government is working in partnership with the community to counter the radical ideology propagated by the terrorists. We have a good base for this because we have been working with the local community religious leaders for some years now. As I said, we have the Religious Rehabilitation Group which has taken upon itself the responsibility of helping to counsel and rehabilitate those who have gone down the wrong path. Not only that, they reach out to the wider community, to put forward anti-extremist messages, and also to explain why certain interpretations which lead people towards extremism are not the correct teachings, and to guide the wider community along the right path. The objective of these efforts is to marginalise militant ideas and prevent them from gaining a foothold among the wider community.

More recently, in the Syrian conflict, the Muslim community has taken active steps, for example, to provide bona fide channels for Singaporeans to render humanitarian aid to Syria, so that the good intentions of our Singaporeans are not exploited by extremists who use humanitarian aid as a cover for their violent agenda.

I should say that it requires the effort from all of us, so that we build our community harmony together, we try to make sure that Singaporeans remain united, and that we do not cause additional friction and tensions between the communities where these have not arisen and are not necessary.

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The Syrian conflict does pose a very serious long-term threat for Singapore and for other countries, and we do want to make sure that we work together and not allow it to pull our society apart.

I want to thank Deputy Prime Minister for the statement as well as consciously making the distinction between practising Islam in a peaceful and moderate way, compared to one that is radicalised and supporting armed conflict. May I ask two supplementary questions?

How is MHA tracking these potential radicalised volunteers right now? Is there a systematic programme, especially for those who may be influencing those in Singapore? And because the Deputy Prime Minister did mention that the Internet sites are also a key factor today, have there been sites that have been identified and banned at this point?

Lastly, the Deputy Prime Minister also spoke about being proactive in creating awareness as well as rehabilitating those who have been radicalised. Will there be more resources given by the Government to help groups and those who are interested in creating greater awareness, as well as helping out in this effort?

The security agencies are, as usual, keeping their ears to the ground to see whether they have received information on people who are becoming radicalised or who have such tendencies. We work with other countries. Most of these sites, in fact, all of these sites, are hosted overseas. We encourage the community in Singapore to be aware of them and not to subscribe to the ideology. We also encourage Singaporeans not to stoke inter-communal tensions, where these do not exist and are unnecessary.

It is also important for the community itself to take active steps to protect itself. As I have said, the way it was described to me by one of my Middle Eastern counterparts is, when they do take action or do counselling over the person who had such tendencies, they tell the family, "I have saved your son", because, in truth, that is what has happened. By taking action early, we are able to bring counselling and other resources to save this person from doing harm to himself, to others and to his family as well, by the direction that he has taken.

It is also important that all Singaporeans are aware of what is going on in Syria and the serious implications it can have on us. Tomorrow, I will be having a dialogue with several local religious leaders of different faiths together with Minister Yaacob, to discuss with them Government's concerns over the Syrian conflict and to foster better understanding and appreciation of the challenges we face, so that we do not look at it just as an issue for one community but we look at it as an issue which we all need to face together.

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To the Deputy Prime Minister, I am happy to hear that MHA has been engaging the Malay/Muslim as well as the other communities on this Syrian crisis issue. Would MHA be updating in the future any development that would enhance our understanding as well as the threat posed by the Syrian issue, should there be further developments?

Certainly, that is a good idea and we will continue to do so. Today, I appreciate very much the opportunity of having been able to update the House on the issue and what we are doing, and we hope that this messaging will also get out to the wider community in Singapore.

2 Dr Lim Wee Kiak asked the Minister for Foreign Affairs with regard to Malaysia's Forest City project in the Johor Straits (a) what is Malaysia's latest response to Singapore; (b) how will this massive reclamation project impact on the transboundary environment; (c) what are the protocols under international law on the carrying out of such reclamation projects; (d) whether this protocol was observed before the project was announced in the media by the developers; and (e) whether Singapore will be carrying out any impact studies to ascertain how this project will impact on our environment.

3 Mr Ang Wei Neng asked the Minister for Foreign Affairs whether Singapore has engaged Malaysia on the conduct of an Environmental Impact Assessment in respect of Johor's intention to build a massive man-made island near to the Tuas Second Link.

Mdm Speaker, may I seek your permission to take Question Nos 2 and 3 together?

Yes, please.

Mdm Speaker, Singapore is very concerned about the potential transboundary impact on Singapore from reclamation projects in Malaysia that are in close proximity to Singapore. Countries are obliged under the UN Convention on the Law of the Sea (UNCLOS), and general international law, not to cause harm or permit activities within their jurisdiction to cause transboundary harm to their neighbours.

In the present case, this would include Malaysia not permitting reclamation activities of this scale and nature to take place so close to the international boundary with Singapore without first conducting an Environmental Impact Assessment (EIA). Where such

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assessments indicate that any damage may be of a transboundary nature affecting Singapore, Malaysia has a duty to consult Singapore. If damage to our environment has been caused or is imminent, Malaysia has a duty to immediately notify Singapore. Countries are also obligated to work closely on such matters and to share any relevant information with each other. Apart from the UNCLOS and general international law, under the 2005 Reclamation Case Settlement Agreement between Singapore and Malaysia, both Singapore and Malaysia are obliged to monitor our respective environments in the Straits of Johor, share information and address any adverse impacts, if necessary.

There are two reclamation projects in question. The first is by Country Garden Holdings Co Ltd and Kumpulan Prasarana Rakyat Johor in the western Straits of Johor, also known as Forest City; and the second is by Guangzhou R&F Properties Co Ltd in the vicinity of Johor's old Customs, Immigration and Quarantine Complex by the Causeway, also known as R&F Princess Cove. Singapore was not given prior information on these reclamation projects.

In this regard, we have, on a number of occasions, registered our concerns with Malaysia regarding these projects. We have requested for all relevant information on all their reclamation and construction works, including the EIA reports and projected timelines for their completion, for our further study and consideration. These were conveyed through letters from NEA to its Malaysian counterpart and through third party notes, which are formal diplomatic correspondence between governments. Prime Minister Lee Hsien Loong spoke and wrote to Prime Minister Najib Razak on this matter. Minister for National Development Mr Khaw Boon Wan also wrote to his co-chair of the Malaysia-Singapore Joint Ministerial Committee for Iskandar Malaysia, Minister in the Malaysian Prime Minister's Office Dato' Seri Abdul Wahid Omar, to express Singapore's concerns. Our concerns have also been expressed to other Malaysian ministerial colleagues. This issue was also discussed at the Malaysia-Singapore Joint Committee on the Environment Working Group meeting in Malaysia in May 2014.

In our communications with Malaysia, we have conveyed our concerns that the reclamation projects could lead to an increase in the current velocity in the Straits of Johor. In turn, this could affect safety of navigation in the Straits, as well as increased erosion to the seabed and foreshore defences that support the infrastructure for the Second Link and Singapore's shoreline. The reclamation projects could also result in changes in the morphology and water quality in the Straits of Johor which directly affect Singapore's coastal and marine environment, as well as fish farms and other facilities in the East and West Johor Straits.

Because of these potential transboundary impacts on Singapore, we have requested Malaysia to suspend reclamation works until Singapore had received and studied all the

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relevant information.

On 30 June 2014, Malaysia responded with some preliminary general information on the proposed reclamation projects for Forest City and R&F Princess Cove. Malaysia promised to share all other information, including the EIAs, once their relevant internal processes are completed. Malaysia has stated that no reclamation works are currently being undertaken on these projects, and that it remains committed to fulfilling its obligations under international law and will take all necessary measures to avoid any adverse transboundary impact. We welcome Malaysia's cooperation on this matter and look forward to receiving the rest of the information we requested as soon as possible. We are also seeking further clarifications on some of the information that Malaysia provided. In the meantime, we will study the information provided and conduct the necessary studies to ascertain how this project will impact Singapore.

Mdm Speaker, in the spirit of bilateral cooperation between our two countries, we remain committed to working together with Malaysia to address our concerns over the possible transboundary impacts of Malaysia's reclamation projects. In this regard, we have proposed to hold consultations with Malaysia so that both sides can further discuss and exchange information on these projects.

Mdm Speaker, I would like to thank the Senior Minister of State for the reply. I would like to ask the Senior Minister of State two supplementary questions.

First of all, what is Singapore's course of action in the event that there is a disagreement, after reviewing the Environmental Impact Assessment studies and they decide to go ahead? Do we go to the International Court of Justice (ICJ)? Do we go to the International Court of Arbitration?

Secondly, is there any change in terms of the boundary lines after they have done their reclamation? And the part that they are reclaiming now, what would their boundary lines be like and how far is our boundary line from this particular development?

I thank the Member for the supplementary questions. I think it is too premature to talk about any development at this stage and we must not to be hypothetical about it. We must let consultations and information exchange go forward, and to study them first before we hypothesise what we will do or what they will do, and what can happen in the future.

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On the second question, the boundary lines between any countries have already been fixed. Unless there are disputes, they have to be settled. Between Singapore and Malaysia, it is very much settled. Whatever reclamation each country does, does not change the boundary lines between the two countries.

Madam, I thank the Senior Minister of State for the reply. I have the following supplementary questions.

I understand that the length of the Second Link Bridge over the water is about 1,920 metres, and presumably half of the length is under Singapore's jurisdiction. With the massive land reclamation in Johor, what would be the nearest point of the reclaimed land to Singapore? Will it pose any border security issues?

The second question is: does the Singapore Government have any more plan to further reclaim land at the Straits of Johor?

The third question is: how could we use the lesson learned from the previous land reclamation dispute between Singapore and Malaysia in 2003 to resolve the current issues of the reclamation land near the Second Link?

As I had mentioned to Dr Lim Wee Kiak, the boundaries between our two countries do not change, whatever reclamation works are done by one country or another. While I am not sure how much is the distance from the proposed reclaimed land to Singapore, I will wait for the information to be more apparent, when it is given to us.

On the second question, whether there is any more reclamation land by ourselves, I am not aware of this. I think the right authority would answer this, if a Parliamentary Question (PQ) is submitted. On whether the agreement on the 2003 dispute is used, indeed, it sets a precedent for both countries to work together and to consult each other on any reclamation work that each other does in the Straits of Johor, whether in the east or west of the Straits.

Mdm Speaker, may I seek clarification as to whether there is a frequency and a timeline for consultations to take place?

The consultation generally takes place yearly. But it does not prevent us from asking for clarification and to have meetings if it is urgently needed.

Mdm Speaker, many of my residents are very disappointed with Malaysia's reclamation work in the Johor Straits. I would like to ask the

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Senior Minister of State: is it possible to urge Singaporeans not to buy any project at this Forest City project?

I think we have to separate the issues around legalities between what we have to settle and the commercial exposure that residents have to make on their own, bearing in mind what they will bear in future or not. I think that is not the Government's mandate to tell them. The people must be open-minded and must know what they are into and understand the situation as it develops.

The following question stood in the name of Assoc Prof Tan Kheng Boon Eugene –

4 To ask the Minister for Law (a) what are the reasons for not bringing Article 5(2A) of the Constitution into force given that the constitutional amendment was first passed in 1991; (b) under what conditions will the Government be ready to bring Article 5(2A) of the Constitution into force; and (c) whether the Government will instead bring into force Article 5(2A)(b) and Article 5(2A)(d) to entrench the constitutional provisions relating to fundamental liberties and general elections respectively ahead of the constitutional provisions entrenching the elected presidency.

Question No 4, please.

Mdm Speaker, the 1991 constitutional amendments that created the institution of the Elected President were unique arrangements. We made fundamental changes to the law and procedure for Government, key statutory boards and key Government companies.

Given the complex and novel nature of the changes, it was not possible to anticipate all the possible consequences and operational details. The provisions have been amended, revised and fine-tuned along the way, as we gained practical experience working the safeguards. A summary of these various amendments is outlined in an Annex. Amendments were made in 1994, 1996, 1998, 2001, 2002, 2004, 2007 and 2008.

Mdm Speaker, with your permission, may I ask that a copy of the Annex be distributed to Members?

Yes, I give permission for it to be distributed. [A handout was distributed to hon Members. Please refer to the Annex.]

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If I may continue, Mdm Speaker. The experience of the amendments shows that adjustments, modifications and refinements must be put in place, be fully ironed out, before the scheme can safely be entrenched. To bring Article 5(2A) into force before that would otherwise potentially trigger a national referendum each time we needed to make a further refinement or adjustment. Our view is that we should give ourselves more time, before entrenching the provisions.

In addition, in 2008, the Constitution was further amended to introduce a new Net Investment Returns framework, to improve the basis on which the Government can use the returns from investing our reserves for budgetary spending. This amendment gave us the fiscal space to meet increased spending needs, while protecting the reserves for future generations.

At present, Net Investment Returns Contribution makes a substantial contribution to our Budget – about 2% of GDP, or $8 billion per year. As I have explained to this House in 2009, the Government's intention was to operate these revised spending rules for a number of years, and consider entrenching them after that if no additional major changes proved necessary.

The current context is that our society is ageing quickly. Within the next 20 years or so, close to 1 million Singaporeans will reach retirement age. Over the last few years, the Government has made several major policy shifts which will significantly increase spending on infrastructure and social services, especially healthcare. Our healthcare spending alone is likely to increase three-fold, from $4 billion in 2011 to about $12 billion by 2020.

To pay for this increased spending, we will need to strengthen our revenue base. Over the next five to 10 years, we cannot rule out further refinements to our tax system and to the basis on which we draw on net investment returns for current spending. We cannot decide today precisely how this should be done. We must therefore preserve our ability to make necessary adjustments in due course, so that we can maintain Singapore's strong financial position, and our fair and progressive system of taxes and transfers.

For these reasons, it remains the Government's intention not to bring Article 5(2A) of the Constitution into force until the position is clearer.

Finally, the Member has also asked whether we can bring into force the entrenchment of the provisions relating to elections and fundamental liberties, in advance of the rest of Article 5(2A). The answer and the reasons why we cannot do so were explained to this House in February 2007. As the previous Minister for Law explained, the Attorney-General had advised the Government that, having regard to the provisions concerned, the

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implementation of Article 5(2A) cannot be staggered, as this would go against the intent that Article 5(2A) should operate as an integrated package.

The following question stood in the name of Mr R Dhinakaran –

5 To ask the Minister for Trade and Industry what is the key progress achieved by ASEAN member countries towards the ASEAN Economic Community at the recent ASEAN Summit.

Question No 5, please.

Mdm Speaker, ASEAN member states have made steady progress in building the ASEAN Economic Community (AEC) by 2015. We are strengthening customs and cross-border cooperation, enhancing trade facilitation initiatives, as well as eliminating tariff and addressing some non-tariff measures to facilitate and increase trade in goods. We are also working hard to complete the ninth package of commitments under the ASEAN Framework Agreement on Services, which will reduce services barriers, including the lowering of foreign equity limits. On investment, there are on-going activities aimed at improving ASEAN's investment regimes and promoting ASEAN as a single investment destination.

At the 24th ASEAN Summit held in Nay Pyi Taw, Myanmar, from 10 to 11 May this year, ASEAN Leaders reviewed the efforts made by ASEAN member states and reaffirmed their commitment to intensify efforts to implement the remaining action plans, in order to establish a single market and production base.

ASEAN member states are also working to develop the AEC's post-2015 agenda. This is because economic integration is a journey, and the region needs to continue to follow the course on which it has embarked, even after 2015. ASEAN member states recognise that integration is the only way forward if ASEAN wants to compete successfully in an increasingly globalised world.

Mdm Speaker, one clarification for the Senior Minister of State. It is accepted that the targets that are to be met by end of 2015, would largely be 70% to 80%. I think that is a conventional wisdom of what would be achieved by the deadline of end of next year. Is there any projection as to when the remaining 30%, 20%,

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is likely to be achieved, post-2015?

Well, that is why the post-AEC 2015 agenda is important. I think the ASEAN member states and the officials are working hard to try to define the next steps, and some of the deliverables that we can achieve in the next two to three years. ASEAN being a consensus-building body and also recognising that there are different developmental stages among the 10 member countries, it takes time to come to consensus and agreement that can be accepted by member countries. So, on the whole, while ASEAN AEC blueprint is not perfect, I think we are headed in the right direction.

The following question stood in the name of Mr R Dhinakaran –

6 To ask the Minister for Foreign Affairs whether the Vietnamese authorities are extending their protection for Singaporean companies in the Vietnam-Singapore Industrial Parks after the recent violent protests.

Question No 6, please.

Mdm Speaker, the Singapore Government takes a very serious view on the unrest that broke out at the Vietnam-Singapore Industrial Parks (VSIP) I and II in Binh Duong province on 13 and 14 May 2014. The VSIPs have long been a symbol of the strong economic cooperation between Singapore and Vietnam and are projects endorsed by both governments. To this end, we have made representations at various levels to the Vietnamese government to emphasise our strong concerns, the need for the Vietnamese government to provide security, and that the violence, indiscriminate looting, and the burning of the Singapore flag at the VSIPs were unacceptable.

The Vietnamese government has expressed its sincere regret over the unrest and has assured us that it would take concrete measures to ensure that such incidents would not occur again. During Vietnamese Deputy Prime Minister Vu Duc Dam's meeting with Prime Minister on the sidelines of the Nikkei conference on 22 May 2014, Deputy Prime Minister Dam conveyed Vietnamese Prime Minister Nguyen Tan Dung's deep regret over the unrest at the two VSIPs and gave full assurance that such incidents would not happen again. The Vietnamese government also pledged to conduct a full investigation and take necessary action against the perpetrators. The same message was conveyed to Minister Shanmugam

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by Deputy Prime Minister and Minister of Foreign Affairs Pham Binh Minh.

We note that most of the affected companies in the two VSIPs have restarted their operations and the Vietnamese government has taken measures to normalise the situation in the VSIPs. The Vietnamese government has also given its assurance that it will provide compensation and due assistance to the affected foreign companies, including Singaporean firms. We will continue to work with the Vietnamese government to ensure that the interests of Singaporean companies and investors in Vietnam are protected.

Can I ask the Minister, from my understanding, the unrest in Vietnam is directed against China, it was an anti-China protest. Why was the Singapore flag burned in this instance, because it has nothing to do with Singapore?

Mdm Speaker, I thank the Member for the clarification. We have no reasons to believe that there were any systematic calls for the burning of the Singapore flag. Singapore and Vietnam have enjoyed good relations between the governments and the peoples. So, I have no reasons to believe that it is a systemic reflection of any unhappiness with Singapore or Singapore companies.

7 Mr Nicholas Fang asked the Minister for Culture, Community and Youth if he will provide updates on the contingency plans being developed to minimise the impact of transboundary haze on the Southeast Asian Games (SEA Games) in 2015.

Mdm Speaker, transboundary haze has been an issue during the dry period between June and October. We will do whatever we can to engage our neighbours and manage the issue upstream, and we are doing so through various regional forums such as the SEA Games Federation, so that the Games can proceed smoothly. We will also have contingency plans in place to mitigate the effects of the haze on athlete preparation and the organisation of the SEA Games.

Drawing on lessons learnt from dealing with the haze in recent years, we will work closely with the National Sports Associations (NSAs) to ensure that Team Singapore athletes can continue to train safely in the event the haze returns in the run up to the SEA Games. This includes arranging for indoor training where possible when the haze situation worsens.

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The Singapore SEA Games Organising Committee (SINGSOC) is also making plans to mitigate the impact of the haze on the organisation of the Games itself. For example, SINGSOC will build in buffers in the competition schedule to allow for the postponement of events if necessary.

SINGSOC is also developing a framework to determine whether or not to proceed with events at differing levels of air quality. The framework will take reference from the air quality descriptor and public health advisories issued by NEA and will be overseen by a committee comprising representatives from the International and Asian Sports Federations, as well as experts in various fields, such as medical, communications and security.

Based on this framework, we will postpone events or move them indoors, as and when the need arises. But not all sports can be played indoors and there are limits to how much we can adjust the competition schedule. So, if the bad air quality persists, then we may have no choice but to shorten or cancel certain events.

In conclusion, I would like to assure the Member that we will spare no effort to ensure a safe Games for all athletes, officials, supporters, volunteers and spectators.

I thank the Minister for the answers. I have three clarifications. In terms of the contingency plans for the preparation phase for Team Singapore athletes, is there any thought given to perhaps sending our athletes overseas to prepare in the run-up? We have seen, this year in particular, the transboundary haze's appearance in countries like Singapore has been coming earlier and earlier. A lot of it is dependent on the climate situation. So, can we consider helping our athletes prepare better by sending them overseas?

My second clarification is: has there been any standard set as to the level of air quality that will trigger events being moved indoors, and events being cancelled completely?

My third clarification is: given all these contingencies of shifting events around and with the potential for postponing them, is there any indication of extra costs being incurred by SINGSOC and by Singapore as the host?

Madam, let me answer the last question first. As I had mentioned earlier, we are already, in the preparation of the schedule, putting in place some of these buffers so that there can be postponements, if needed. These can be done without much increase in costs. For example, we have scheduled the marathon very early in the competition. That gives us more buffer time because if something happens on that particular day, then there is a buffer to shift the date of the marathon to another date later during the

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Games. These are some of the things we have done as contingencies for preparation of the Games.

If the haze is so bad that certain events cannot continue, then, as I had said, some of them will have to be cancelled. I do not think this will incur significant costs. Provisions are made in the contract so that we can make these cancellations in the event of such scenarios. I think we are able to manage the cost implications from the haze.

The level of air quality and the framework in order to determine when and whether or not to continue, to shift indoors, as I have mentioned earlier, these are things that are being prepared quite thoroughly for, so that we have a solid framework to guide our decisions.

On the first point about overseas training, we have some preparations for overseas training. Some of these are already being done, regardless of the air quality in Singapore, simply because we want to give our athletes more exposure to compete with the best or perhaps because the training environment overseas and the exposure they have from overseas games would give them better preparation. These will be taken into consideration as well, should the air quality in Singapore worsen to such an extent that an overseas training stint is required.

8 Mr Baey Yam Keng asked the Minister for Communications and Information how the Government will be enhancing its public communications to reach as many Singaporeans as possible so that major new policies and initiatives like Pioneer Generation Package and MediShield Life are well understood.

9 Mr Baey Yam Keng asked the Minister for Communications and Information with regard to the various Chinese dialect YouTube videos explaining the Pioneer Generation Package (a) how such videos will be better tapped on so that Pioneer Generation members who do not understand any of the four official languages can better understand and appreciate how they will benefit from the package; and (b) whether the Government will consider using free-to-air broadcast channels as one of the communication platforms.

Madam, may I take Question Nos 8 and 9 together, please?

Yes, please.

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Madam, the Government recognises that it is important for the beneficiaries of the Pioneer Generation Package and MediShield Life to receive accurate and timely information that is relevant to them.

This is why MCI adopted the approach of communicating the Pioneer Generation Package and its benefits in Chinese dialects. Malay and Tamil videos are also being prepared and will be released soon.

The dialect videos were produced primarily to communicate with dialect-speaking Singaporeans at community and grassroots events. For the convenience of many, such as caregivers and family members of Pioneers, who want to access these videos at their own time, we have posted these videos online on key information portals, such as the Gov.sg YouTube Channel and our newly launched Gov.sg Facebook.

We are also using the existing dialect programming time belts on both TV and radio channels to broadcast these dialect videos.

The dialect videos have been aired on Channel 8 during the dialect opera programming belt on Friday mornings. They have also been adapted in different dialects for radio broadcast during the daily Capital 95.8 FM dialect news line-up. Capital 95.8 FM carries news bulletins in Cantonese, Hokkien, Teochew, Hainanese, Foochow and Hakka.

Besides the grassroots dialect videos, we have also produced videos for free-to-air channels in the four official languages on the Pioneer Generation Package and MediShield Life. We will continue to find engaging ways to effectively communicate Government policies. One recent set of English videos on the Pioneer Generation Package which was aired on free-to-air channels was based on the World Cup theme. We have also produced info-ads in the papers as well as flyers for distribution at community events. There will be other videos and collaterals in the coming months.

MCI will continue to enhance the Government communications effort and build up capabilities across all Government agencies.

Madam, I have two supplementary questions. First, I would like to also speak up for public servants holding communications portfolios. Sometimes, communications cannot do wonders and policy itself is very complicated. We may need to nip the issue at the bud at the way the policies are developed. My question is: does MCI play a role in advising the other Ministries how to develop policies that are easier to communicate and, hence, easier for people to understand and appreciate. If so, how? If

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not, why not? I would like to ask my second question in Mandarin, Madam.

(In Mandarin): [Please refer to Vernacular Speech.] The Minister of State Ms Sim Ann has been working very hard to produce the YouTube videos in dialects for the Pioneer Generation to understand this very important message. These YouTube videos are uploaded so that people can watch them from anywhere at any time. But they were not telecast on TV except during Friday morning's dialect opera programming belt. So, apart from budget constraints for the TV advertisements, is there any difference in the Government's dialect policies between the traditional media and the social media?

Madam, I think across the whole-of-Government, it is well understood that public communications messages should be as simple as possible. At the same time, we do recognise that policies themselves often have to be complex because the policies do need to cater to Singaporeans with very diverse needs and in very different situations. Simplicity and clarity must not come at the expense of accuracy in conveying important details.

Besides simplifying public messages, good communications are also about ensuring effective support measures, such as having helplines as well as face-to-face outreach and explanation. What MCI does is to help Government agencies work towards clear and effective communications by providing officers who are trained in communications by giving advice in specific instances and also developing new capabilities to reach out to Singaporeans using different platforms, some of which Mr Baey has mentioned. Madam, in Mandarin.

(In Mandarin): [Please refer to Vernacular Speech.] First of all, on behalf of my colleagues in the Ministry of Communications and Information, I would like to thank Mr Baey for his appreciation of the various videos that were put out. Indeed, my colleagues have put a lot of thought and efforts in producing these videos. Mr Baey has asked about the Government's policy towards dialects, and whether there is any difference between the traditional media and social media. Let me explain.

In order to support the Speak Mandarin campaign, we have restrictions on the use of dialects with regard to public broadcasting media, especially free-to-air channels. But this does not mean that dialects are completely prohibited. As I have mentioned earlier, both on radio and TV, we have dialect news and programme belts. As for other communications platforms, the Government did not impose such restrictions. For example, for movies and cable TV, there is more room to use dialects. As for other forms of communications, such as videos, DVDs, public entertainment activities and Internet, we do not restrict the use of dialects.

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I would like to thank the Minister of State for her reply. I just have two supplementary questions. First and foremost, I just want to say as well that the videos that were produced, both the dialect and the Mandarin versions, were quite well received by my residents. I thought it was good work done.

My question is this: the Minister of State did mention that the Malay and Tamil versions will be coming out later. Why were these not produced earlier because these are all official languages and are we prioritising dialects before our two other official languages? I thought, in terms of capacity, given that there are production houses out there which could also help, we could have prioritised the Malay and Tamil language videos earlier.

I want to thank the Member Mr Zaqy Mohamad for his question. MCI is a champion of the use of the four official languages, so we are completely in agreement that producing collaterals and videos in the four official languages is very important.

Allow me to share a little bit on the background on the production of these particular videos that the Member was talking about. I think it also illustrates the way in which we evolve the development of new communications capabilities which I also alluded to in my earlier answer.

The decision to produce the dialect videos, as I have mentioned, arose from the recognition of the need to communicate with dialect-speaking Singaporeans who might not be able to access very readily the collaterals and the videos that were actually already produced in the four official languages. Prior to the appearance of the dialect videos, there was already material that was produced in the four official languages.

Considering the audience that we were trying to reach out to, the production team decided to take a slightly novel approach, which is to take a comedy skit-type of approach. It was not just the use of dialects but the fact that it was the use of a comedy-skit format that made the videos popular. Having learned from that, we then decided to apply that to other languages as well.

That sort of creates the impression that some Members may have that we started off with the dialects first. Actually, it was more because we realised that the comedy-skit format also worked very well and we decided to complement the existing material that is in the four official languages by also putting in something that is more skit-like, that is more interactive, that has a bit of a storyline which, hopefully, will make the messages more engaging.

Madam, I declare my interest as a member of the media and an employer of one of the companies that puts out some of the videos on the

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free-to-air channels. I have to say that some of the videos have been very well received. The fact that thought was put in to make them topical to coincide with the World Cup season, means that the Pioneer Generation Package (PGP) message was brought forward in a very engaging way. I agree with what the Prime Minister said on his Facebook that it is very effective.

I would just like to ask the Minister of State: has the Ministry analysed the different channels and avenues where engagement and explanation have been pushed out? Many Members of this House have been doing face-to-face engagement. They have been working with REACH, they have been doing Facebook chats which is a relatively new innovation. Given these – the traditional media channels as well as face-to-face engagement – does the Ministry have any feedback on which one is more effective or has been more receptive? And going forward, where would the emphasis be placed in terms of the future efforts for current and future policies?

Once again, I wish to thank the Member for his commendation of the efforts that our colleagues have put into the videos. I would say that this is really an evolving exercise because at the end of the day, communication is a multi-faceted process. Beyond putting out strong collaterals, effective videos, it is also the ability to help the individual access the answers to the specific questions that he or she may have. I think that is very important and that is why I mentioned the importance of having other channels such as face-to-face outreach and communication.

I would say that it is probably too early to tell, but we certainly are working very closely with the organisations and the individuals for helping us disseminate messages on the ground to see what works and what could be improved upon in order to fine-tune the entire process.

I thank the Senior Minister of State for her reply. I have just a couple of questions. First, would the Ministry consider producing videos similar to the one that Brian Richmond did during this World Cup season, but slowing down the pace in which the information is conveyed, because for even older Singaporeans, it is probably a bit too fast for them.

My second question, I am not sure whether this was covered in your Mandarin reply earlier, but would the Ministry consider using paid media advertising, for example, transit TVs on buses or advertising on TV screens in high traffic areas, which are shopping malls or supermarkets to convey such videos as well?

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I thank Dr Intan for her questions. This also shows the feedback loop in action and I thank her for the comments on the English videos. Certainly, we would look at various ways of varying the pacing or the presentation of information in different formats so that a wide range of audience can find it helpful. In terms of the use of paid channels, we do not rule out any of these channels. The key, like I have mentioned, is to have a judicious mix of not just broadcast paid advertising but I think also to ensure that when people want to know a bit more – because part of the impact is in engaging people to want to find out more and to find out how their specific questions can be answered – that at that point, the information is also readily available and that the answers are there.

10 Mr Christopher de Souza asked the Minister for Education what further steps and initiatives will be put in place to assist in achieving the goal of "Every School A Good School".

Mdm Speaker, as emphasised in the 2014 Committee of Supply debate on MOE and in MOE's Addendum to the President's Address this year, we are deeply committed to making Every School A Good School – one that caters to the needs of its students, creates a positive learning experience for each student, enables teachers to be caring educators, and fosters supportive partnerships with parents and the community.

To support this, we are encouraging and supporting schools to develop rich learning programmes that will cater to our students' diverse talents and interests. Each of our Secondary schools is working towards developing an Applied Learning Programme (ALP) and a Learning for Life Programme (LLP) by 2017. This will create a diverse and colourful landscape of Secondary schools with distinctive and authentic programmes that enable students to apply knowledge and develop life skills. MOE supports schools in the development and implementation of the ALP and LLP. Each Secondary school will receive $50,000 per year for each programme or $100,000 per year in total.

MOE continues to ensure that all our schools are well-resourced to provide a holistic education for their students. First, schools are equipped with the facilities needed. We are also upgrading facilities across 71 more Primary schools in the next few years. Second, all schools receive a range of funds for their school operations and programmes. MOE adopts a needs-based approach to the provision of funds. For schools with more students on financial assistance, their Opportunity Fund quantum would be proportionately adjusted. The Opportunity Fund has enabled Singaporean students from less advantaged backgrounds to participate and benefit from the co-curricular and enrichment activities organised by the schools.

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Beyond funding and infrastructure, at the heart of every school is a core of teachers who lead, care and inspire. Our educators are at the forefront of our drive to make Every School A Good School.

We are introducing Student Development Teams where Year Heads are appointed to safeguard the quality of school experience and learning opportunities of each level of students. By 2016, all schools will have Student Development Teams.

We are strengthening professional development and improving instructional practices across schools. The Academy of Singapore Teachers is leading this, assisted by other professional platforms and specialised teacher academies.

More teachers are deployed to support levelling-up programmes for low progress learners, such as the Learning Support Programme (LSP) for English and Learning Support for Maths (LSM).

Finally, a good school fosters supportive partnership with parents and the community. Since 2014, schools have received an annual top-up of the Parent Support Group (PSG) Fund to enable them to organise a variety of parent engagement and parent education programmes.

We already have a strong education system with a good level of achievement across all the schools. Going forward, MOE will continue to strengthen the system and enable all our schools to deliver a student-centric, values-driven education. We will continue to invest in our schools and support our teachers. In doing so, we will have a wide range of good schools that bring out the best in every child.

Mdm Speaker, I would like to ask the Senior Minister of State this question: would MOE allow for a heritage fund, or enhanced one if it already exists, to be allocated to each school so that each school can record and display its own heritage within the school. This would allow every school to establish its own identity, entrench in its own unique history and heritage. Why I say this is that parents and potential students can then see the rich identity of the school and that could draw them to that particular school. This could augment the drive words, "Every School A Good School".

Mdm Speaker, I thank the Member for his supplementary question. I should say at the outset that I agree that a school's heritage is important. It gives the students a sense of identity, it gives them a sense of the school's history and it gives them a sense of belonging and knowing where they come from and the community from which they sprang, if you like. We can see this very clearly in the number of parents who want to send

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their students to the schools that they came from. That sense of identity and bonding is very strong.

That said, I am not sure whether it would be necessary to establish a specific heritage fund. As I said earlier, all schools receive a range of funds according to their operations and programmes. I think the first approach is to see whether a school can fit it within its current funding and there is no reason why it cannot be combined with something else. For example, if you wanted to do something for your co-curricular activities or Citizenship and Character Education, that can also be wrapped up in the heritage values. But if a school has, let us say, a specific project which requires more funding, it can certainly put up that request and we can consider that.

Mr Yee Jenn Jong.

Thank you, Mdm Speaker. I think it is a good initiative for MOE to strive for every school to be a good school, yet we still see long queues every year for Primary 1 places in certain schools and also the huge pressure during the Primary School Leaving Examination (PSLE) because of the desire to enter certain academic streams and certain schools. I would like to ask the Senior Minister of State how is the Ministry tracking how we are moving towards this goal of achieving "Every School A Good School". Are there any KPIs that MOE is using to measure how they are achieving this goal, especially in getting the public to buy into this message?

Mdm Speaker, I thank the Member for his question. I think it is a work-in-progress and certainly some parents may see it or feel that some schools are preferred from their perspective. But, overall, in terms of what makes a school a good school are really the things that we have outlined.

Firstly, a good school caters to the needs of its students well. Secondly, we must nurture the student; make sure that the student is engaged. Thirdly, you want to make sure that the teachers are resourced, equipped and supported so that they can be good and caring educators. Fourthly, a good school would foster a strong community relationship and good partnership with the parents.

These are actually the KPIs. These are the things you look at to determine whether the school is a good school. And then how do you support that? You have to make sure that the school is properly resourced, that the pedagogy is well delivered, that the school engages with the parents and that the teachers have good training. In terms of KPIs, those are the things we would look at.

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Over time, as the Minister had explained at the Committee of Supply, "Every School A Good School" does not mean every school the same school. What we are really striving to do is for each school to be able to deliver all the base things perfectly well but, at the same time, for each school to have certain specialities or what we refer to as peaks of excellence which students can look at and say that, "Well, this is more suitable for me than that particular school", so that, over time, you spread across the spectrum schools that meet the diverse talents and needs of our students.

11 Mrs Lina Chiam asked the Minister for Education whether the Ministry will consider relooking at the competition framework for inter-school games to ensure a level playing field for student athletes from regular schools and those from the Singapore Sports School.

Madam, the annual National School Games is organised by the School Sports Council for all its members, which include all Government schools, Government-aided schools, independent schools, privately-funded schools, and specialised independent schools, such as School of the Arts (SOTA), NUS High and the Singapore Sports School. It provides a platform for all athletes, regardless of which school they come from, to compete and be part of a shared learning experience.

The Sports School competes in less than half of the 28 sports that are offered at the National School Games (NSG). Where appropriate, the Sports School deliberately sends relatively junior players to compete in the NSGs, as part of their development. Based on last year's competitions, a total of 110 championships were organised for the "B" and "C" Divisions, which cater to students from all secondary schools. The Singapore Sports School contested in 46 of these championships and won 16 National titles. While this is a good performance, it also shows that other schools can also perform well when pitted against the Sports School.

Learning to lose graciously and win honourably is integral to character development. Strong teams in the National School Games raise the playing standards of our students, and provide valuable learning opportunities for teams to hone their mental strength, play intelligently, bond and to experience both successes and failures. In this light, the Sports School's participation in the National School Games has raised the overall level of competition while providing its student-athletes the opportunity to be part of a shared learning experience together with athletes from other schools.

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It takes great courage to face off strong opponents, whether they are teams from Sports School or other schools. On the ground, we see many instances of such courage from our students. Hong Kah Secondary, for instance, has a strong football culture, and its school football teams have, in the last three years, consistently finished among the top four at the Nationals. In fact, its "C" Division team won the National Title in the last two years, an outstanding feat for a sport that is contested by more than half of our schools, including the Sports School.

The School Sports Council will continue to monitor and review its inter-school competitions and will take appropriate measures when necessary to ensure that the National School Games fulfils our educational objectives.

I thank the Senior Parliamentary Secretary for the answer. I have three questions. First of all, will MOE consider re-allocation of resources for schools that have talent in other sports, other than Singapore Sports School that specialises in niche sports, for them to have a chance to compete in competitions? Second, have any medals been won by school students against the Singapore Sports School? And, third, has MOE taken steps to mitigate the effects of psychological impact on student athletes when they suffer huge losses to the Sports School athletes during the inter-school games?

Madam, I am not very clear about the third question. Let me try to answer the first two questions. All schools are resourced with the funds to develop CCAs, including sports, so they can choose the sports that they want to develop for their students, whether or not they want to compete at the zonal as well as the national level. All schools are given the funds to develop the students' abilities in sports and other CCAs.

I think I have answered the second question that other schools have also done well against the Sports School. I have said earlier that the Sports School contested in 46 championships out of 110 championships in various divisions and won 16 titles, which indicated that other schools have also the ability to do well even against the Sports School. Can I ask Mrs Chiam about the third question?

Has MOE taken steps to mitigate the effects of psychological impact on student athletes if they suffer huge losses to the Sports School athletes during the inter-school games?

All wins and losses are taken very seriously by teams. I am sure every student wants to do well, but what is important is to be able to win and to lose graciously. If you play in a competition like the semi-finals of FIFA World Cup and lost seven to one, it must

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be a big blow. Like the Brazilian team, I am sure our schools which want to do well will analyse on how they can do better the next time, which is a good state. I am sure we want to develop this zeal and determination in our students, apart from just winning competitions.

12 Mr Christopher de Souza asked the Minister for Education with regard to allowing for opportunities to be given to students whether more places in the Polytechnics can be set aside for ITE students and more places in the local Universities can be set aside for Polytechnic students.

Mdm Speaker, the Government has been increasing opportunities for ITE and Polytechnic graduates to pursue further studies at the Polytechnics and Universities respectively.

The proportion of ITE graduates progressing to full-time diploma programmes at the Polytechnics has increased from about one in 10 in 1995 to more than one in four today. Aside from providing more places, MOE also introduced the Direct Entry Scheme to Polytechnic Programme (DPP) in 2013 with an initial intake of more than 950 students. This allows well-performing Secondary 4 Normal (Academic) students to progress directly from ITE to a Polytechnic, instead of spending the year in Secondary 5.

The proportion of places at our Autonomous Universities held by Polytechnic graduates has also increased, from around 20% in Academic Year (AY) 2009 to about 30% in Academic Year 2013.

In 2009, the Taskforce on Expanding Upgrading Opportunities for Polytechnic Graduates recommended the establishment of the Singapore Institute of Technology (SIT) to partner overseas universities in creating more degree opportunities for Polytechnic students. In 2012, the Committee on University Education Pathways Beyond 2015 (CUEP) recommended that the degree Cohort Participation Rate (CPR) be raised from 30% in 2015 to 40% by 2020. The additional places provided through SIT and SIM University as applied degree pathways are intended to benefit our Polytechnic graduates. As part of these changes, SIT also became Singapore's fifth Autonomous University this year, offering a distinct approach to degree education that caters to a wider spectrum of preferences and abilities.

We recognise that progression is important to Polytechnic and ITE graduates. Obtaining diploma or degree qualifications are not the only means to progress in one's career. While

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the Government has been increasing progression opportunities for Polytechnic and ITE graduates who wish to upgrade immediately, MOE is also developing multiple pathways that offer viable upgrading alternatives. For example, Polytechnic and ITE graduates may work first and pursue further studies later or progress through professional certifications and training. The Applied Study in Polytechnics and ITE Review (ASPIRE) Committee is currently reviewing measures to deepen the quality of Polytechnic and ITE education and to further enhance career prospects and progression opportunities for Polytechnic and ITE graduates.

Madam, it is encouraging that the statistics has moved from 10% to about 25% over 20 years for ITE students going into Polytechnics. My question really is borne out of discussions with ITE students who, if you ask them a question of whether they want to go to Polytechnic, by and large, almost all of them put up their hands. My question then is, does MOE envision that 25% is going to increase over the next five to 10 years? And for Universities, my question is, is it envisioned that the SIT gathers more Polytechnic students within its corridors so as to decrease the number of students having to pay for private degrees, and that can be quite a hefty sum at the age of early 20s or mid 20s? Those are my two questions.

Madam, I thank the Member for his questions. Let me take the second question first. Certainly, it is anticipated that with SIT as well as UniSIM, there will be more places for Polytechnic students and, hopefully, rather than pursuing a degree in private institutions which will cost a lot more, the Polytechnic students will afford themselves of this new opportunity. I should also mention, as I indicated earlier, that both SIT and UniSIM are intended to be applied Universities, meaning that there would be a lot more emphasis on the practical aspects of learning, and that makes it a very natural next step for graduates from the Polytechnics because Polytechnic education is, in itself, applied or occupational education.

So, you can see that what we have done in the CUEP recommendations is basically open up the number of places in the universities with the idea that this would provide more opportunities for the Polytechnic students.

With respect to the second question about whether we envisage the number of ITE students going to Polytechnics to be increased over the next five to 10 years, I would say the answer is yes. The question is, at what point do they upgrade to Polytechnic? Is it necessary be immediately after ITE or could it possibly be after spending sometime at the workplace, gaining experience, and then when they go and take a diploma, it is directly relevant to their field of work or industry that they are working in? And the latter is something that we would like to see develop so that people are to leverage on the certificates that they obtain at the ITE, keep in the industry, deepen their skills and move forward to progress in the area that

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they have gained experience in.

13 Ms Irene Ng Phek Hoong asked the Minister for Manpower in light of the Ministry's Labour Market First Quarter 2014 report which states that the unemployment rate for citizens has risen to 3% (a) how can this be explained given the tighter labour market and stricter access to foreign manpower; (b) what is the profile of these citizens without jobs; (c) what are the challenges of placing them in jobs; and (d) whether employers have adjusted to the tight labour market by making jobs more attractive with better working conditions, salaries and benefits packages.

Mdm Speaker, although the quarterly unemployment rate for citizens rose slightly from 2.8% in December 2013 to 3% in March 2014, it remains low and has been largely stable for the past three years.

The slight increase in quarterly unemployment rates could reflect higher job search activity, as higher wages, more vacancies, and greater availability of flexible work arrangements in a tight labour market encourage more citizens to enter the labour market to look for jobs. As the job search process may take some time, some slight increases in quarterly unemployment rates are expected. Slight fluctuations in the unemployment rate are also to be expected across quarters and we have seen that varying from quarter to quarter over the last several years. But, in the main, it revolves around this plan.

The profile of the unemployed is varied. About one in two of the unemployed citizens in March 2014 were aged 40 and over. In terms of educational qualifications, about half had Secondary education or below. About one in five is long-term unemployed.

The key challenge faced in helping some of these unemployed Singaporeans find jobs is in ensuring that their skills remain relevant to evolving industry needs. To help them upgrade their skills, we provide substantial subsidies for the upgrading of skills through our Continuing Education and Training (CET) system. Jobseekers receive between 70% and 90% course fee subsidies depending on the type of courses, and we also have the Place-and-Train (PnT) programmes to help jobseekers find jobs and pick up the skills they need in their new jobs. Individuals have a part to play, too – to learn new skills, and be open to different job opportunities in growing industries. And, of course, we need to maintain a strong and vibrant economy to create quality jobs for Singaporeans.

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Second, for economically inactives who are returning to the workforce, being able to find a job that allows them to balance their work commitments and family and care-giving responsibilities is a key concern. We have recently enhanced the Work-Life Grant under the WorkPro scheme to provide greater support to employers to implement and sustain good work-life practices, such as flexible work arrangements.

MOM will continue to monitor the unemployment rate closely and work with tripartite partners to help unemployed Singaporeans find jobs.

Madam, we have heard companies saying that they are closing down or restructuring because of the tighter supply of foreign manpower. Can I ask whether this has also resulted in more Singaporeans losing jobs and this could be one factor why the unemployment rate for citizens has been rising? My second question is whether the Minister is concerned that there might be a looming problem of structural unemployment as our industries continue to restructure to higher value-added companies?

Mdm Speaker, as a result of restructuring, it is inevitable that some companies merge and consolidate; some will move offshore, some may close. In terms of data, while we do have companies closing, we do find that there is a net formation of companies.

To follow on with the second question, what is important is: are we generating sufficient jobs for Singaporeans? While we have individuals who may transit from one sector to another, jobs are being created, opportunities are being created. So, that is a plus point. The next step that we need to take is to equip workers with relevant skills so that they are able to take on these new jobs. For those workers who are laid off, and for those who are looking at switching sectors, that is where our continuing education and training efforts come in to help them.

Upstream, our education system needs to equip our students who are entering the job market with skills that are in demand by industries. So, that is being done. We have relatively low youth unemployment.

The last step really is to help facilitate job placements. That is what WDA does, along with close collaborations with tripartite partners. That is the system that we have in place to support all segments of our workforce.

By and large, while we have frictional unemployment and you see variations from quarter to quarter, we do have fairly low unemployment rates in Singapore.

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Order. End of Question Time.

[Pursuant to Standing Order No 22(3), provided that Members had not asked for questions standing in their names to be postponed to a later Sitting day or withdrawn, written answers to questions not reached by the end of Question Time are reproduced in the Appendix.]

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[(proc text) Order read for Resumption of Debate on Question [8 July 2014], (proc text)]

[(proc text) "That this House endorses Paper Cmd 4 of 2014 on 'MediShield Life Review Committee Report' as the basis for designing MediShield Life, to provide every Singaporean with better lifelong protection against large medical bills through better collective support, in a scheme that is financially sustainable, affordable to all, and strengthens our social safety net." – [Minister for Health]. (proc text)]

[(proc text) Question again proposed. (proc text)]

Mdm Speaker, I rise in support of the Motion to endorse the "MediShield Life Review Committee Report" raised by the Minister for Health. I want to declare that I am a general practitioner in private practice.

I want to start by saying that MediShield Life must be one of the best forward-looking and caring policies of our Government. The component of MediShield Life I like best is the "cradle to grave" coverage for everyone. This gives peace of mind to all. This initiative will be most appreciated by those who are presently disadvantaged; such as those afflicted with illnesses that are deemed uninsurable by insurers, or those uninsured due to the lack of means to insure themselves.

Last week, in my house-to-house visit, one retired gentleman anxiously asked me to reassure him that he and his wife will be eligible for MediShield Life. He told me that his wife was still in hospital and had been in and out of hospital for many months. Due to the multiple medical hospital bills of his wife, he had exhausted all his lifetime savings and he was very concerned for his wife's and his own future medical bills. You should have seen how happy he was when he got the confirmation from me that MediShield Life is for everyone, irrespective of age and existing medical conditions.

At another grassroots event with young families, one young mother came forward to thank the Government for MediShield Life. She said that she had one son born with congenital heart problems that still required him to undergo more heart operations as he grows up. She was very appreciative and she said MediShield Life took a heavy load off her worries for her son's future medical hospital bills.

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The implementation of MediShield Life will be timely indeed. Research suggests that half of one's lifetime medical expenses accrue past 60 years of age. There will be a tripling of the number of Singaporeans aged over 65 years to 900,000 by 2030. The level of chronic ailments, such as diabetes and hypertension, continues to creep up; thus the need for hospital care will soar. The spiralling healthcare costs, which have doubled in less than a decade, hold uncertainty for the future and are a main concern for many.

I support the risk-pooling concept of MediShield Life with the universal health insurance model. This will mitigate healthcare affordability and sustainability for all.

Universal health insurance must be accompanied by collective responsibility from everyone. This will ensure sustainability and long-term fiscal soundness through social prudence. May I ask MOH if more considerations can be given to this important fundamental?

Collective responsibility should involve all policyholders, healthcare providers and insurers. The "right to treatment attitude" by policyholders and the "right to claim as much as possible" can be the devastating ill-effect of universal health insurance. Over servicing by healthcare providers and over-zealous insurers in selling products that policyholders do not need are the others. May I ask MOH whether the formula for MediShield Life includes incorporation of regulations and checks to address these unsavoury practices?

Some regulations and checks to achieve long-term fiscal soundness must be put in place. For instance, Mdm Speaker, with private insurance, there should be better clarity on product structures and transparency to enable informed choices. With medical providers, there should be guidelines on the provisions and fees structures for medical services so as to discourage over-servicing and over-charging by any groups, regardless of whether they are in the public or private sector. More importantly, I hope there can be collaboration amongst all stakeholders for better transparency and bench markings to mitigate escalating costs.

Mdm Speaker, one of the challenges for MediShield Life, in the longer term, will not be the inevitable premium hikes. It is the rate of increase of the premium hikes. May I ask MOH if it can enlighten the House on this issue? Will the future cohorts of older residents have difficulty with MediShield Life premiums as they grow older and as they become non-employed? How does MOH plan to keep MediShield Life as affordable as possible for these future cohorts when the subsidies end? Is there a need to keep a close tab on the MediShield Life fund?

My concern is on the excessive claims on MediShield Life due to the present inherent insurance structures. Healthy young people are attracted to the enhanced benefits of Integrated Shield Plans at affordable premiums whilst they still earn steady employment

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incomes and when insurance premiums are usually partly or fully covered by their Medisave. Such Integrated Shield Plans are thus painless compared to paying out with hard cash. Many such private plans also provide riders that take care of all co-payments for hospital bills. This may lead to the "buffet syndrome", thereby taxing the MediShield Life fund.

However, as people age and retire, together with increasing premiums of private insurance, they are likely to downgrade their insurance to MediShield Life. This will be especially so for those who have exhausted their Medisave in servicing their private plans all the previous years. This means that many pay for private insurance when they were young and healthy, and requiring few claims, only to switch to MediShield Life when they are older and likely to require more claims due to illnesses. In effect, Mdm Speaker, people will be paying private insurers when they least need the coverage, only to let MediShield Life cover them when they become older.

Integrated Shield Plan is profit-orientated, not like MediShield Life, and, as with any other private insurance, there may be occurrence of the cherry-picking phenomenon. Integrated Shield Plan insurers can entice healthy individuals to take on enhanced benefits and features at higher premium and thus stand to reap actuarial profits, but avoid or divert the older age groups to MediShield Life by raising premiums as they age when they are more likely to claim. How does MOH plan to minimise this occurrence at the expense of MediShield Life? Will MOH be able to extract a share of the actuarial profits, enjoyed by private Integrated Shield Plan insurers, in addition to the basic MediShield premiums?

Insurance premiums are determined based on retrospective data. Actuaries do not take into account possible medical advances, new drugs or technologies. All of these are advances that policyholders want. But these come with a higher cost.

MOH can mitigate challenges by having good practices at its public hospitals. There is the never-ending demand for the newest drugs, the latest treatments or the most advanced technologies. It is prudent to adopt an evidence-based approach, with proven scientific values on evaluation of their effectiveness and cost, for all new drugs, new treatments and advanced technologies. There is increasing practice of defensive medicine by doctors to protect themselves from lawsuits. Can this be addressed as this will inevitably drive up healthcare costs?

MOH can consider better incentives and encourage innovations to achieve better care and higher benefits. Could MOH be flexible on managing large patient pools where healthcare providers can treat patients before their conditions become acute and require hospitalisation? Could MOH also look at how to change the delivery of healthcare to more patients, focused more on patients' needs and less on the need for doctors and hospitals? A good example of this would be the announcement by MOH last month for palliative care

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where funding was to be based on the number of patients looked after rather than on the number of home visits made. May I ask MOH if MediShield Life will cover this group of patients under homecare?

Individual responsibility is very important for the long-term sustainability of MediShield Life. Dr Christopher Wild, director of the World Health Organization's (WHO) International Agency for research on Cancer and co-editor of The World Cancer Report 2014, said nearly half of all cancers that occur can be prevented and "tobacco use, infections, obesity and physical inactivity, excessive alcohol consumption, high exposure to sunlight and workplace hazards" are all major factors. Could MOH have a component of preventive care as part of MediShield Life? Perhaps, MOH could tie insurance premiums to modifiable health-risk factors, such as healthy lifestyles or adherence to health treatments, for chronic diseases? May I ask MOH if more incentives or innovations can be aligned and tied with MediShield Life to reward MediShield Life policyholders in good health, similar to the "no claims bonus" for car insurance?

Presently, about 60% of residents have Integrated Shield Plans. Many have expressed concerns on the affordability of the increasing premiums of Integrated Shield Plans, especially as they grow older.

Many who opted for this plan gave the reasons of the flexibility to choose preferred hospital doctors and the dislike of non-air-conditioning of C and B2 wards. Those on Integrated Shield Plans now may be hesitant to give up their existing Integrated Shield Plans, as they will lose all the benefits that they have been paying for. They are also stuck with it because health insurance companies provide full coverage only for people who are healthy at the time they join. They cannot easily change plans or, worse still, they may become uninsurable should they change their minds later on. May I ask how MOH plans to solve their dilemma here? How would MOH facilitate people to get at least B1 Integrated Shield Plans, even for those with existing illnesses, albeit with a higher premium? Could MOH ensure that the products offered are truly beneficial to policyholders and are standardised? Could MOH also consider capping premiums of B1 Integrated Shield Plans within certain parameters and regulate the premium increases? With this B1 plan in place, it will set the benchmark for other Integrated Shield Plans and, thus, it will be easier for policyholders to compare and to make choices before commitment.

Older folk may like non air-conditioned wards but, in today's context, a majority of people, especially from the younger generation, prefers having air-conditioned environments. Will MOH consider phasing out non air-conditioned wards as a plan, going forward?

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At the end of the day, Mdm Speaker, it all comes down to good communication. Good policy must be accompanied by good communication and communicators. With the slew of major policy changes taking place since early this year, I wonder if we have over-estimated our citizens' propensity to absorb all the good intentions of our Government.

Nevertheless, seeing how vital it is to provide a buffer to the many challenges of an ageing population, the many changes to improve the quality of living for Singaporeans as we age gracefully is necessary. We must plod on smartly. For sure, there is a continuous need to communicate the details of the Pioneer Generation Package, CPF LIFE and, now, MediShield Life, by all means.

I hope MOH will go all out to better inform the public on MediShield Life. I welcome the communication emphasis of the benefits of MediShield Life on the affordable premiums and no lifetime claim limits, lower out-of-pocket medical expenses due to reduced co-payment rates and higher annual claims. I hope MOH will continue to publicise these points so that more can understand and appreciate the very good intentions of this life-time insurance for all. More importantly, we must counter doubt-mongers over the differences in opinions or the personal preferences on MediShield Life so as not to drown the original beauty and intent that the MediShield Life Plan was meant to be.

I feel that MOH should also emphasise on that communication is the collective responsibility of everyone as this will be the factor that decides the long-term sustainability of MediShield Life.

Medisave, in itself, also needs a revamping message. Many people may not value Medisave or treat it like it is not their own cash. They may, therefore, be less prudent with it, especially when using it to pay for Integrated Shield Plans. Many healthy people have said that they may never get to use their Medisave in their lifetimes and this is a misconception that has to be explained. Many are also not aware of the minimum Medisave sum required to be put aside.

MOH is only starting to embark on the implementation and dissemination of information about MediShield Life. It is not going to be a straightforward task. I hope MOH will put in its best efforts here in order to succeed in its aim of giving peace of mind and secure healthcare for all Singaporeans.

Mdm Speaker, in Mandarin, please.

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(In Mandarin): [Please refer to Vernacular Speech.] Birth, ageing, sickness and death are the natural laws of life. Ever since ancient times, people have been actively exploring ways to overcome sickness and ageing, and have spent huge amounts of resources in the hope of a healthy life and longevity.

I would like to thank the MediShield Life Review Committee for its efforts. The Report balanced the interests of different parties, hence, I support the recommendations.

MediShield Life is designed to help Singaporeans pay for the medical expenses of serious illnesses; it will benefit both the young and the old. Now, Singaporeans can have peace of mind and live their golden years without worries. People no longer have to worry that they can afford to die but not to get sick.

Singaporeans do not want to burden the next generation. Last night, I went to a resident's wake. The family told me that they, too, did not want to add burden to the next generation with their sickness. In fact, they hope the next generation can live better, without being burdened by the heavy medical expenses in the future. These are the exact benefits that MediShield Life can bring by reducing the burden on the children and alleviating these worries for them. By 2030, there would be more than 900,000 people aged 65 and above which will make MediShield Life even more meaningful and crucial.

I also agree with the following observations raised by the Committee.

First, with MediShield Life, will healthcare expenses rise subsequently? The Committee pointed out that it could lead to over-consumption of healthcare services, but I do not think the possibility is high. This is because nobody wants to fall sick; if we could help Singaporeans maintain a healthy lifestyle and go for regular health checks to prevent illness from happening, we can prevent healthcare over-consumption. When it comes to looking after our loved ones, it is quite understandable for people to be kiasu or kiasi. They simply want to make sure their loved ones are taken good care of and nothing bad will happen to them.

At the same time, standardising the prices of medical services can effectively control Singaporeans' healthcare cost. Even with Government subsidies, Singaporeans are still facing rising medical expenses. If we could train more outstanding healthcare professionals and step up medical research to develop better and more effective medicines and equipment, patients may be able to recover faster, thereby reducing the length of hospital stay. This will greatly reduce their medical expenses.

With population ageing, do we need to adjust the patient-healthcare professional ratio? I hope more private clinics can joint CHAS. The Government may also need to increase the

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number of B2/C beds to meet demand.

We need to encourage the younger generation to do financial planning; we need to step up education to help them understand MediShield Life is a major social policy shift. They should save and prepare for the future and not to indulge in unnecessary consumption or spend the money of the future; they should understand pleasure comes after toil, and change the mindset of muddling along.

(In English): Meeting healthcare needs is not a simple demand-and-supply linear equation or relationship. It can be as complex as a matrix of many factors.

One of the important factors is confidence in our healthcare system and practitioners. That explains why a lot of people are seeking treatment in Singapore. It will not be acceptable even if it is cheap or even free if our healthcare system is poor and badly managed – as pointed out by Singaporeans. Therefore, it remains paramount and important that we need to continue to work towards building a world-class and best healthcare system and people.

We must continue to attract the best medical practitioners to remain in Singapore and continue to invest in the best equipment ever possible for Singaporeans. We must continue to pursue world-class and the best and renowned medical institutions to set up office, training and research centres in Singapore.

On this note, we already know how successful the Government has achieved so far and what more can be done to attract more such world-class institutions to set up centres here.

Mdm Speaker, it was reported that a team of American psychologists found that people who were positive in their thinking lived an average of 7.5 years longer than those who regretted the passing years. The researchers, led by Dr Becca Levy from Yale University in Connecticut, said the effect of a positive attitude towards ageing was greater than physiological measures, such as low blood pressure and cholesterol – each of which is thought to add a maximum of four years to life.

In short, not only positive thinking impacts your ability to cope with stress and your immunity, it also has an impact on your overall well-being. It helps reduce risk of death from heart problems. It prevents depression and, thus, increases lifespan and avoids suffering as a result of serious illnesses.

With that and all the positive benefits associated with MediShield Life, I support the Motion and wish everyone here a healthy and happy life.

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Mdm Speaker, the introduction of MediShield Life was announced by Prime Minister Lee Hsien Loong in his National Day speech in 2013 as the third key shift which compliments other policy shifts in healthcare financing for all Singaporeans, with lifetime basic protection against large medical cost and for greater peace of mind.

The Committee has completed its review and submitted its report on the universal health plan with key principles adopted by the Committee on 23 June 2014. Its recommendations for the proposed MediShield Life national health insurance scheme are: better protection against large medical bills, extending coverage for life until age 92, and insurance for those with pre-existing conditions.

Madam, demographics is the most important factor putting economies at risk. Our healthcare financing needs to evolve with changing demographics and healthcare needs. An older population, with smaller families, is many times more expensive to manage than a younger population. Medical insurance and pension schemes do not necessarily take into consideration the huge risks caused by demographic changes. Women can be discriminated against, because they outlive men, and pay less into retirement schemes because of family commitments.

A rapidly ageing population has linkages to discount rates, yields, longevity risks, social stability and, finally, economic growth. If we do not ensure that the CPF takes into consideration risks of increasing longevity, we will not be doing our future generations right by transferring the burden to them.

Since we have chosen the annuities route, we hope to see a more complex strategy by CPF Board that can effectively hedge inflation risks. The use of the Special Singapore Government Securities (SSGS) is not sufficient as a tool by itself. The Government needs to develop a strong system to avoid individual poverty and a collapse of our annuity and medical funding frameworks.

We understand that the Government is considering increasing taxes, direct or indirect taxation or income tax and so on in order to meet Singaporeans' request for higher benefits from medical insurances and retirement funds. But we hope that the Government can make their working assumptions transparent so that Singaporeans can better understand the Government's intentions.

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The Singapore People's Party places a very high premium on the health of all Singaporeans for all illnesses. The provision of healthcare facilities must be accepted as a social responsibility by the Government.

Madam, I am in favour of the revised MediShield Life scheme which will give Pioneers better peace of mind for their healthcare bills and ease the burden of caregivers and family members. We believe that the aged will rely heavily on long-term care services. As we age, we will have a significant right-tail distribution of healthcare expenditures. In figure 7.4 of the White Paper, we note that the revised scheme may pay up to 70% of the case study provided as an example – a higher percentage than the previous rate of 43%.

However, we hope MOH can come up with simpler ways of explaining the complex policy to Singaporeans, perhaps with a straightforward short video on YouTube in the four official languages, to help the average citizen understand the workings of the proposed MediShield Life scheme.

The scheme should be made more equitable for the "asset rich, cash poor" group who may be unfairly penalised because of their annual home values of above $21,000. Help should be given to them to "deal with bureaucracy" to ease those who need help to cope with their premium increase.

The Government should form a committee to look into the impact of rising health costs, caused mainly by the vested interests of pharmaceutical departments and manufacturers of hospital equipment which have pushed up health costs to the rate of inflation.

We would also like to ask a hard question. If the Government can make it compulsory for all CPF account holders to subscribe to an annuity scheme, why is it not making all Singaporeans buy MediShield Life? After all, the bigger the pool of insured, the more manageable is the shared risk which will also help in reducing premiums across the board.

Universal coverage under the new MediShield Life will imply higher premiums – there is no free lunch. A trade-off has to be made between better benefits and higher premiums. But for those who cannot afford the enhanced package, could the Government provide subsidies after means-testing? And how will the Government plan to help the two-thirds lower income group cope with the premium rises after the transitional period of subsidy is over in 2019, bearing also in mind that there are over 1.65 million or 45% inactive CPF members out of 3.53 million CPF members who may not have sufficient money in their Medisave account to pay their MediShield Life premiums? Or should the unemployed have lesser schemes than the employed? To be a truly inclusive society, no one should be left out of insurance coverage with the Government bearing most of the costs together with

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Singaporeans.

We are not sure how much more the Government would spend to support the revised healthcare insurance plan when it announced that it will also be providing premium subsidies and Medisave top-ups for the Pioneer Generation for life and premium subsidies for lower to middle income households. Mr Leong Sze Hian, a regular blogger, has asked for the actuarial study to be made public so that Singaporeans can understand if there is a real net cash outflow to maintain the MediShield Life scheme. It was reported that, every year, premiums exceed claims since the inception of the MediShield scheme, to the tune of an estimated more than $1 billion to date.

May we also take this chance to highlight the importance of pre-emptive healthcare management? Promoting healthier lifestyles is more important than the best insurance schemes. No claim bonuses could encourage the pursuit of healthy life styles, reduce claims and lower premiums.

In this vein, perhaps the Minister could consider a calorie tax on high calorie foods and drinks in Singapore, just as what Mexico has done – the higher calorie the food item, the greater the tax on the item. It is generally a pre-emptive system to increase burden on irresponsible food providers. A recent study by the Robert Wood Johnson Foundation in the United States suggested that applying a tax based on the amount of calories contained in a serving rather than its size would be more effective in reducing obesity.

I am glad to note that greater subsidies are provided for patients of B2 and C class wards but would like to ask the Minister whether this will affect the holistic service quality and the range and options of treatment in the lower class wards. Some patients have even expressed the doubt whether medications provided for patients have the same potency of those in B1 and A wards – like the saying in Chinese: “一分钱，一分货”. You get what you pay for.

The Government should allow Medisave to be fully utilised to pay for MediShield Life premiums or Integrated Shield Plans that cover all deductibles and co-insurances for B2 and C class. There should not be a limit imposed.

The Government should encourage more companies to have greater portability plans and allow the employers to switch between insurers that ride on MediShield Life without additional underwriting and duplication of their employees' medical benefits. This will lower their premium costs.

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We hope MOH will also address pensioners' concern about their existing life-long pension benefits and to avoid duplication of their medical benefits with MediShield Life.

In this respect, it was noted that pensioners who stay in community rehabilitation hospitals are only allowed $5,000 limit of Medisave usage.

Madam, rehabilitation stay in community hospitals usually take months for elderly patients' recovery. I would urge the Minister to extend the Medisave limit as in other restructured hospitals to help pensioners defray the out-of-pocket bills which may amount to thousands of dollars, depending on the ward, even with MediShield plans.

Additionally, we advocate for more choices for affordable premiums as long as citizens understand the downside risks of Integrated Shield Plans. I think Singaporeans also provided the same feedback on page 46 of the White Paper.

MOH should take this opportunity to do a thorough overhaul to the MediShield and IP schemes and make it truly comprehensive and easy to understand.

MediShield should also cover pre- and post-hospitalisation care that adds up to significant costs. MediShield premiums should be kept within Medisave contribution levels that are affordable to Singaporeans.

In conclusion, there is no perfect healthcare system in the world. A country must have the ability to constantly change and evolve to stay relevant to the needs of the people, the quintessential quality for a good healthcare system.

I would like to thank the MediShield Life Committee Review Board for their comprehensive work.

Thank you, Mdm Speaker. Before I proceed with my speech, let me just highlight a few points in response to hon Member Mrs Lina Chiam's comments. First and foremost, I would like to inform her that no one will be left out of the MediShield Life scheme. It is a scheme for every Singaporean and PR in Singapore, from life to death.

Secondly, in terms of the subsidies and expenditure, the Government is going to subsidise to the extent of $4 billion in the next five years. So, that is a substantial amount of

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subsidy.

Thirdly, when the Member brought up the point about the type of care that is rendered to people who choose the lower class wards, for example, the subsidised wards of B2 and C class, let me reassure her, speaking from the point of view of a practitioner of medicine for the last 24 years, the type of care that we provide for our patients is the same across the classes. It is just the level of subsidy that differs with the different classes. But the doctors, medications and the type of treatment that we provide are the same.

Madam, our 3M framework offers a strong foundational healthcare financing system which has generated the interest of health economists and many countries over the years. Over the decades, it has been reviewed and liberalised to make it more flexible, robust and adaptable to the changing needs and expectations of the populace. The critical point about this scheme is its long-term sustainability.

MediShield Life is a bold and progressive move on the part of the Government and MOH, covering our citizens from birth to the end of life. The move comes at a critical period whereby countries are all grappling with ageing population, rising healthcare costs and, of course, inflation.

In general, I support the proposals put forth but I do have several concerns to raise.

Firstly, the subsidies for premiums in MediShield Life are tagged to the value of your property and, for the group whose property is more than $21,000, there will be no subsidies offered for the high-income group. I feel this could be a concern because this group may comprise of people who are retirees, who had purchased their homes many years ago at an affordable price or inherited them even, and they may not be cash-rich either. Even if they be eligible for the Pioneer Generation Package now, come 2019, their premiums will be relatively high, without the subsidies. Recently, the Minister for Health announced that they will be eligible for the transitional subsidies on a case-by-case consideration, but my concern is: what happens after these first four years?

The rate of appreciation with age can also be a concern. The question is, "Is it too high?" and is age-banding the best way to categorise and do this, if one considers the table that has been put forth? From 2019, for Singaporeans aged between zero and 20 from high-income families, they would pay an annual premium of $130, whilst those over 90 years would have to pay $1,530 annually. This is a whooping 12-13 fold rise.

In view of this, should we decide on setting the increments using a ratio or rate-banding? That means if we set the ratio at 4:1 or 5:1, then the older individuals will not have to pay

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beyond four to five times being paid by the younger person. Something for us to consider.

As MOH is reviewing, with insurance companies, on the finalisation of the Integrated Shield Plans, I support the move to have the key features of the standardised plans tagged at the B1 rate, but it is also important for us to educate and make sure that people make the right choice of ward class when they seek healthcare.

Also, I hope MOH can take this opportunity to review our private healthcare insurance with the respective companies to make them more progressive and robust, as in some countries.

One more query I have is, will those with existing illnesses be managed differently, Madam, from those with no pre-existing illnesses in the revised Integrated Shield Plans which are to be announced?

Next, on portable healthcare benefits, it will be a good move for a vibrant economy, such as ours, where workers will go to where their options and opportunities are better. Perhaps, we can consider further dialogues with the tripartite partners and even offer grants and incentives for supporting employers and companies. As I see it, this can help reduce duplication of the coverage between employers' medical benefits and the MediShield Life scheme in the long term.

As the Minister mentioned in his speech yesterday, there has been some progress in this area with the dialogues. I hope that we can have some updates and, perhaps, an estimated possible timeframe for consideration as well.

One other group of people who have been wondering how it will affect them as well will be the pensioners. Thus far, not much has been shared on this. I wonder if the Minister has any further updates on this. Currently, we have about 32,000 pensioners on various schemes in Singapore.

One group of people that we can tap on to serve as our ambassadors for MediShield Life will be the healthcare professionals and healthcare workers. Can we also ensure that we reach out to the institutions to educate them further on MediShield Life and other related policies? Why am I saying that they should be our ambassadors? Well, because the healthcare professionals are the ones ordering the tests and investigations, making the decisions. They have a role in contributing towards our healthcare expenditure and, thus, towards a cost-efficient healthcare system as well. They are also the ones we can count on to help educate their patients. I do hope MOH can work with the various institutions and even primary healthcare providers to empower them and garner their support and help on

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this matter to communicate and help us explain MediShield Life. This will also be necessary with private healthcare institutions, I feel.

Will MediShield Life affect our population's healthcare consumption patterns and profile? Well, we will have to monitor and do surveillance and see what happens. Simultaneously, I feel that education and health promotion are critical for informed choices and decisions which are going to be made for long-term affordability considerations. Madam, in Malay, please.

(In Malay): [Please refer to Vernacular Speech.] Madam, the MediShield Life Scheme is very comprehensive and is a good move to help Singaporeans cope with healthcare costs. It is supported by various subsidies, especially for the Pioneer Generation, as well as those in the low and middle income groups. MediShield Life not only helps individuals but can also lessen the burden of their family members because it is their children and grandchildren who usually help out with the premium payments.

Our Malay/Muslim community also has a high rate of chronic diseases. This means more risks, complications, treatments, medication as well as admissions to hospitals for treatment and therapy. Thus, MediShield Life, which has removed the annual or lifetime claim limits, will bring major benefits to those who frequently utilise our healthcare system. For example, those who are suffering from end-stage renal failure and require lifetime dialysis treatment, or diabetics with various complications as well as patients with stroke and many long-term complications. These are the groups who will benefit most from this scheme.

I also hope our community will take note and try to find out more about this scheme which is very beneficial to them. Come to our dialogue sessions and share it in your constituencies. Ask questions so that you can gain the benefit from this long-term scheme.

For those who have Integrated Shield Plan policies, do not rush to make a decision whether to stop or to continue with it. First of all, I would like to ask that they study the details presented and understand it fully. Discuss it with your family members and also get their views about your decision.

(In English): Finally, Madam, can MOH consider setting up a Review Committee or some representatives and include a hotline as well to assist in handling queries or clarifications and case-by-case consideration for appeals and matters related to the topic within the next year or so, especially in this initial period leading up to the implementation? There should be representation in the various languages as well. This would be very helpful to assist the public and our citizens in enhancing their level of understanding.

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Moving forward, there is no perfect healthcare system, nor is there a perfect healthcare funding model worldwide. We have to do what works for us and our citizens, but we must remain flexible and nimble, as appropriate.

Health promotion and prevention must still remain the thrust of our healthcare system. Primary care must continue to be strengthened and gaps must continue to be filled.

Healthcare is a basic need we must fulfil for society, but our health lies in our own hands. I support MediShield Life and its implementation.

According to the World Health Organization (WHO), the goal of universal health coverage is to ensure all people have access to health services they need without the risk of facing financial hardship when doing so.

Madam, I welcome the proposed MediShield Life to address the fundamental issue of providing basic universal health insurance for all Singaporeans, including those with pre-existing conditions. At the same time, I want to express my concern about the risk of financial hardship caused by out-of-pocket payments and the inclusion of pensioners into the scheme.

It was revealed in Parliament in 2009 that 20% of all subsidised patients would still need to fork out cash to pay for their hospital bills beyond Medisave and MediShield deductions.

The affordability of out-of-pocket payments under MediShield is determined by three components: deductible, co-insurance, and policy year claim limit. The MediShield Life Review Committee (MLRC) has recommended a reduction in the co-insurance rates and an increase in the policy year claim limit but it has left the deductible untouched.

Although I understand the rationale in using deductibles to preserve the intent of the original MediShield as a basic insurance scheme for large medical bills, a high deductible is certainly going to affect out-of-pocket expense for those who are not cash-rich and for low-income families.

The WHO estimated that 100 million people in the world are pushed into poverty every year due to direct out-of-pocket payments for using health services.

In the pursuit of providing better protection against large hospital bills and chronic treatments, have we inadvertently increased the risk of financial hardship for patients who,

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more often than not, may only encounter non-catastrophic medical bills not claimable under MediShield Life? These bills could be substantial, especially to lower income Singaporeans. On top of that, Singaporeans will also have to contend with rising premiums since this is a compulsory scheme.

The transitional subsidies for MediShield Life will end by 2018 and the premiums will rise substantially. For a single-income family with two young children and a stay-at-home spouse, the sole breadwinner will have to bear the brunt of the increase in premiums for the entire family. The same burden will also hit single parents with young children. And if these Singaporeans are aged between 21 and 40, they will be hit with the largest percentage increase in premiums come 2019. This will certainly put a strain on their finances.

Although Singaporeans can use their Medisave accounts to settle the premiums and out-of-pocket expenses, the use of Medisave is not without limits and conditions. Cash top-ups will become inevitable. The scenario after 2018 is, indeed, uncertain but I am heartened to hear that the Minister will look into these issues and ensure disadvantaged Singaporeans will be able to afford MediShield Life come what may.

Next, I want to talk about the impact of MediShield Life on pensioners.

MediShield Life will be made compulsory for all, including pensioners who are currently receiving better medical benefits than what the universal scheme can offer. The Government has announced that it will pay for the premiums for this group of pensioners so that they will not be made worse off under MediShield Life coverage.

For pensioners under the Fixed Amount of Ward scheme (FAW), their public hospital bills are capped at $8 per day and outpatient treatment at polyclinics is free. Under MediShield Life, the deductibles alone will become a significant financial burden, especially for low-income pensioners.

The MLRC Report qualifies the lower income group as individuals with monthly per capita household income of $1,100 or less. It was reported that there are about 8,500 pensioners who receive less than $1,000 in gross monthly pension as of 10 January 2008.

Pensioners will also need to contend with the loss of extended medical coverage for their dependants under MediShield Life. Their dependants can no longer ride on their medical benefits. The additional out-of-pocket expenses for hospital bills and the annual premiums for MediShield Life coverage for their dependants are additional costs to them.

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Some pensioners may not have enough savings in their Medisave accounts as they are not required to set aside any Medisave since they already enjoy life-long retirement medical benefits. Under MediShield Life, these pensioners will have to pay the deductibles and co-insurance portions in cash.

Madam, exemptions from compulsory schemes are not new. Even a compulsory saving scheme like CPF allows exemptions. Currently, pensioners who are receiving a monthly pension can apply to be exempted from the Minimum Sum Scheme. Pensioners can be fully or partially exempted depending on the amount of pension they receive each month. It makes perfect sense for pensioners to be fully or partially exempted from the Minimum Sum Scheme because their lifelong retirement needs are met.

The same principle should also be applied to pensioners under the proposed MediShield Life scheme. Pensioners under the various medical schemes should be given a choice to join MediShield Life because their medical needs are also met. Many of the early pensioners served the nation as nurses, policemen, soldiers, clerks, teachers and so on for a good part of their adult lives in the hope that they could retire with a small pension and not worry about their medical needs in their sunset years.

There are about 32,000 pensioners today. The pension scheme has already been discontinued and this number will not grow anymore. The number of early pensioners receiving free lifetime medical benefits under FAW is even smaller, less than 1,000. As a percentage of the total population, these FAW pensioners constitute a mere 0.025% of the compulsory insurance pool. Even if we take the entire group of pensioners into consideration, they will only make up 0.83% of the insurance pool. Their exclusion will not cause an impact.

MediShield Life is designed to give Singaporeans some peace of mind in healthcare needs, something the pensioners are enjoying all these while. To mandate pensioners to join the scheme may have the opposite effect if they end up on the short side of the benefits. The Government has already made the provision to guarantee pensioners medical benefits for life. This guarantee should stand for pensioners who wish to remain status quo.

Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 4.15 pm.

Sitting accordingly suspended

at 3.55 pm until 4.15 pm.

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Sitting resumed at 4.15 pm

[Mdm Speaker in the Chair]

[(proc text) Debate resumed. (proc text)]

(In Mandarin): [Please refer to Vernacular Speech.] Mdm Speaker, the MediShield Life is a significant milestone in our healthcare reform and is a clear demonstration of the Government's will to improve the healthcare insurance safety net for Singaporeans, especially those who have fallen through the cracks in our current system.

The MediShield Life, in tandem with revamps of MediShield in the earlier years, is yet another reform which provides a comprehensive cradle-to-grave medical protection for Singaporeans. This is probably a first in the world. Although other countries have similar systems, ours have our own unique features. We do not insure from the first dollar but focus on protection against serious illnesses. By doing that, we make sure the premiums are affordable to all.

More importantly, the Government provides permanent, transitional and additional premium subsidies so that no one will ever lose their coverage because they cannot afford their premiums. For the pensioners, Public Service Division (PSD) announced a series of measures last week to ensure that they will continue to enjoy comprehensive medical benefits and will not lose out because of the introduction of MediShield Life.

Madam, MediShield Life is a new, yet not completely new national healthcare insurance scheme. To put it simply, MediShield Life is built on the foundation of the current MediShield, then "plus 2, reduce 2 and multiply by all". The two "pluses" mean the increase of coverage and claim limits; the two reductions mean the reduction in co-payment and deductible. "Multiply by all" means that everyone will be covered, even those with pre-existing conditions who could not join any insurance scheme previously. Singaporeans and their families will no longer face the predicament of not being able to pay for large medical bills due to serious illnesses. This insurance scheme, which is "for all, for life", is most timely in our rapidly ageing society.

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Often, we hear people say that, in Singapore, you can die but you cannot afford to get sick. But in fact, in Singapore, we have not seen anyone who cannot receive treatment because he is unable to foot his medical bills. In addition to the current 3M framework, the introduction of MediShield Life and CHAS will render this old saying obsolete. It also shows that the Government is determined to build an effective medical social safety net that gives Singaporeans peace of mind when they are ill.

I hope that the Government will pay more attention to explaining the details of MediShield Life. At the same time, Singaporeans should also try to understand it with patience. Although MediShield Life looks simple, it is quite complicated when implemented, because it has to look after everyone's interests. The communication efforts should focus on the elderly who will benefit most from the scheme. I urge the Government to adopt the same communication modus operandi as the Pioneer Generation Package to explain to the elderly the benefits of MediShield Life.

I hope the Government can introduce various measures in the future to ensure that the revision of the premiums of MediShield Life would be within reasonable limits. We cannot solely depend on the Government to control the premiums; medical providers and hospitals should all play an important role. This is because the biggest factor influencing the premiums is the claims amount. I urge our medical providers to be prudent and carry out only essential and critical treatments so that we can keep insurance claims at an accurate level and that premiums will not inflate unnecessarily.

The basic principle of any insurance scheme is risk pooling. The Government has committed $4 billion to help Singaporeans join MediShield Life. This is a right move. I hope the Government can strengthen Singaporeans' awareness of staying healthy and introduce measures to promote a healthy lifestyle, thereby preventing the ballooning of healthcare expenses. An old gentleman told me that he welcomed the Pioneer Generation Package and MediShield Life with joy and happiness, but he emphasised that although the schemes were good, it was best not to utilise them!

Let me use a few verses to summarise:

"MediShield Life protects everyone.

If you become seriously ill, no need to worry.

The premiums will be steady for five years. But in the sixth year, it will jump.

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Hope the Government can extend a helping hand and improve communications to reduce anxieties.

Even with a medical safety net, it is most important to stay healthy!"

I hope everyone in Singapore will do his best to allow MediShield Life to achieve its target so that we have peace of mind when we are old or sick.

Now that we have deepened and enlarged the scope of our national medical insurance, I urge employers to take this opportunity to adopt portable medical benefits for their employees. If employers say no, we have to understand why. Is it due to lack of resources or intention? Is it because they do not want to or they are not able to do it?

Mr Teo Siong Seng said that employers should be allowed to keep the flexibility offered by their current medical benefits arrangements. I do not understand this. With the implementation of MediShield Life, all employers should take this opportunity to restructure their employees' medical benefits to maximise employee benefits and avoid wastage. With MediShield Life, employers would no longer need to be concerned with cost issues associated with employing older and part-time workers, back-to-work women and people with pre-existing conditions. MediShield Life is for all and for life. I am not sure whether keeping the current scheme is an option. I feel all employers should take this opportunity to improve their medical benefits so that all Singaporeans will be better taken care of. The Group Hospitalisation and Surgical Plan is, in fact, an unguaranteed cheque. In the last few recessions and in the economic restructuring process, we saw many workers who could not get this cheque cashed in times of need. So, I hope employers can make up their mind to reform their medical benefits.

I understand that in the past few years, higher rentals and a tight labour market have driven up the overall business cost. While cost is the most important consideration on the employers' mind, for employees, medical benefits are the thing they value most. Hence, employers should give priority to this concern. From now to the end of 2015, employers have more than one year to prepare for this new scheme through the Tripartite platform. The Singapore Business Federation and Singapore National Employers' Federation should work together with unions to help employers understand the benefits and urgency of restructuring their current medical benefits.

For a long time, our model has been depending on partial contributions by employers, employees and periodic Government top-ups. Within this three-way structure, while the Government plays an important role, the employer is another important pillar. Currently, only 5% of employers have adopted the Portable Medical Benefits Scheme; I hope MOM can

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introduce more incentives, such as tax deductions, to encourage more employers to redesign their medical benefits.

Finally, whether MediShield Life can ensure people have no worries when they fall seriously ill and need to be hospitalised depends on not just the Government. Medical providers, employers and each of us must contribute by staying healthy and making sure there is no wastage of medical resources. Only by making the efforts together can we build a sustainable healthcare system. I support the Motion.

Mdm Speaker, the recommendations put forward by the MediShield Life Review Committee led by Mr Bobby Chin were the result of intensive deliberations and consultation with the public.

These are important recommendations that will ensure that MediShield Life is designed to provide better lifelong protection for all Singaporeans. The Committee also called on the Government to step up outreach and public education efforts on healthcare finance.

I would like to say a few words about how we intend to help Singaporeans achieve a better understanding of our healthcare financing system and the impact the MediShield Life Review Committee's recommendations will have.

More than 1,500 Singaporeans shared their feedback and concerns about health insurance and MediShield Life with the Committee over the past seven months. Many had personal stories and experiences to share about the healthcare system.

Some had benefited and explained how subsidies and insurance helped them pay for their bills. Some came with the view that insurance was not useful until they realised through the discussions that they were the lucky ones who had not fallen sick. I was encouraged to know that most of them left the focus groups with a better understanding of how insurance can protect them against large hospital bills.

What was clear, however, was that many Singaporeans only have a very rudimentary understanding of the healthcare financing system. As Ms Ellen Lee mentioned, many Singaporeans do not fully understand how Government subsidies, Medisave, MediShield and Medifund work together to keep healthcare costs affordable. To be fair, the issues are complex and require effort to grasp. Most Integrated Shield Plan policyholders also do not understand how MediShield and Integrated Shield Plans work together. Questions raised through the media, dialogue sessions and via online channels, such as the MediShield Life

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and REACH microsites, after the release of the Committee's Report further indicate the lack of knowledge of how the system works.

I would like to share some of my experiences with the Pioneer Generation taskforce, which I co-chair with Senior Minister of State, Mrs Josephine Teo. The Pioneer Generation Package brings many benefits to our Pioneers and will give them a stronger assurance about healthcare affordability. However, we have had to make major investments in outreach and communications in order to reach out to our Pioneers.

Our Pioneers are a very diverse group. Some did not have the luxury to go through formal education and might not even be able to read or write. Our Pioneers, whether they are Chinese, Malay or Indian, mainly use dialect or their own vernacular to communicate with their families and friends. But at the other end of the spectrum, we also have pioneers who are well-educated, constantly on Facebook, and want to know each and every aspect of the Pioneer Generation Package!

Reaching out to our Pioneers has thus not been easy. The taskforce has been innovating and experimenting with new communication means.

For the first time, as the House had heard earlier, we produced online videos in Hokkien, Teochew and Cantonese. I note that these videos have been well-received by the community, with the fortune teller Hokkien video, which was the first to be launched, having received a respectable 110,000 views by the middle of June. Quite clearly, using such heartland languages strikes a deep chord.

The latest batch of videos has Pioneer Generation DJ Brian Richmond commentating on a soccer match. In the video, a player receives a yellow card, but when the referee turns it around, it is actually a Pioneer Generation Card! I actually thought it was quite funny, until I heard feedback that some pioneers now think that the Pioneer Generation card they will receive is yellow in colour or, in Hokkien, "ng sek"! I would like to clarify with Members that the Pioneer Generation Card is red and white, not yellow, and there is certainly no penalty associated with the PG Card!

Critically, we identified that our frontline and service touch-points are where we will interact with our Pioneers the most, and sometimes in their more vulnerable moments, when they are sick or seeking help. We have invested significant efforts to train our hospital frontliners and engage our GP partners and ILTC providers. More than 1,000 healthcare frontline staff at the polyclinics and Specialist Outpatient Clinics in public hospitals had been briefed on the Pioneer Generation Package. We will continue to brief frontline staff at these public healthcare institutions up until 1 September, when the enhanced subsidies kick in.

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Engagements with the GP community will also spread the word about CHAS benefits under the Pioneer Generation Package. We also intend to work closely with our grassroots to adopt more targeted, face-to-face outreach through their networks.

So far, the feedback we have received about our outreach efforts for the Pioneer Generation Package has been positive and we will adopt the learning lessons for MediShield Life.

Soon, our outreach for the Pioneer Generation Package will be expanded to incorporate more information about MediShield Life and how the enhancements will benefit our Pioneers.

All our uninsured pioneers today, estimated at 110,000, will have coverage under MediShield Life, including those who previously could not join because of the age cap. They will have greater lifelong protection against large hospital bills through the removal of lifetime claim limits and larger MediShield Life payouts. Existing coverage exclusions, if any, will be removed, although they may need to pay a loading on their premiums.

The most important message we want all Pioneers to know is: "You will pay less, for better protection. Your MediShield Life premiums will be lower than what you pay for MediShield today." For the older Pioneers aged 80 and above in 2014, they will have their MediShield Life premiums fully covered through the MediShield Life subsidies and Medisave top-ups; they will not have to worry about whether they can afford the premiums.

To sum up, our Pioneers will spend less, yet get more value.

I will now speak briefly about Integrated Shield Plans. About 60% of Singaporeans have purchased more benefits and coverage through Integrated Shield Plans (IPs). One key focus of our outreach is to enhance awareness of how IPs work. Everyone who has an IP is already on MediShield, but not many people know this. Today, these plans build on MediShield to offer greater choices and coverage for policyholders. When MediShield Life is launched, the MediShield tier of IPs will be replaced by MediShield Life. In other words, MediShield Life will provide the "base" and the IPs will provide the "icing" on top. This "icing" takes the form of enhanced benefits like better ward classes and is provided by a private insurer.

Many Singaporeans value the additional choices that IPs offer. But they may not be aware that they are paying much higher premiums, which rise significantly with age. In absolute dollars, the premiums for MediShield and IPs are fairly similar when the policyholder is young. However, the premiums go up with age, and many realise this only when they are in their silver years, when premiums rise sharply and the Medisave

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Withdrawal Limit becomes insufficient, making it necessary to top up their premium payments with cash. Medisave withdrawal limits are sufficient to cover MediShield and MediShield Life premiums. But as IP premiums are significantly higher, the withdrawal limits are only able to help pay for a portion of the difference.

We will help IP policyholders understand how their plans work with MediShield Life. With MediShield Life's comprehensive benefits, Singaporeans with IPs might want to consider whether the "base" coverage offered by MediShield Life is sufficient to meet their needs, or whether they still need the "icing" on top. A better understanding of how MediShield Life and IPs work is needed, in order to help Singaporeans make informed decisions about their healthcare insurance.

We will work with employers and union leaders through the SNEF and NTUC to help them better understand how MediShield Life and/or IPs interact with existing employer medical benefits. The eventual aim is to help workers understand better why the lifelong coverage provided by MediShield Life benefits them, and why it is important for them and their families to have portable medical benefits that last beyond a single employer. It will also help employers understand how they can start to think about restructuring their medical benefits, in ways that are cost-effective and beneficial for their employees.

SNEF, NTUC and the Government have formed a tripartite work group to look at the issue of portable employer medical benefits, and the Government will consider strengthening incentives for companies willing to provide portable medical benefits for their employees. These could be through employers providing additional Medisave contributions, or paying part or all of their employees' MediShield Life premiums.

Mdm Speaker, many Members of this House have spoken about the importance of communications and outreach to prepare Singaporeans for the rollout of MediShield Life. We will leverage on multiple communications and media platforms over a sustained period to raise awareness and understanding of our healthcare financing system.

First, as Miss Penny Low has pointed out, it is important to reach out face-to-face to Singaporeans, even into the heartlands, to communicate the benefits of MediShield Life and explain our healthcare financing system. To do this, the grassroots are critical. Over the next few months, we will hold a series of briefings for grassroots leaders across the island. We hope that through this network, the general awareness of the various healthcare schemes and their benefits, amongst grassroots leaders will be enhanced, and they, in turn, will help us explain the schemes to their residents.

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Second, we will work closely with the private insurance industry. As more than half of Singaporeans are on IPs, many depend on the touch-points with their IP provider as key sources of information and advice on their health insurance coverage. Private insurers will take a more active role to explain details about MediShield Life to their clients, such as how MediShield Life and their IPs work together; as well as how IP policyholders will receive their subsidies. This is so that their clients can make informed decisions on the appropriate plans that meet their needs and means. MOH will work with the IP insurers to ensure responsible marketing of their products, including proper disclosure.

Community organisations and self-help groups like CDAC, MENDAKI, SINDA and the Eurasian Association can also be our multipliers to reach out to different communities of Singaporeans, including those who are non-English speaking. We will be producing advertorials and interstitials in the mainstream media – print, radio and TV – and easy-to-understand collaterals to reach out to Singaporeans. For those who prefer online platforms, we intend to use platforms, such as the MOH and CPF websites, as well as the REACH micro-site on MediShield Life to reach out to Singaporeans. We welcome other suggestions that Members may have as well.

The outreach efforts will be carried out in phases. In the initial phase, the focus will be on the general benefits of MediShield Life and the healthcare financing system. In subsequent phases, we will focus on more details like how Singaporeans will get their premium subsidies, how to make claims and more information on how IPs work with MediShield Life.

Our outreach efforts go beyond merely explaining the technical details of our healthcare financing system, which some may find difficult to understand or may not want to know. It is also about clarifying misconceptions and giving assurance. For instance, Ms Mary Liew and Ms Tin Pei Ling raised concerns about premium affordability for housewives and single parents, while Mrs Lina Chiam raised concerns about premium affordability after the transitional subsidies expire. Today, housewives who do not have Medisave balances have their premiums paid by their husbands or working children. For housewives from low- to middle income families, they will be eligible for premium subsidies, which are a permanent feature of the scheme and cover up to two-thirds of the population. So, after the transitional subsidies, two-thirds of the population from low- to middle income will continue to benefit from premium subsidies.

The Government will also continue to top up Singaporeans' Medisave Account, for instance, through Workfare. For the very needy, additional premium support will also be available. Through a combination of targeted Government help and family support, they do not have to worry about premiums. Just to reiterate and reassure Mrs Lina Chiam, no one

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will drop out of MediShield Life due to inability to pay.

Additionally, we have from time to time to also clarify certain misconceptions, such as that relating to pensioners that Mr Png Eng Huat spoke at length about earlier. In fact, for the pensioners, just last week, the Government actually announced that it would help the pensioners with their MediShield premiums so that they will not be worse off. And we need to clarify this misconception with pensioners and reassure them.

Additionally, our communications effort is also about putting a human face to the message. This will allow our fellow Singaporeans to know that help is at hand should they need it. Indeed, we hope that this outreach effort would lead to a stronger community and enhance our sense of "togetherness" – that we are all in this together. This sense of collective responsibility and inclusiveness is truly at the heart of what MediShield Life aims to achieve.

To conclude, I would like to say that the task of communicating MediShield Life effectively will be a challenging one, perhaps even more so than for the Pioneer Generation Package. But only when we succeed in getting our message across can we truly say we have taken heed and accepted the MediShield Life Review Committee's observation that the Government needs to step up outreach and public education efforts on healthcare finance to enable Singaporeans to better plan for their healthcare needs. And we intend to do so. Mdm Speaker, I support the Motion.

Mdm Speaker, I rise in support of the Motion. Better Protection. For All. For Life. These three simple yet powerful phrases exemplify the impact that MediShield Life will have on the lives of Singaporeans. First, MediShield Life will provide better protection for Singaporeans against large hospital bills and rising medical costs, now and in the years to come.

Second, MediShield Life will cover all Singaporeans, regardless of whether they suffer from pre-existing conditions, or their financial situation. Thirdly, MediShield Life will be available and will provide medical coverage for Singaporeans for life, regardless of age or background. Better Protection. For All. For Life.

Further, the Government has committed to ensuring that the proposed increase in premiums for MediShield Life remains affordable and manageable for all Singaporeans, by providing help to them with their MediShield Life premiums. To ensure that all Singaporeans will be a part of and will benefit from this insurance scheme, the Government will provide

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close to $4 billion in subsidies and financial support over the next five years.

What is before Parliament today is a product of the recommendations of the MediShield Life Review Committee (MLRC) that was tasked to provide recommendations on the proposed MediShield Life scheme. The impetus for the Committee was to allow the Government to put into action its commitment to allay concerns of Singaporeans about healthcare – and there were many concerns about healthcare and continue to be – to address gaps in the existing MediShield scheme and to study the shift to universal and lifelong insurance coverage under MediShield Life.

Therefore, to ensure that MediShield Life will provide better protection for all Singaporeans for life, the Committee's recommendations strike a careful and delicate balance between providing more benefits for MediShield Life and keeping it affordable, while ensuring that the healthcare system is sustainable in the long run.

By calibrating the MediShield Life scheme with these factors at the forefront of their minds, what is envisioned is a healthcare scheme which provides stronger protection for all Singaporeans against large hospital bills, especially those at the B2 and C levels – and a system which will provide them with peace of mind against large healthcare bills, for life.

Although not within their original mandate, the Committee also made suggestions to the Government to review the landscapes and features of Integrated Shield Plans (IPs), including the possible development of a standard IP with B1-level coverage, which will enhance healthcare protection for Singaporeans beyond the basic MediShield Life levels.

As a whole, the proposed MediShield Life scheme will provide a more holistic approach to healthcare for Singaporeans and, together with other levers in our existing healthcare system like Medisave, it will ensure that Singaporeans have a stronger and more robust protection for their healthcare needs, throughout their lifetime.

I firmly support the Motion for two main reasons. First, the recommendations of the MLRC on MediShield Life exemplify how the fruits of Singapore's economic success and growth will be shared amongst all Singaporeans. Second, the White Paper outlines how the Government will ensure that the proposed changes to our healthcare system will be effective in providing better healthcare protection, while remaining affordable for all Singaporeans.

First, I support the Motion as the proposed MediShield Life scheme will benefit all Singaporeans for life, regardless of age, financial background or if they are currently suffering from a pre-existing medical condition.

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As many Singaporeans have had a part to play in the economic prosperity that we have enjoyed, especially our Pioneer Generation, it is only fitting that all Singaporeans are included as part of the MediShield Life scheme and will be able to share in the fruits of Singapore's economic prosperity. This effort to include all Singaporeans as part of what some argue is a national insurance scheme will ensure that no one is left behind. Further, all Singaporeans will be able to share in the economic success of our nation.

One important group of individuals that will benefit under the MediShield Life scheme are Singaporeans who suffer from pre-existing conditions. These are individuals who may not be covered by the existing MediShield scheme but are, in fact, the ones who are most in need of protection. These Singaporeans have had to bear the brunt of rising healthcare costs likely on their own, and would have often times struggled to pay hospital bills for the treatment of unexpected illnesses or even expected illnesses. With MediShield Life, these fellow Singaporeans will now be provided with basic healthcare protection that will help to significantly reduce their long-term healthcare costs and hospital bills.

Other groups of individuals who will also benefit from the MediShield Life scheme are Singaporeans from our Pioneer Generation, as well as Singaporeans who are from lower-to-middle income households or who are needy. These are Singaporeans who are also in need of better protection, healthcare wise, but may need more help in the near term to ease the shift from MediShield to MediShield Life. Therefore, these individuals will be given additional premium subsidies to tide them over in the transition over to MediShield Life. Therefore, no Singaporean will be left behind and everyone will be afforded basic healthcare protection.

As Singapore continues to develop into a global hub and grows from strength-to-strength economically, it is heartening to see that all Singaporeans will be able to have a share in the economic pie of Singapore's success, and that a robust social safety net will be created or is being created to better protect Singaporeans. Further, I support the Motion as it outlines how the Government will provide better healthcare protection for all Singaporeans, while ensuring that MediShield Life premiums remain affordable for all.

As a whole, in order to ease the shift to coverage under MediShield Life, particularly for the cost of bringing those with pre-existing conditions into MediShield Life, the Government will be bearing the bulk of the costs to ensure that the impact of premiums are kept manageable for all. To this end, the Government has earmarked close to $4 billion in subsidies and other forms of financial support to operationalise the proposed MediShield Life scheme in the next five years.

Funds, which have been set aside already, will be channelled to bring Singaporeans with pre-existing conditions onboard the national scheme. I think this reflects the responsibility of this Government. Over and above special premium subsidies, Singaporeans will receive

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transitional subsidies for the first four years to help them with the increase in premiums by offsetting the net increase in their premiums.

The wide scope of coverage for the subsidies illustrates how seriously the Government is committed to ensuring basic healthcare protection remains affordable and attainable for all Singaporeans. However, Mdm Speaker, while I support the main tenets of the proposed MediShield Life scheme, could the Minister explain how this scheme will continue to be funded for generations to come, such that it is a coverage that Singaporeans can rely on some 30, 40 years down the road? Further, given the rapidly ageing population of Singapore, could the Minister explain if that projected demographic will affect MediShield Life premiums in the longer term? Essentially, this looks good and feels good now, but how will it be funded to ensure it is a financially sustainable endeavour that will remain in existence 30 or 40 years down the road when there will be Singaporeans relying on MediShield Life coverage?

Lastly, to ensure that there is greater awareness and understanding of the above-mentioned changes, the Government and the community as a whole must make consistent efforts to ensure that all Singaporeans, young and old, understand the upcoming changes to and the intricacies of MediShield Life, and how it will provide them with lifetime basic protection against rising medical costs. All of us in this House have a role to play in that regard. This public education element will ensure that Singaporeans have a better understanding of our healthcare system, and it will also empower them to play an active role in planning for their own and their family's long-term healthcare needs.

On the whole, MediShield Life and the other proposed changes to the healthcare system will, indeed, provide better protection for all Singaporeans, for life. As we continue to build a compassionate and caring society, we are reminded that each of us has a part to play in sharing in the modest cost to expand the coverage of MediShield to include all Singaporeans, under MediShield Life.

By working together and helping one another, we can ensure that all Singaporeans can look forward to their golden years with peace of mind knowing that they will not be overwhelmed by rising medical healthcare costs or left without adequate medical protection. With MediShield Life, all Singaporeans will have the assurance that they will be adequately protected, for life. Madam, I would like to register my firm support for MediShield Life.

Madam, I rise in strong support of the White Paper on MediShield Life. I would like to especially focus on a very significant feature

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of the Review Committee's recommendations – that of universal coverage.

During the Our Singapore Conversations conducted with 47,000 Singaporeans, healthcare has emerged as one of the top three concerns for them. Many people worry that as the population ages and life expectancy increases, healthcare would not be affordable. It is clear that access to affordable healthcare throughout life is an important basic need of all Singaporeans.

Yet, 7% or 270,000 Singaporeans and PRs are uninsured under the MediShield, which is our basic public insurance scheme. Out of these uninsured, 60,000 of them have pre-existing conditions of varying severity. Amongst those who are insured, another 65,000 are estimated to have exclusions. In total, I would say more than 100,000 Singaporeans and PRs have been uninsured for years

For many years since I joined this House, I have asked for health insurance to be a "must-provide" service by the Government, for all. Health insurance and affordable healthcare are basic essential services that must not be denied to anyone in our Singapore family, whatever health conditions they are born with, or acquired during their lifetime either through accidents, old age or other reasons.

I often wondered and had articulated in this House, why, for instance, a person with Down's Syndrome would be deprived of health insurance-paid hospitalisation if he should meet with an accident through no fault of his. Or why a person who acquired a heart condition or diabetes should be denied basic health insurance or other medical benefits that other citizens have access to. I had asked for Government and other key insurance providers to look into addressing this big gap for the several years that I have been in Parliament.

To be fair, the attention and support given to the special needs community especially by the Government have been remarkable in the last decade. This is thanks to the clear signal sent by the Prime Minister since his inauguration. The call to consider the special needs community, those who are disabled, was also supported by the active leadership and good work of several Ministries, such as MSF, MOE and, more recently, MOT.

But one important missing piece has always been health insurance. It is not an easy piece to fix. Inclusion has a price. Even as Singaporeans call for an inclusive society and to ensure that everyone has access to public health insurance and healthcare, not all the calls share the same degree of conviction. Many people do not mind sharing the cost of insurance for all, only if it means they are made to pay just "a little bit more". Many, of course, want the Government to pay the bulk of any premium increase. In my less optimistic moments, in the last year when MediShield was being considered, I had thought that the MediShield Life

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Review Committee and the Government will continue to leave the uninsured behind, citing cost as an obstacle.

While all this is happening, baby steps, indeed, had been taken. MOH had cautiously introduced the policy of ensuring all children born after 1 March 2013 to be covered under MediShield, whatever their condition; leaving out only those who were born before March 2013. Another encouraging baby step that was taken last year was when I was able to work with NTUC Income – thanks to then CEO Tan Suee Chieh and his team – they piloted and launched their first disability-specific insurance product for the autism community. So, that was really encouraging.

But the real deal has now come in a reformed MediShield Life that features universal coverage – for life, for all; albeit with a recommended 30% loading for those with pre-existing conditions but with Government agreeing to foot 75% of the cost of inclusion.

I am extremely encouraged by this show of moral courage of the Government in supporting this particular recommendation of the Review Committee to cover everyone. It is a move that has so far earned the support of most Members of Parliament, regardless of the party colour that they don; not to mention the many special-needs persons who previously were being denied health insurance. I have spoken to them and they are very, very supportive and grateful. Good leaders do the right thing despite challenges, despite difficulties. Including every Singaporean in a basic healthcare scheme – regardless of their age, condition, ability to contribute economically or other perceived liability – is the right thing to do. I therefore thank and salute the Minister and his team for strongly endorsing the universal coverage recommendation by the Committee. Thank you for putting your money where it matters – to pay for the bulk of the cost to bring the previously uninsured into MediShield Life.

I have five suggestions to make, for Minister's consideration.

Suggestion One is Universal Permanent Subsidy. On the recommendation to apply permanent subsidies only for two-thirds of the population, I wish to ask the Minister to consider a subsidy formula that is currently used in Government-sponsored, for example, Early Intervention Programmes in MSF. This model applies a universal flat subsidy to All Singaporeans, whatever their income is; and then add a second component of means-testing to those of lower income. Considering that health insurance is a very basic essential service, I urge the Ministry to consider applying a universal flat permanent subsidy to all Singaporeans first, regardless of income; and then apply another layer of subsidy that is means-tested.

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Suggestion Two is regarding the premium loading for those with pre-existing conditions. On the recommendation of an additional 30% loading on the standard premiums for the first 10 years to be paid by individuals with pre-existing conditions, I would like to seek Minister's clarification on: (a) how this additional loading of 30% is computed; (b) how the duration of 10 years is derived at; and (c) the criteria by which individuals with disabilities are evaluated for this additional loading. Because, as most of us know, disabilities come in varying degrees of severity – some are mild, some moderate and some more severe. Just because someone has been to a Special School, just because he has a form of mild or moderate autism or just because someone meets a technical definition of intellectual impairment, for example, an IQ of below 70, does not mean that that person is automatically a high-risk profile, subject to the loading.

Suggestion Three relates to the IP option for all. On the recommendation that the Government works with the insurance industry for a Standard IP at Class B1 level coverage, Madam, I fully agree with this recommendation. But I would also like to ask the Minister to play a regulatory role so that key IP providers adopt fair and consistent practices so that persons with pre-existing conditions will not be at the mercy of or be totally left out by the for-profit providers. IPs, as the Committee pointed out, are of significant public interest, with 60% of Singaporeans having bought IPs of various forms. Persons with pre-existing conditions should not be denied and deprived of the choice of upgrading to Class B1 because of either unfair risk-loading practices or private insurers' lack of interest to cover this target group. I ask the Ministry to consider working out to offer a standard IP for all, regardless of health conditions, using the same principles of standard loading if need be, as the basic MediShield Life.

My Suggestion Four concerns employer plans. At the job front, for persons with pre-existing conditions, I urge the Government to ensure that persons with pre-existing conditions are not excluded from plans that provide some basic employment benefits, such as Workmen's Compensation, Group Hospitalisation and Surgical Plans and Term Life Insurance Plans. I think these plans need to be aligned so that people with pre-existing conditions or congenital conditions will not be left out.

My last suggestion refers to Small Enterprises and Voluntary Welfare Organisations (VWOs). For small enterprises and the not-for-profit VWOs, I urge the Government to consider a rebate of sorts. These are set-ups that can scarcely afford a further increase in operational costs, and the mandatory additional 1% Medisave contribution to pay for the MediShield review will certainly impact them. I ask the Minister, MOH, the Government and the relevant Ministries to consider how these Small Enterprises and VWOs could be supported.

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So, these are the five suggestions.

In conclusion, Madam, it has been said that "where your treasure is, that's where your heart is also". This Government has committed a hefty treasure of close to $4 billion over the next five years to provide every Singaporean with lifetime basic protection against medical costs so that they can have greater peace of mind. This move tells me that the Government's heart is in the right place – with the People. Thank you for agreeing to deploy the country's treasure to where it should rightly be – basic protection for every Singaporean, regardless of their health status.

I thank the Review Committee and the Secretariat for its excellent work. A very well-written and reader-friendly White Paper. Thank you very much. I thank the Government for strongly endorsing the Committee's recommendations. I strongly support the White Paper on MediShield Life.

Madam, I wish to congratulate and thank the MediShield Life Review Committee, led by Mr Bobby Chin, on their hard work and extensive recommendations.

The Committee has managed to strike a good balance between several competing demands in coming up with their recommendations. These demands include:

The need for MediShield Life to be financially sustainable so that there is no inter-generational transfer of liabilities. We have avoided the situation in which our children and our grandchildren end up paying for our elderly's healthcare costs, other than within the same family unit.

To reinforce the original aim of MediShield which is to pay for large healthcare bills, while leaving smaller bills to be paid for by other means, either by out-of-pocket payments, Medisave, employee benefits and so on. MediShield Life rightly pays more than the old MediShield for the big bills.

To avoid the two main pitfalls of private insurance schemes, which are adverse selection and moral hazard; which, in layman's terms, means "cherry picking" by insurers and "buffet mentality" by the insured. The scheme is all-inclusive, even for those with pre-existing diseases, and deductibles and co-payment remain as key features.

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To give Singaporeans peace of mind – there is now no lifetime limit-caps and annual limits of withdrawal have been substantially raised.

To keep MediShield Life premiums affordable and well within what the vast majority of working Singaporeans contribute in terms of Medisave contributions so that there need not be out-of-pocket payments to fund MediShield Life premiums.

To foster a spirit of collective welfare through healthy Singaporeans funding a small portion of the additional premiums of less healthy Singaporeans in order to achieve universal coverage.

Mdm Speaker, each of the above six demands is, in itself, already a formidable policy aim to be achieved, let alone all six. But if we just reduce MediShield to its elemental state – MediShield Life is essentially about healthcare financing.

Healthcare financing can also be divided into two broad elements – funding and payment. Actually, to the man in the street, or the auntie in the market, they are not very much interested in how healthcare is funded, even if policy wonks are so obsessed. For example, whether the Government funded the Pioneer Generation Package, which is essentially also about healthcare financing, $800 million or $8 billion makes little difference to Mr Tan or Mdm Wong. Mr Tan or Mdm Wong is primarily interested in payments – how much are they going to pay for the remainder after Government funding.

So, the two biggest things on everyone's minds are: how much will the premiums be in the long run? And, two, how much will the payouts be when we need to use MediShield Life?

These two aspects will determine whether MediShield Life will work and achieve its policy intents in the long run. I am quietly optimistic that MediShield Life will work as long as the Government can maintain control over the MediShield Life ecosystem.

Yes, the key word is "control". Control is not a nice word. In this Internet Age, it is probably a politically incorrect word. But I would like to proffer that control is exactly what is needed for MediShield Life to work. The other is moderation.

Implicit or otherwise, the MediShield Life Review Committee already has built in the elements of control and moderation in its recommendations, the most important being the recommendation that MediShield Life can be used no matter what class of beds the patient chooses, from C to A, but the withdrawal limits will be pegged to B2 and C Class bills. In other words, the A Class patient and the B2 patient will withdraw the same amount of money for

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the same treatment from MediShield Life.

Madam, herein lies the most critical success and differentiating factor of MediShield Life from other insurance schemes, especially private insurance schemes. For any insurance scheme to work well, aside from relying in good actuarial practices, one has to contend with three factors: one, the size of the insurance premium; two, the payout; and, three, the out-of-pocket portion, that is, the difference between the total healthcare bill as given by the healthcare provider and the payout.

Most healthcare insurance providers cannot control the size of the healthcare bill. They can only control the premium and the payout. In other words, other than in very limited cases, the healthcare insurance provider has little control over the healthcare provider.

But MediShield Life is very different. In effect, the Government controls all three aspects of the ecosystem. By pegging payouts to B2 and C Class bills, it has put into place control and the avoidance of mission overreach. The offering of B2 and C Class services is essentially that of a monopoly run by restructured hospitals that are wholly owned by MOH.

Although there are many restructured hospitals offering B2 and C, by virtue of the funding formulas and the ownership and the appointment of board directors, the Government also has very good oversight and governance over these same hospitals.

So, in systems design, we have good control over both the demand and supply sides of the equation, unlike conventional healthcare insurances in which there is little control over the supply side.

Madam, if MOH can truly exert control over how B2 and C Class services are scoped and delivered and subsidised, then I think we can be very optimistic that MediShield Life will work. If costs and scope of B2 and C Class services are not well controlled and moderated, then two things will happen: first, premiums will have to go up significantly or out-of-pocket payments by patients will have to painfully increase. In the worst case, both will happen simultaneously and MediShield Life may fail as a healthcare funding policy tool.

Madam, I would like to now spend a little time on my favourite MediShield Life Review Committee recommendation, that is, providing a standardised IP for B1 Class. Personally, I like this because it also addresses the sandwiched portion of our society. Those who are not poor but also cannot afford the un-subsidised A Class or private hospital charges, that is, the middle and upper middle class folks.

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But philosophically, I also have a problem with the IP continuing in its present form. I would like to suggest that the private insurers concentrate on providing products for A Class and private hospital services and exit the B1 segment. This is logical because if you think about it, we want several providers for a certain product or service so that, through competition, innovation and differentiation between providers, the consumer can benefit.

But once a product is standardised, there is very limited if any scope for competition, innovation and differentiation to take place. Also, like C and B2, the B1 service is also a uniquely restructured hospital product in that it receives a 20% subsidy rate. Most private hospitals offer very few four-bedders and these beds are not subsidised. So, if the service product is standardised and unique to restructured hospitals and the insurance product is also now standardised, then, in theory at least, there is little economic sense for there to be many providers. In fact, a single insurance provider will enjoy economies of scale and better risk-pooling.

Hence, I would like to call on the Government to consider taking over the administration of IPs for B1 services, just as it does for the B2 and C Class services. If it does so, it can also institute certain elements that private insurers are very hesitant to practise, such as front-loading of premiums and coverage of pre-existing diseases.

Madam, the next point I would like to make is that I hope MOH can consider releasing some data and projections on MediShield and MediShield Life. A frequent comment is that MediShield is too "profitable" – it collects more than it needs because it pays out so little. This is not true. I think it would be good if MOH can release MediShield's Loss Ratios for the last 20 years, and how it compares with private medical insurance, while taking into account that some front-loading and, hence, lower loss ratio may be desirable in a life-long insurance product, such as MediShield, as compared to a private one in which it is only as good as the year in which you have paid your premium.

Going forward, it would be good, too, if MOH can also now declare upfront what are the actuarial assumptions for MediShield Life so that we know why and what we are paying for. For example, what are the life-expectancy, healthcare inflation and loss ratio assumptions in the design of MediShield Life?

The actual performance of MediShield Life can then be monitored against its design assumptions by all interested parties and stakeholders when it is introduced. It will also facilitate benchmarking against other medical insurance schemes. This will give all MediShield Life users a better and collective sense of ownership and responsibility in making the system work. This disclosure of information will also enable all stakeholders to make

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informed decisions and constructive recommendations to improve MediShield Life.

Madam, the last point I would like to add is whether the 3M framework of Medisave, MediShield and Medifund will take up a larger share of total healthcare expenditure. One of the common comments of the 3M framework, that is, Medisave, MediShield and Medifund, is that 3M only funds a purported 10% of total healthcare expenditure. Government expenditure now accounts for 40% of total healthcare expenditure, up from 33% a few years ago. That leaves about half of total expenditure to be still funded either by out-of-pocket, employee benefits or private insurance. Will this share of funding change with MediShield Life?

Finally, I would like to once again express my appreciation to the MediShield Life Review Committee for their conviction and courage in coming up with the various landmark recommendations in the design of MediShield Life, and also to the Minister for Health for accepting these recommendations and in coming up with $4 billion to fund the transition period. Four billion dollars now and the $8 billion in the Pioneer Generation Package underscore the Government's determination to give Singaporeans peace of mind when it comes to the subject of healthcare costs. As I have said before, while $12 billion of funding may matter very little to Mr Tan in the street and Mdm Wong in the market, Mr Tan and Mdm Wong will find out that what they have to pay out of their pocket or savings will be very much reduced with the introduction of the Pioneer Generation Package and MediShield Life. I am very confident that our people will know and will feel the difference once the tyre hits the road. I support the Motion.

Mdm Speaker, with increasing life expectancy and inflation, public concerns from accessibility to quality and affordability of healthcare have been hanging heavily over the heads of Singaporeans. Senior citizens, in particular, especially those who have invested their hard-earned cash on their house and their children, would find themselves in a spot for not having invested on health insurance when they were younger. With significantly pricier premiums for their age groups or, even worse, a rejection from the insurers because of their age and/or because of pre-existing health problems, the dilemma becomes even greater. In today's healthcare setting, it is easy for one to rake up an astounding medical bill with just a surgery and a few days of hospital stay.

Worse still, in some cases, it may have discouraged patients from seeking further treatment, such as chemotherapy and radiotherapy.

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I know of someone who was diagnosed with stomach cancer. At first, the family members did not want to tell him that he had cancer. But later on, the doctor said that the cancer had spread to the liver. After the operation, he needed to have chemotherapy, and that was the time the family members told their father that he had cancer. And the father told the children he did not want to have further treatment. He did not want to have chemotherapy. Why? Because he said he had some friends who had sold away their houses and their shophouses to seek treatment but eventually the friends still passed away.

The upgrade to MediShield Life comes at a very timely moment and has addressed this ominous problem along with other concerns, such as incurring large medical bills when diagnosed with critical illness. Just now, the hon Member Mr Png Eng Huat mentioned that 100 million people in the world got into poverty because of medical expenses, if I listened correctly. It is precisely because we care for our Singaporeans and do not want our Singaporeans to go into poverty because of medical expenses that is why we introduced MediShield Life. I congratulate the Review Committee for their hard work, and I am pleased that the Government has deemed it fit to accept all its recommendations and move this Motion for the House to debate.

We have often heard the argument that the Government could reduce healthcare costs. Yes, perhaps, but to what extent? Rising healthcare cost is an inevitable global problem.

The New York Times, in an article entitled "A World of Rising Health Care Costs" last year, revealed that having to inject more funds into healthcare has become a common predicament among industralised countries and some big developing countries.

Our healthcare sector is also influenced by external factors. In fact, there was a big debate about pharmaceutical companies having different pricing for different countries, depending on whether they are classified as Third World or others. Instead of following in the footsteps of the struggling welfare states and placing the onus solely on the Government and national reserve funds, it is far more pragmatic and sustainable to have in place a healthcare model that emphasises "Shared Responsibility" and then, when necessary, more assistance from the Government.

I have confidence that this enhancement of MediShield Life supports this model well.

Dr William Haseltine, President and Founder of ACCESS Health International, was in praise of our subscription to the shared responsibility model. He referred to our CPF as "a big social stabiliser, and a big stabiliser of health", and suggested that the USA could solve some of its current problems by taking a leaf out of our books with mandatory health savings

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accounts and regulation of insurance company prices and policies.

MediShield Life is a true reflection of the society we strive to be – one that is inclusive, leaving no one behind, from those with pre-existing illnesses to the aged. These were the vulnerable groups previously not insurable.

While the increased premiums to cope with a more comprehensive healthcare scheme may seem like a penalty to the young and healthy, it clearly seeks to drive home the message of shared responsibility and paying forward, that is, to pay more when we are young and working so that, when we are old, premiums need not grow exponentially.

In any case, in spite of the premium increments, the enhanced MediShield Life keeps medical expenses manageable for most, while shoring up various gaps. Based on feedback from the ground, Singaporeans, I believe, generally prefer to be able to pay their insurance premiums out of their Medisave accounts.

On the other hand, premiums for health insurance policies offered by private insurance companies tend to go up exponentially with age, and it may be inevitable to pay a portion of the premiums out of one's pocket instead of paying the full sum via Medisave.

In fact, I have received feedback from many of my residents over the last few years that their premiums from the private insurance companies have gone up tremendously. So, my residents are worried. With the introduction of MediShield Life, will their premiums be increased again? They worry that the companies will take this opportunity to increase the premium upwards. Perhaps, the Government needs to monitor the premium of IPs and asking them to break it down into MediShield Life, plus whatever that is extra.

There are also residents who misunderstood that MediShield Life is all-encompassing. I have already heard residents talking about not renewing their existing insurance plans when MediShield Life kicks in.

MediShield Life provides better protection against large hospital bills and expensive chronic treatment. Perhaps, we need to bring up awareness on what is a large hospital bill. There may be many more smaller hospital bills that are not covered under MediShield Life, and these will have to be picked up ideally by employers' coverage. Otherwise, individually, they will have to buy another insurance to cover the smaller hospital bills, if they do not want to pay cash. Mdm Speaker, in Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] MediShield Life truly reflects our aspiration for an inclusive society that leaves no one behind, from those with pre-existing

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conditions to the aged.