Parliament No: 9 Session No: 2 Volume No: 73 Sitting No: 17 Sitting Date: 13-08-2001 Section Name: ORAL ANSWERS TO QUESTIONS Title: MEDISAVE (Use for annual medical check-ups) MPs Speaking: Mr Lim Hng Kiang (Minister for Health); Dr Jennifer Lee; Dr Lily Neo; Dr S. Vasoo; Mr Sin Boon Ann; Mr Tan Soo Khoon (Mr Speaker);

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MEDISAVE

(Use for annual medical check-ups)

    4. Mr Sin Boon Ann asked the Minister for Health whether his Ministry will consider reviewing the guidelines to include the use of Medisave for annual medical check-ups.

    The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, the Medisave scheme is primarily designed to help individuals meet their personal or immediate family's hospitalisation expenses, especially during old age. However, over the years, we have extended Medisave to certain outpatient treatment, such as chemotherapy.

    My Ministry has considered extending the use of Medisave for health screening, including annual medical check-ups, and decided against it. First, there are many types of health screening, of which many are not cost effective. Second, for certain cost-effective health screenings, such as mammography and pap smear, my Ministry has already made them affordable by providing heavy subsidies at the polyclinics. Also, we have introduced the Community Health Screening Programme for the elderly to detect diabetes, hypertension and high blood cholesterol. Again, the cost is minimal, as the elderly pays up to $5 for the screening which costs around $20. Therefore, Singaporeans need not rely on Medisave to pay for cost-effective health screening.

    There is always the temptation to liberalise Medisave for various types of healthcare services. We have to guard against such a tendency, as an overly

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liberal extension of Medisave will result in even higher rates of contributions into the Medisave Account.

    Mr Sin Boon Ann (Tampines): Sir, I would like to ask the Minister whether he will consider reviewing the various types of medical screening that are available, because we all know that with advancements in technology, certain kinds of test can actually help one detect serious illness early enough and, with early detection, it will help Singaporeans manage their Medisave savings better in the long term. So I would like to ask the Minister whether he will consider looking at the various kinds of screening again to see whether these can be introduced at some point of time in the future.

    Mr Lim Hng Kiang: Mr Speaker, Sir, this is indeed what we have done. We all believe in evidence-based medicine, and we regularly look at the tests which are done. If the clinical trials and the tests show that certain types of screening are indeed effective, then we introduce these and we make these mass-based. This we have done for pap smear and mammography, and we have also done, for the community health screening, for diabetes and high blood cholesterol and hypertension. But there is a wide range of medical screenings. So we look at the evidence and, if the evidence shows that a nation-wide mass screening is effective, we do indeed undertake this screening.

    Mr Sin Boon Ann: Mr Speaker, Sir, I can think of one example of screening that would help manage the patients' medical resources in the long term. For instance, if we can scope Singaporeans intensively and aggressively, we can help detect some form of stomach cancer and colorectal cancer. And early detection in these areas of cancer would be useful for the patients concerned.

    Mr Lim Hng Kiang: Mr Speaker, Sir, there is no evidence right now that a nation-wide scoping, as Mr Sin puts it, is going to be cost effective in preventing or detecting these cancers early enough. There are just too many false positives and false negatives involved.

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    Dr Lily Neo: Mr Speaker, Sir, may I ask the Minister for Health whether he agrees that prevention is better than cure. If it is, would he not encourage more people to practise this concept using their own funds by allowing them to go for health screening for the common cancers, such as colorectal cancer as mentioned earlier by my parliamentary colleague, Mr Sin Boon Ann, and breast cancer using their Medisave?

    Mr Lim Hng Kiang: I do believe that prevention is better than cure and, therefore, I urge all Singaporeans to have a very healthy lifestyle. Screening is not a key mechanism for prevention. If we all undertake to have a healthy lifestyle, we will go a long way in making health care affordable and reducing healthcare costs.

    As I have said, I have not ruled out health screening as a useful device. But before we undertake a mass health screening and also allow Medisave to be used for health screening, we have to be very careful. First, we have to be convinced that the health screening based on trials and evidence is effective, otherwise we undertake a major health screening and we get people all worked up, too many false results and it is not money put to good use.

    Secondly, we must remember that Medisave is really intended as savings for medical treatment for old age. The amount of money that we put aside for Medisave is estimated, for the average Singaporean, to pay for about 10 or 11 hospitalisation episodes. So if we ask our constituents, those below 60 years old, as I do regularly in the dialogue sessions, to put up their hands if they had been hospitalised more than twice or thrice, very few had done so. In fact, most of the hospitalisation episodes are when we are old, when we are 65, 70 or 75. That is the whole purpose of the Medisave account - to save for the day when we are retired and we have to pay for our hospitalisation. When we are still active, earning and have our own savings, we should use these to pay for the other types of health screening which different people want to undergo, and reserve the Medisave accounts for hospitalisation in our old age.

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    Dr S. Vasoo (Tanjong Pagar): Mr Speaker, Sir, may I ask the Minister what other new healthy lifestyle programmes his Ministry will be promoting.

    Mr Lim Hng Kiang: We stick to the old one, ie, do not smoke, eat healthily, exercise, manage our stress.

    Dr Lily Neo: Mr Speaker, Sir, may I seek your patience and indulgence of the hon. Members of this House? I beg to differ with the Minister for Health on what he has just said.

    Sir, last year, 4,220 Singaporeans died from cancers, constituting about 27% of all deaths. Colorectal cancer is the commonest cancer among Singapore men and women, and breast cancer is the most frequent killer of Singapore women.

    Mr Speaker: Dr Neo, can you ask your question?

    Dr Lily Neo: Sir, can I seek your patience? I am coming to my question.

    Mr Speaker: Can you ask your question now?

    Dr Lily Neo: I will come to it, Sir, because I need to state the facts.

    Mr Speaker: I am sorry. You will have to frame your facts in your question.

    Dr Lily Neo: All right. Mr Speaker, Sir, the most important factor is early detection. Therefore, may I ask the Minister for Health whether he will facilitate more people to go for early detection by allowing them to use their Medisave?

    Mr Lim Hng Kiang: I do not dispute the number of people who died through cancer. People also die through heart disease, strokes and many other causes. The approach is, really, for effective mass screening, we do encourage. For mammography, we have it in our polyclinics, and we subsidise it up to 50%.

    I do not think cost is the main deterrent in people coming forward for screening. We have run free mammographies, and the take-up rate is still very low. So it is a

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whole process of education and getting people to come forward. Cost is not the key issue here.

    Other forms of health screening, where there is evidence that they are effective, we would do so. Colorectal cancer is one of the key cancer killers in Singapore. We are looking at other tests, not necessarily scoping, as a way of doing some kind of screening. We are still in the process of evaluating the efficacy of such tests.

    But I would urge against a trigger-happy use of our Medisave. Medisave should be largely utilised for hospitalisation episodes in the later stages of our life.

    Dr Lily Neo: Sir, may I ask the Minister whether it is correct to say that mammography in the polyclinics is only applicable to women aged 50 years and above on demand, that there is no population screening programme and there is also a co-payment fee of $50 for each screening? But since an average of three women are diagnosed with breast cancer, half of them are below 50 years of age, and that breast cancer is curable if detected early, should not the Minister facilitate more women to go for early screening and save lives?

    Mr Lim Hng Kiang: We have to use our Medisave carefully. I sympathise entirely with women who want to do their breast screening early. I would urge them to do so. My usual reply to them is: save on one hairdo and use the money for breast screening. I have been taken to task by many of my hairdressers in Telok Blangah but I think this is still my main message.

    Dr Lily Neo: May I ask the Minister whether it is better to use Medisave to detect early diseases and save lives rather than safeguarding the Medisave for old age and end-stage diseases by which time, the funds in the Medisave would have been made redundant in the case of cancers for such patients?

    Mr Lim Hng Kiang: Sir, if the Members here support an increase in the Medisave contribution rate, I would allow Medisave to be used for such screening.

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    Dr Lily Neo: Mr Speaker, Sir, I would like to register my thanks to the Minister for Health for his consideration and may I also urge the Minister to expedite this reconsideration. But, Sir, would he also comment on the colonoscopy for colorectal cancer, please?

    Mr Lim Hng Kiang: I have already said so in my reply that there is no strong evidence that mass screening through colonoscopy works. There are studies done in the United States and other countries and there is no evidence to say that mass screening works. We are looking at the evidence. We are looking at such clinical tests and when we are convinced that it is effective, we would do so.

    Dr Lily Neo: Sir, may I ask the Minister whether I am correct to say that colonoscopy is actually the most widely and currently advocated screening test for colorectal cancer and is, at the moment, being adopted by America because they have very high incidence of colorectal cancer just like Singapore?

    Mr Lim Hng Kiang: I have had this debate in my Ministry many times and my doctors tell me that right now, there is no evidence, on efficacy grounds, to do it in Singapore.

    Mr Sin Boon Ann: Is the Minister suggesting therefore that the annual executive health screening programme that some of us go through is not really an effective form of medical detection?

    Mr Lim Hng Kiang: It is an effective screening and I think you should use your cash to pay for it. For the bulk of Singaporeans, if they all just turn up for the community health screening, I will be very happy as the Health Minister. Even if I allow Medisave to be used for executive health screening, it would not be the bottom 50% of Singaporeans who will go for this screening and this is the group that presents the greatest challenge for us, not the top 30%. And even if you go for executive health screening, you do not scope every year. The doctors would tell you if you are in the high-risk group, and you only scope if you are above 50 years

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old. If you can afford it and you want to do it every year, by all means, do so. But please do not use Medisave.

    Mr Sin Boon Ann: Sir, would the Minister not agree with me that it is precisely for the bottom 50% of Singaporeans who cannot afford the cash outlay that they need to use these Medisave resources, which is their own money, for the purpose of this health screening?

    Mr Lim Hng Kiang: For the bottom 50%, if they turn up first for the community health screening, it will go a long way to minimise the health problems faced by them. That is our priority. That is our main challenge - to get the older folks and lower-income people to do regular health screening. The $20 health screening will go a very long way in minimising all these chronic illnesses.

    Dr Jennifer Lee (Nominated Member): Sir, I essentially think that we probably are alarmed. I would like to ask the Minister, before I get called to order, if we could have the reassurance that for all the efficacious screening tests that can be done, his Ministry will do the best to expeditiously implement such screening programmes so that, in fact, we do not have to resort to liberalising the use of Medisave. I think that may be a better way of going about it.

    Mr Lim Hng Kiang: My Ministry would definitely do so. We are in charge of healthcare. We want the best outcomes for Singaporeans. If we are assured that health screening is effective, you can have my assurance that we will do it quickly.