A Few Questions for the Health Minister
Dear Minister Ong
Firstly my commiserations on missing out on becoming the interim seat-warmer in waiting (at least until your boss LHL, whom you served loyally as PPS from 2002 to 2004, changes his mind yet again).
However the reason I am writing to you today is that I have grave concerns about red flags and discrepancies in your Ministry’s budget for 2022. This was passed by Parliament with little or no scrutiny by the Opposition yet it is now the single highest spending Ministry. By way of comparison Education received $13.6 billion while Defence got $16.4 billion. From an expenditure of $2 billion as recently as 2006 your budget has grown to over $19 billion in 2022, a nearly ten-fold increase. 92% of this is operating expenditure ($17.84 billion) so the money is not going to finance the increase in capacity which you laud in your speech to the Committee of Supply. In fact your speech is remarkably short on facts and figures.
If we divide your Ministry’s budget by the number of Singaporean residents we get a spending figure of approximately $4,750 per resident. I assume that all healthcare spending on foreign workers including Employment Pass holders is private and that the Government is not making Singaporean taxpayers pay for their healthcare. I would also argue that a more appropriate denominator should be the number of Singapore citizens and not include PRs, who should not benefit from subsidised healthcare as male PRs have not done NS. However I will ignore that for the time being.
Government spending of $4,750 per Singapore resident in 2022 compares with a budget of around £2,600 (or $4565 at current exchange rates) per person for 2022/2023 in the UK, the bulk of which goes to fund the National Health Service (NHS) which is free at the point of delivery to all UK residents. So the UK, with a publicly funded health service out of taxation) appears to be spending only very slightly more per capita than Singapore. As I am sure you are aware having studied at the London School of Economics, all visits to the GP are free and so are all specialist consultations and hospital operations including the costs of beds and surgery. There is a charge for prescriptions but many categories (the over 60s, the disabled, those with chronic conditions) are exempted
The Singapore healthcare system is of course not remotely as generous. The overarching principle of your Government’s philosophy is that Singaporeans must pay for everything because there is no such thing as a free lunch. Presumably the revenue collected from Singaporeans for healthcare (whether at poly clinics or hospitals) must go somewhere yet it does not appear to be shown in the Budget. I am guessing that the revenue is collected by MOH Holdings Pte Ltd, the company the Government set up to manage the public healthcare clusters back in the early 2000s. Why are the accounts not included in the Budget or at the very least available easily on the MOH Holdings website? Why the secrecy?
I have tried to gain access to the accounts of MOH Holdings through the Accounting and Corporate Regulatory Authority’s (ACRA) website but despite paying $26 out of my own pocket for the last set of accounts I was sent an extract with no accounts attached. My emails to ACRA pointing out the error and asking to be sent the accounts have gone unanswered. I also emailed MOH Holdings directly but was rebuffed by one Sheela Narayanan, who did not disclose her job title until requested. She then told me she was Deputy Director Corporate Communications. Ms Narayanan declined to provide the accounts merely stating that I could obtain them from ACRA.
I do not see why as a Singapore citizen I am unable to see the accounts of MOH Holdings and when I do pay for it I do not receive the information I paid for. I would be grateful if your Ministry would send me a copy of the financial statements of MOH Holdings for the last three years. I hope you will not rebuff me with the argument that MOH Holdings is a private company and therefore Singaporeans are not entitled to the information, which was the argument used by your senior colleague Lawrence Wong when refusing to provide Parliament with amount that the PM has paid his wife as head of Temasek.
I would like answers to the following initial questions (either from you or from the Minister of Finance Lawrence Wong) :
1. Why does the Budget only include spending by MOH and not revenues collected, either directly from Singaporeans or through their Medisave accounts or Medishield Life policies apart from the insignificant sum of $93 million? I am perplexed because your website shows that Medisave balances reached $110 billion as far back as 2020 and that Singaporeans used only $1 billion in 2020 to pay for direct medical expenses.
2. On your website it also states that over 90% of the cost of treatment in B/C class wards is covered by Medisave and Medishield (I presume the balance is covered by out-of-pocked expenditures by SIngaporeans). If that means the $1 billion withdrawn to pay for direct medical expenses then why is your Ministry requesting a budget of $19 billion and $17 billion for operating expenditures? It is difficult to believe that the Ministry’s healthcare expenditures per Singaporean resident could be so high and more than in the UK, given that the proportion of over 65s in Singapore is lower (under 16% compared to over 18% in the UK) and the cost of manpower (except possibly doctors) is so much lower.
3. Your Ministry has budgeted $9 billion in transfers to institutions and organisations in 2022. I assume the bulk of this goes to MOH Holdings. Given that Singaporeans pay for the bulk of their healthcare through their own savings, Medisave and Medishield, It seems likely then that MOH Holdings is running a substantial surplus. What is happening to this money? Is it being transferred directly to GIC or Temasek or used to cover losses elsewhere? It should be easier to answer these questions once you send me the accounts for MOH Holdings.
4. Elsewhere on your website it says that Government healthcare expenditures include spending from endowments and trust funds yet this has not been broken out in your Ministry’s Budget. What contributions came from the Merdeka Generation Fund, the Pioneer Generation Fund, the Eldercare Fund, the Medical Endowment Fund or the Long Term Care Support Fund? Why are these being included in the Expenditure estimates if the money has already been set aside? I have previously expressed my concern that there seems to be double counting. Money is set aside in earlier years but then is expensed against revenues a second time in the Budget. I would be grateful for your reassurance that this is not happening. If this is not a question you can answer perhaps you can pass it your senior colleague Lawrence Wong.
5. I note that the increases in healthcare expenditures in recent years seem to mirror the increases in the Net Investment Returns Contribution. I would be grateful for your reassurance that there is no connection between the two and that the Government is not trying to deceive Singaporeans through matching book entries with no new money actually entering the system.
I look forward to receiving answers to my questions. If I have made any errors then the responsibility rests with me alone. Regrettably I do not have access to the resources that you and the Finance Minister possess or even that available to the Leader of the Opposition. I am sure there is a perfectly innocent explanation for why Singaporeans are paying so much for healthcare (through both taxes and direct expenses) and have accumulated so much in apparently unnecessary Medisave balances that are loaned to the Government. If you fail to answer my questions I will assume that there is something that you do not want Singaporeans to find out. Much as I would like to believe that the PAP’s mantra of “ownself check ownself” leads to incorruptible and efficient government, it defies logic and reason for Singapore to be unique among all the world’s one party authoritarian states ruled by one man particularly as your government refuses to provide the information necessary to make sure it is properly accountable as it would be in a democracy.
The Reform :Party
I find it a fair and polite letter requesting knowledge on how and where monies are being spent in the minister’s portfolio. Singaporean should be thankful you are doing the job of the mainstream media. Cheers.
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