Dear Lawrence Wong,

I have asked you and the Minister for Health repeated questions on many occasions about MOH’s Budget (see here and here for just two articles of many). My back of the envelope calculations showed that total spending by MOH on a per capita Singapore resident basis (based on the estimated 2022 figure of over $19 billion) was more than the UK spent on a per capita basis on the NHS. This was very odd given that Singaporeans have to pay every time they use the public health service. I asked why your Government didn’t show the revenues it collects from residents, either in the form of out-of-pocket payments or from Medisave balances or Medishield Life payments in the Budget.

In particular, if your Government has nothing to hide, why are the accounts of the public healthcare system which has been corporatised under a holding company, MOH Holdings Pte Ltd, not made available in the Budget but are instead hidden behind a paywall requiring anyone wanting access to them to pay a substantial fee of $73. How does that contribute to transparency and accountability? You have creatively expanded the meaning of “ownself check ownself” into “ownself hide important facts and money flows from your citizens and then use POFMA and other tools to intimidate us from asking questions”. After all if no one can see what is going on then your claims will go unchallenged and you can continue to bamboozle Singaporeans with lectures about the need for prudence and belt tightening while the bulk of the surpluses you collect from the citizens slip by unrecognised and unchallenged.

I have now paid the fee and reviewed the accounts of MOH Holdings and it has left me even more baffled. As a public service I reproduce below the balance sheet, comprehensive income statement and cash flow statement for the year ending 31 March 2022.

As I only have the accounts for MOH Holdings up to 31 March 2022, nearly 18 months ago, the only comparison I can do is with the revised spending figures for Health in 2021 given in Budget 2022. For basic transparency and accountability you should publish the latest accounts and not try to hide them from Sinvaporeans by making them pay to see them.

After a limited comparison, it became clear that it was impossible to reconcile the figures your government claims to spend on health with the subsidies that MOH Holdings actually receives.

Lets look at operating expenditure first (see screenshot below). MOH Holdings’s accounts show the Government provided roughly $7 billion in subventions to MOH Holdings for the year ending 31 March 2022 .However the total MOH Budget in 2021 was about $18.5 billion. So where was the extra $11 billion spent? According to the breakdown in the Budget, MOH provided roughly $1 billion in social transfers to individuals which presumably is Medisave top ups. This accounts for $1 billion but still leaves about $10 biillion unexplained.

Furthermore $121 million of the $7 billion subvention to MOH Holdings came from Pioneer Generation and Merdeka Generation subsidies. I trust these came out of the funds that were set aside in 2014 and 2019 and were not double counted in MOH’s Budget.

Looking at the relevant extract from the Budget document showing Revenue and Expenditure for 2021, It is impossible to tell where the $7 billion or rather $6.9 billion came from since Transfers to Institutions and Organisations totalled $8.5 billion. You list a further $5.5 billion in Grants, Subvetntions and Capital Injections, $900 million to Statutory Boards and $4.6 billion to Other Organisations, without providing any breakdown or explanation. The notes on the Revised FY 2021 Budget are extremely short on detail and do not correspond with the spending categories.

Turning to Development Expenditure, MOH spent $1.1 billion in 2021 yet Capital Grants to MOH Holdings were only $280 million. Please explain where the additional money was spent as the projects listed in the notes relate to capital expenditure on assets owned or managed by MOH Holdings.

Moving on to the MOH Holdings accounts themselves and to the comprehensive income statement, the notes explain the sources of the income of $4.3 billion listed on the first line but no explanation at all of the $4.2 billion in other operating income. You need to provide a breakdown of other operating income. I note that at least 95% of the $4.3 billion came from patient fees but only about $1 billion was paid from Medisave. Total Medisave CPF balances have now reached $129 billion or close to $30,000 per Singaporean resident. Please explain why your Government restricts the use of Medisave so much that only about a quarter of total expenditure was covered. Also why can’t the Medisave saving rate be reduced? The Government certainly earns a premium over the 4% that is paid to account holders and this premium will have widened considerably with the global rise in interest rates. None of this is returned to Singaporeans except in a very tenuous way through the so-called Net Investment Returns Contribution, of which most is saved and not spent, in a kind of round-tripping operation.

Finally DPM Wong can we get your comments on why MOH Holdings is holding such a large amount in cash and investments? According to the balance sheet as of 31 March 2022, it held about $8.6 billion in cash and other financial assets. The other financial assets appear to have largely been short term debt securities which hardly suggests an optimal allocation. This is a substantial amount of money and would allow MOH Holdings to continue operating for more than a year without any Government subvention. Is there any particular reason why it is holding so much in assets? How can stashing secret pots of money away from Parliamentary and public scrutiny be conducive to good financial management and the prevention of fraud? While $8.6 billion is peanuts against likely total Government financial assets of $3 trillion, the fact that these hidden assets keep turning up suggests that even $3 trillion is too conservative and the total should be revised up considerably.

I hope you will answer my questions and not in the cowardly fashion typical of your Government, use POFMA or other repressive tools to hide information from the public and silence or attempt to ridicule those who ask questions. Why was MOH’s Budget $18,4 billion in 2021 when I can only find about $1 billion in individual subsidies and $8 billion in subventions to MOH Holdings? Furthermore, why have you falsely claimed in Parliament that MOH’s Budget needs to triple by 2030, which would take total spending by MOH to $60 billion? Why is your Government allowing money to accumulate in unaccountable vehicles rather than reporting it back to Parliament as unspent funds? Why are MOH Holding’s accounts hidden from public and Parliamentary scrutiny? Why do you and your master, PM (or BG) Lee, always claim that taxes need to go up when the state coffers seem to be bursting? Please provide some answers as I’m sure I’m only scratching the surface of what is really going on. Meanwhile I invite members of the public to comment on the accounts I have posted and point out any further issues that I should be raising.

Published by kjeyaretnam

I'm a Singaporean economist who became an opposition activist. I blog to provide an alternative to the porkies that the Pinkies tell. It just so happens that my alternative is the truth. That's why I've never been sued in any civil or criminal court no matter how hard hitting my criticism. I'm quoted and interviewed and asked to speak across the world but largely censored in Singapore in an effort to silence my political opinions. The left hate me because they think I split their vote and because I eschew their outmoded economic models. Models that don't work. The Right and the Conservatives hate me because I'm a liberal. I'm not sure what the middle think of me. I don't think there are more than a handful of people in the middle, here in Singapore. I'm a Singaporean born and bred, dual heritage, my parents Singaporean established here before the State of Singapore was created. I'm not Eurasian. I read economics at Cambridge and could be broadly described as from the Keynesian school but I believe in interventions. I was formerly a successful hedge fund manager. After economics and politics my greatest interests are history, film and Makan. I run but I run so I can eat like a Singaporean. View all posts by kjeyaretnam