By: Leong Sze Hian

Parliament debates removing century-old law

I refer to the article “Parliament debates removing century-old law” (Straits Times, Jan 11).

1st time since 2004 – send to Select Committee

It states that “It ended with members of the House voting to send the proposal to a specially convened Select Committee for extra scrutiny – a rare step that last happened in 2004 with the Building Maintenance and Management Bill.

So that the affected hospital staff can have their say

The Ministry of Health told The Straits Times that the Kwong-Wai- Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill was sent to the Select Committee so that the affected hospital staff can have their say on the move.

Singapore’s largest nursing home

At the end of this year, it will run Singapore’s largest nursing home, with more than 600 beds.

Dr Lam noted that the hospital has already gone beyond the restrictions of the old law. For instance, its services are open to the public, regardless of the race, religion and dialect of the patients.”

Move to repeal the law was initiated by the hospital management – but when?

As to “The move to repeal the law was initiated by the hospital management, he added, without saying when” – when was the move initiated?.

From charity under 1910 law to a Companies Act company registered as a charity supervised by MOH?

Without the law, the hospital will be run as a company.

With regard to “It was incorporated and registered as a charity last year. The hospital will be governed by the Companies Act and supervised by the Ministry of Health as a charity” – how different will it be in the future, compared to the last 106 years when it was not “supervised by the Ministry of Health?

No change compared to its first 100 years?

In respect of “”The hospital’s operations will not be affected and patients are unlikely to experience any inconvenience or any adverse changes as a result of the transition”” – will things like fees, means-testing, etc change in the future, compared to its first 100 years?

The issues in 2010?

On 6 April 2010, Andrew Loh and I co-authored an article “Kwong Wai Shiu – 100 years old but will it survive? (theonlinecitizen) –

“The hospital, located along Serangoon Road and which came about from an agreement between the British colonial authorities and the merchants, was built on a 6 hectare piece of land with a 99-year lease. The British government charged it a nominal annual rental of S$1.

Fast-forward to 2010.

$1 rent increased to $1.4m?

When its 99-year lease expired in February this year, the land was returned to the Singapore government. After discussions with the Ministry of Health (MO) and the Singapore Land Authority (SLA), the hospital was granted a new 5-year lease – till 2015 – and had its rental increased from the nominal S$1 to S$1.4 million.

Transparency?

It has been reported by the media that the MOH, under the new agreement, “has agreed to substantial increase in subsidies” for the hospital. These subsidies could be up to S$1 million to pay its rental of S$1.4 million and a further S$4.8 million for its annual expenses. These figures are, however, just speculation as the government has not made any such agreement public. Even the hospital’s management doesn’t seem to know exactly how much the government will provide.

Inevitably, such non-disclosure by the government throws up many questions.

Why raise charity hospital’s rent by 1.4 million times?
As a non-profit community hospital which has been running as a charity since 1910, and which depends on patient fees and donations, why is the hospital’s rent being raised 1.4 million times, from $1 to $1.4 million?

Increase $1.4m, then subsidise $1m?

It is puzzling that the SLA would raise its rental to S$1.4million and then for MOH to say it will subsidise the rental by up to S$1 million. Even if that were so, its rental would still rise by $400,000 – in one fell swoop, without any explanation by the SLA or the MOH.

Did MOH help 6 hospitals that had to raise charges?

It is even more curious if you consider that last year, and according to the Straits Times, “four of the six community hospitals here raised their charges, some by as much as S$50 a day” and the MOH did nothing to help them with the costs of operating the hospitals.

Why the sudden ostentatious generosity towards KWSH now?

MOH only gave $170,000 (1.5% of the hospital’s annual expenses)?

In conjuction with KWSH’s rental being increased, we now know that MOH only gave $170,000 last year to KWSH, which is only about 1.5 per cent of the hospital’s annual expenses.

Subsidy up from $170,000 to $4.8m, but up fees which has been maintained for 16 years?

I find it puzzling that KWSH was able to maintain prices for the last 16 years with just $170,000 from MOH. Now, however, under an agreement with MOH last September, the ministry said it would provide as much  as 40 per cent of the hospital’s annual expenses – expected to be some $4.8 million. Even with this infusion from MOH, KWSH now says that it does not rule out the possibility of raising prices next year.

So, previously with just $170,000 (which is just 1.5 per cent of its annual expenses), from MOH, the hospital did not have to raise charges, for 16 years.

Now, even with $4.8 million (which is 40 per cent of its annual expenses) from MOH, the hospital may raise charges?

What gives?

Increase fees, despite 28-fold increase in funding?

We would like to suggest that the agreement be made public, so that we may try to understand why KWSH may have to increase prices, despite a 28-fold increase in MOH funding.

Will other hospitals get increase in funding too?

Will the other community hospitals receive similar substantial increase in funding too?

Criteria for funding?
The MOH said, in response to a Straits Times query, that “funding to community hospitals was on a need basis”. What criteria exactly does the MOH use to determine the amount of funding?

Since the agreement was in September last year, why is it taking so long, as about six months have lapsed already, for KWSH to extract financial and patient records for MOH to determine the size of the subsidy funding, as reported by the Straits Times?

Means testing starts after 100 years of “no means testing”?

Also, as a result of the agreement, KWSH has begun means testing to decide the level of subsidy that each patient should get.

What this means is that a Singaporean patient whose family income is as little as $1,440 (based on a family of four) may have to pay 25 per cent of the cost, rising gradually to 100 per cent for higher income families up to $5,600, in accordance with MOH’s subsidy scale.

100 year-old tradition of giving free care to anyone, without the stress of means-testing is gone?

This is a departure from KWSH’s 100 year-old tradition of fulfilling its mission of giving free care to anyone, and serving patients without the stress of having to be means-tested under MOH procedures.

1 VWO opted out of means testing?

In this connection, at least one Voluntary Welfare Organisation (VWO) had opted out of means-testing in the past, to spare its beneficiaries the stress of the process for the critically ill.

Don’t increase rent lah?

Since KWSH had a operating surplus of $1.4 mllion (which coincidentally is what they have to pay for rental now) for the last financial year, perhaps maintaining the status quo without any increase in rent or funding may turn out to be better from the perspective of patients.

Cheapest healthcare in S’pore?

As a charity 50-bed community hospital, 350-bed nursing home, outpatient clinic, day rehabilitation centre and traditional Chinese medicine (TCM) centre, we understand that its charges are probably the lowest in Singapore, and most of its patients are the poor and lower-income.

Even cheaper than polyclinics?

For example, its TCM general consultation with 1-day prescription at $2 and out-patient doctor consultation (inclusive of standard medication) from $8 to $12, are even lower than what the polyclinics charge.

Most cost-efficient healthcare facility in Singapore?

With a staff strength of more than 250 employees plus volunteers, its annual operating expenses of $11.5 million is arguably the most cost-efficient healthcare facility in Singapore.

Give more financial assistance, instead of raising rent?

To encourage more charity healthcare institutions like Kwong Wai Shiu Hospital, the Government should give it more financial assistance, instead of raising its rent.

Lowest public healthcare spending among developed countries?

After all, as we understand, Singapore’s healthcare spending at less than four per cent of GDP, and public healthcare spending at about two per cent of GDP, is already one of the lowest in the world.

An uncertain future?

Finally, the future of KWSH is uncertain. The hospital’s board members have expressed hope that it will remain as a hospital and nursing home when its current lease expires in 2015. However, a Singapore Land Authority (SLA) spokesman said that it would depend on the outcome of discussions and consultations with MOH and other government agencies.

How different will the KWSH of the future be, after its agreement with MOH for funding?

Perhaps we will only know when its lease ends in 2015.

“It’s hard to imagine that this land does not belong to us anymore” – why take away the “best” healthcare charity’s land?

“My heart was full of pain,” said Ms Ling Bee Sian, director of operations of KWSH, who signed over the hospital to SLA officials in February. “It’s hard to imagine that this land does not belong to us anymore.”

The “real” affordable healthcare may be gone?

Will poor and lower-income Singaporeans still be able to have KWSH to go to in five years’ time?”