Opinion
Margins from drugs and medical procedures to cover cost of Public hospitals?
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I refer to the Ministry of Health (MOH)’s reply “Public healthcare institutions operate on non-profit basis” and Singapore General Hospital’s reply “Our charges are comparable to most hospitals” (Straits Times Forum, Mar 24) to the two letters by Mr David Soh Poh Huat (Do public hospitals profit from medical procedures done?; March 11, and Health Ministry should step in to regulate costs; Forum Online, March 17).
In Mr Soh’s letter, he asked if the Health Ministry clarify if public hospitals profit from medical procedures carried out in the hospitals.
“For example, I understand that a positron emission tomography (PET) scan at Singapore General Hospital would cost a non-subsidised patient around $3,000, whereas undergoing one in a private hospital costs about $1,600.” wrote Mr Soh.
PHIs operate on a non-profit basis, but cover operations/overheads costs?
In its reply, MOH states, “Our public healthcare institutions (PHIs) operate on a non-profit basis. Where margins are applied, these are used to cover manpower, operations and maintenance, and overhead costs associated with the provision of specific services, drugs and investigations.”
What percent to operations/overheads costs?
So, what is the percentage of the prices for drugs that is the margin applied “to cover manpower, operations and maintenance, and overhead costs”?
“Non-profit” means not spending any money?
Does “non-profit” mean not spending any money if all costs, including operations and overheads are covered?
$25m profits?
According to the latest annual reports of the National Health and SingHealth Groups on their web sites – their combined profits (revenue – expenditure) for their last financial year was $25 million.
Any countries’ public hospitals make money?
Are there any countries in the world whose public hospitals make money every year?
Explanation as to why public hospitals may cost more than private hospitals?
The letter from SGH states,
“Whole-body scans account for more than 90 per cent of positron emission tomography (PET)-CT scans done at Singapore General Hospital. The charges for this service, with and without intravenous contrast, are $2,400 and $2,300 before GST respectively.
Our charges reflect the underlying costs of providing the service. This includes manpower, supplies and consumables, maintenance and depreciation, and other non-direct costs such as having an integrated clinical IT platform where images are digitally archived and patients’ medical records stored and made easily accessible for doctors’ consultations across all public healthcare institutions.
This ensures timely diagnosis and access to care.
Our charges are comparable to those of most other hospitals in the public and private sectors, although we note that one private PET centre charges $1,600 for some groups of patients, as stated in Mr Soh’s letter.”
Public hospital procedure cost 50% more than private hospital?
Apart from differences in the specific types of machines and sensitivity of scans, there may be differences in clinical protocols and software used, which could have an impact on longer-term management of patients with complex and multiple conditions” – this “quite long” reply seems to only reconfirm the issue raised in the forum letters as to how can the same procedure cost 50 per cent more ($2,400 divided by $1,600) in a public hospital compared to a private hospital?
Patients can discuss & choose where they prefer to scan?
In SGH’s letter, it was stated that various healthcare providers may also have different pricing strategies and patients can discuss with their doctors the appropriateness of any scan and decide where they prefer to get the scan done.
Do you mean that the doctors at the public hospitals have ever told patients routinely as to the “different pricing” by “various providers” and ask them to “decide where they prefer to get the scan done”?
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Opinion
Means testing or Mean Testing? Are Singapore’s housing grants unfair to middle-income families?
Singapore’s public housing system is often praised for affordability, yet the disparity in housing grants raises questions. Middle-income families face steep declines in grants as incomes rise, receiving far less support than lower-income groups for BTO flats.
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Singapore’s public housing system is often lauded as a model of efficiency and affordability. However, when it comes to housing grants, particularly for the middle-income group, one cannot help but question whether the current system is truly fair.
The disparity in grants between different income groups, especially those buying Build-To-Order (BTO) flats versus resale flats, raises concerns about whether the middle-income segment is being systematically disadvantaged.
The Middle-Income Squeeze
The Enhanced CPF Housing Grant (EHG) is structured in a way that gradually decreases the grant amount as household income increases. While this might seem equitable on the surface, the steep reduction in grants for households earning between S$4,000 and S$9,000 reveals a deeper issue. These middle-income families receive significantly less support despite still facing substantial housing costs.
For instance, a family with a monthly household income of S$1,500 can receive up to S$120,000 in EHG, making a substantial difference in affordability. However, as income rises, the grant amount rapidly declines. A family earning S$5,000 receives just S$65,000—nearly half of what lower-income families receive. For those earning between S$8,501 and S$9,000, the grant amount is reduced to a mere S$5,000.
According to the Singapore Department of Statistics, among resident-employed households, the median monthly household income from work (excluding employer CPF contributions) grew by 10.8 per cent in nominal terms, from S$8,904 in 2022 to S$9,646 in 2023. This places the middle-income range squarely within the median income bracket, yet these families continue to receive significantly less support through housing grants.
This “middle-income squeeze” leaves families in this income bracket in a precarious position. They earn too much to qualify for substantial grants but not enough to comfortably afford rising housing costs, particularly in a high-cost city like Singapore.
The disparity in grant amounts becomes even more glaring when considering that these middle-income families, while receiving minimal grants for BTO flats, could potentially receive up to S$110,000 in grants if the family that doesn’t exceed S$14,000 in household income opts for a resale flat instead.
This discrepancy suggests that the current grant structure may be inadvertently favouring wealthier households.
The Unfairness of “Means Testing”
The term “means testing” is often used to justify such disparities, suggesting that those with higher incomes should receive fewer subsidies.
However, this principle seems to be turned on its head when it comes to housing grants. Why is it that those who can afford to buy more expensive resale flats are receiving significantly more grants than those opting for BTO flats, which are typically seen as more affordable options?
Consider a household with an income of S$9,001 to S$14,000. If they decide to purchase a resale flat, they can receive up to S$110,000 in housing grants, comprising the CPF Housing Grant (CHG) of S$80,000 and the Proximity Housing Grant (PHG) of S$30,000. On the other hand, if the same household opts for a BTO flat, they would receive no grants at all.
This stark contrast highlights a troubling aspect of the current system: higher-income households buying resale flats are awarded significantly more government support than those purchasing BTO flats, which are meant to be the more affordable and accessible option for Singaporeans.
One particularly puzzling aspect of the current grant system is the Proximity Housing Grant (PHG) and the CPF Housing Grant (CHG), which are only available for those buying resale flats.
The government promotes the PHG as a way to encourage families to stay close together and support each other across generations, yet it is unclear why this grant, along with the CHG, is not extended to those purchasing BTO flats. The absence of these grants for BTO buyers adds to the sense of inequity.
In this context, the system appears less like “means testing” and more like “mean testing,” where middle-income families are left with fewer resources to purchase their homes. This approach not only places a heavier financial burden on these families but also raises questions about the equity of the entire housing grant system.
The Consequence of the Sliding Scale and Loan Restrictions
The sliding scale of the EHG, while intended to provide more support to those with lower incomes, inadvertently penalizes middle-income families who do not qualify for sufficient grants yet face the same challenges of homeownership.
For example, a family earning S$9,000 receives just S$5,000 in grants—a negligible amount compared to the S$110,000 a resale flat buyer in the same income bracket might receive through other grant combinations.
Adding to this burden, the recent tightening of the HDB loan-to-value (LTV) limit to 75% further complicates the situation for middle-income families.
With a lower LTV ratio, these families now have to come up with a larger downpayment, which is particularly challenging given the reduced grant amounts. This combination of lower grants and higher upfront costs places middle-income households at a significant disadvantage, making it more difficult for them to finance their homes.
Reverse Means Testing?
Arguably, the system as it stands resembles a form of “reverse means testing,” where wealthier families benefit more from government subsidies than their lower-income counterparts.
A family with a household income of S$9,001 receives no grant if they purchase a BTO flat, yet the same family could receive up to S$110,000 in grants if they choose a resale flat—provided they can afford the cash for the downpayment, which can run into hundreds of thousands of dollars in the resale market. This discrepancy suggests that the current grant structure may inadvertently favour those who are better off at the expense of those who are less financially secure.
The intent behind Singapore’s housing grants is to make homeownership more accessible and affordable, but the current system seems to fall short of this goal for middle-income families, with the distorted public housing system being patched up with grants and subsidies.
The significant disparity in grant amounts between BTO and resale flats, coupled with the exclusion of the PHG and CHG for BTO buyers, raises serious questions about the fairness of the system. The added pressure from the tightened LTV limits only exacerbates the financial burden on these households, making it even harder for them to achieve affordable homeownership.
As Singapore continues to refine its public housing policies, it is crucial that the needs of middle-income families are not overlooked.
These families, who are often squeezed between the lower-income groups that receive more substantial support and the higher-income groups that can afford private housing or resale flats, deserve a fairer share of the pie.
It is perhaps time to re-evaluate the current grant system to ensure that it truly supports all Singaporeans in their journey to homeownership rather than disadvantaging those in the middle of the BTO market.
Opinion
Singaporean voters and the ‘Battered Wife Syndrome’
Opinion: Singaporean voters, much like an abused spouse, remain trapped in a cycle of political dependence and fear. Clinging to the memory of a once-transformative party, they endure empty promises, fearing chaos without the People’s Action Party despite viable alternatives.
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In every election, a significant portion of Singaporean voters return to the ballot box and, with a trembling hand, check the box for the People’s Action Party (PAP).
It’s a ritual that has been repeated for decades, much like the pattern seen in those suffering from Battered Woman Syndrome, a psychological condition identified as a type of posttraumatic stress disorder (PTSD).
Coined by psychologist Lenore Walker, EdD, in her groundbreaking 1979 book The Battered Woman, this syndrome explains the psychological effects of living with prolonged trauma, particularly intimate partner violence.
While not classified as a mental illness itself, the syndrome often leads to PTSD, which is considered a mental illness. The cycle of abuse involves tension building, violent outbursts, apologies, promises to change, and the inevitable return to violence—a vicious cycle of control, manipulation, and fear.
The comparison may seem stark, but it bears relevance to the political experience of many Singaporeans. Like those suffering from Battered Woman Syndrome, they remain trapped in a cycle of political dependence, clinging to the hope that things might one day change.
Yet, election after election, they find themselves voting for the PAP, a party that bears little resemblance to the one that once led Singapore to prosperity.
The PAP of the past, under the leadership of the late Lee Kuan Yew and his contemporaries, was a transformative force.
This generation brought post-independence Singapore from a colonial port city to a global economic powerhouse, earning its citizens’ trust and loyalty. However, those leaders are long gone, and the party today operates in a very different context, with a new set of leaders, policies, and priorities.
As Lee Kuan Yew’s younger son, Lee Hsien Yang, once said, “Today’s PAP is no longer the PAP of my father. It has lost its way.”
Yet, like someone suffering from Battered Woman Syndrome, many Singaporeans continue to vote for the PAP, holding on to the memory of a party that no longer exists. They cling to the hope that this time, things might be different—that the promises made will be kept, and the “abuses” will stop.
But election after election, the reality hits hard: the promises to improve lives and provide support during challenging times remain unfulfilled, especially as the cost of living escalates and homeownership and retirement concerns grow due to policies like tax hikes—only temporarily relieved by measures (carrots) such as GST and CDC vouchers, which some see as a euphemism for food stamps. The relationship between the people and the party remains toxic, and in some ways, worsens over time.
In this analogy, the “abuse” is not physical but political and emotional. It manifests in the erosion of freedoms, the lack of genuine political competition, and the paternalistic attitude that suggests Singaporeans cannot be trusted to make decisions for themselves.
The cycle of control mirrors Walker’s description of Battered Woman Syndrome: tension builds, dissatisfaction grows, and yet, the same promises are made over and over with no real change.
Many voters, much like those trapped in abusive relationships, have been conditioned to believe that without the PAP, the country would fall into chaos, that their livelihoods would be at risk, and that alternatives are too dangerous or incompetent to consider.
This is where the PAP’s control turns into coercive control—a key feature of Battered Woman Syndrome. The party retains control over public discourse, media narratives, and financial policies, limiting the scope for political alternatives and isolating citizens from opposing viewpoints.
The manipulation doesn’t stop at control; it extends to gaslighting as well.
Like an abusive partner, the PAP continues to undermine its “spouse’s” confidence, telling Singaporeans that they are nothing without the party—creating crises through policies and media control, all while using taxpayers’ money to maintain that grip.
The party insists that only the PAP is qualified to govern while portraying those who offer a different vision for the country as untrustworthy or incompetent, even when evidence suggests otherwise. Much like an abuser convincing their partner that they are incapable of surviving alone, the PAP perpetuates the myth that Singapore would crumble without its leadership, despite having a world-class civil service capable of running on its own.
This gaslighting leaves many voters doubting their own judgment.
But here’s the truth that so many fail to see: Singapore, much like someone suffering from Battered Woman Syndrome, has options.
There are opposition parties that offer different visions for the country, leaders who are ready to step up and serve with integrity. However, even when presented with viable alternatives—opposition parties with clear policies and capable leaders—Singaporeans continue to cling to the familiar, fearful of the unknown.
The continued loyalty to the PAP, despite the abuses, is not a sign of strength or wisdom but of fear and conditioning—an unhealthy relationship where the victim has been made to believe they cannot survive on their own.
A key element in this perceived manipulation is the role of state media, such as Straits Times and Channel News Asia, which is heavily funded by taxpayers’ money—directly and indirectly.
For instance, the recent allocation of S$900 million to SPH Media Trust has raised concerns among some observers who view it as an extension of the ruling party’s influence over public discourse.
While the government has justified this funding as necessary to support media outreach and improve journalistic quality, critics argue that such funding can blur the lines for media outlets and raise concerns about potential bias. This can leave citizens unsure of what to trust, making it difficult to distinguish between factual reporting, opinion, or sheer propaganda.
Furthermore, it appears that the alienation of independent media voices may be another tactic used to maintain control.
The Online Citizen (TOC) was effectively forced out of Singapore after being required to reveal the details of its subscribers, and its financial lifelines were impacted by declarations of POFMA Declared Online Locations—possibly as part of an effort to silence independent voices that challenge the government and fact-check the narratives pushed by state-controlled media.
These actions would appear as attempts to remove dissenting opinions and limit the public’s access to alternative perspectives, seeking to reinforce the perception that the PAP is the only viable option, casting doubt on opposition parties and alternative views.
In any case, the public is left with little room to critically evaluate the realities of governance as state-controlled media continues to frame dissent as dangerous or uninformed.
Holding on to a past that no longer exists only perpetuates the suffering.
It’s time for voters to take a hard look at their options, especially in light of the upcoming General Election and the underwhelming performance of the 4G leadership in the PAP. Voters must weigh the promises against the reality, and make a choice that reflects their true interests and aspirations.
Like a battered woman who finally finds the courage to leave, Singaporean voters must find the strength to vote for change.
The path may be uncertain, and the fear of the unknown is real, but continuing to suffer under the illusion of security is far worse. Singapore deserves better, and so do its people.
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