Why do Ministers provide their parliamentary replies in a manner that the public can never find out the answer?

Between 2017 and 2021, arrears by foreigners constituted less than 0.1% of the total bills issued by Public Healthcare Institutions (PHIs).

This was what the Ministry of Health, Ong Ye Kung gave as his written answer to the parliamentary questions filed by Ms Mariam Jaafar, Member of Parliament for Sembawang GRC where she asked about what is the current amount owed for medical services by foreigners on Long Term Visit Pass (LTVP) holders who are part of Singaporean households; and whether more can be done to help these Singaporean households that bear the cost of medical treatment for their foreign family members on LTVP.

Mr Ong’s reply on 5 October, stated that the figure that he gave, includes foreigners residing and working in Singapore, as well as some short-term visitors. However, the Ministry of Health (MOH) does not have data on arrears specifically for LTVP holders.

He added that Government healthcare subsidies are generally accorded to Singapore Citizens (SCs) and Permanent Residents (PRs), in line with the broader Government policy of differentiating benefits by citizenship status.

Mr Ong’s reply to Ms Mariam seems to be rather strange as it only gives a percentage of “less than 0.1%”, but no exact figures.

In this connection, revenue for SingHealth Group — one of the three healthcare clusters in Singapore — was reported as being:

• SS4.29b, for the financial year ending 31 Mar 2018
• S$5.27b, for the financial year ending 31 Mar 2019
• S$5.77b, for the financial year ending 31 Mar 2020
• S$6.12b, for the financial year ending 31 Mar 2021
• S$7.68b, for the financial year ending 31 Mar 2022.

So based on its financial year 2017/18 to 2021/22, the total revenue for SingHealth Group comes to a sum of S$29.13 billion.

There does not seem to be any mention of the revenue for the NationalHealth Group or National University Health System (NUHS), on the internet.

So, let’s assume for the sake of illustration that the two other healthcare groups have a revenue similar to SingHealth’s — which works out to an estimated total revenue of S$87.39 billion.

Does it mean 0.1% that foreigners owe for medical services of the total revenue which is assumed to be what the Health Minister meant by “total bill” of the PHIs, come to a sum of S$87.39 million?

If foreigners owed about $87 million, then how much was owed by residents (S’poreans & PRs)?

In this connection, I googled & the only information that I was able to find, was a parliamentary question filed by Non-Constituency Member of Parliament, Lina Chiam in 2012 where she asked about the total amount of monies owed by patients in restructured hospitals and what is the number of patients who owed hospital bills in respect of permanent residents and foreigners; and Singaporeans.

In response, Then Health Minister Mr Gan Kim Yong replied in a written answer, stating that more than 96% of the restructured hospital patients settle their bills within two months.

“The total arrears owed by patients that exceeded two months, on a cumulative basis, was $75 million as at end-2008 and about $110 million as at end-2011. These figures include arrears brought forward from prior years. They also include patients who are paying their outstanding bills by instalments, or are awaiting assessment for financial assistance by the hospitals. A significant part of the arrears are eventually recovered or paid up over time, but a portion will become bad debt and have to be written off. The total amount written off in FY2008, FY2009 and FY2010 was $27 million, $26 million and $37 million respectively.”

“2011 bills alone, as at end-2011, there were 136,000 bills outstanding for two months or more, translating to $48 million in total arrears. Eighty-three percent of these outstanding bills were incurred by Singaporean patients.”

The above table illustrates the answer provided by Mr Gan. You can see how hard is it to tell how much is in arrears for each particular year other than when the exact figure is given, such as the 48 million of arrears incurred in 2011 alone.

The same frustration can be found in the questions filed by former Workers’ Party MP Mr Chen Show Mao who asked how many cases of patients defaulting on medical bills in local hospitals have there been each year from 2010 to 2015.

He also asked of these defaulters, how many are Singapore citizens or permanent residents and how many are others and what was the current total amount of debt owed by such category of defaulters respectively.

Mr Gan who is still the Health Minister also replied in a written answer, saying that the majority of the patients (about 95%) in public hospitals settle their hospital bills within two months of discharge. This has remained similar over the last six years.

“Among patients with arrears outstanding for more than two months, Singapore Citizens and Permanent Residents account for about 86%. The average amount owed was around $350.”

“The equivalent figure for foreign patients was $1,400. The arrears of foreigner patients are typically larger because these patients do not receive government subsidies at our public hospitals.”

But more questions arise from Mr Gan’s answers:

• About 5 per cent of patients in public hospitals don’t settle bills within two months, but how many defaulted eventually?
• 86% of those who don’t settle bills within two months are Singaporeans and PRs, but what is the breakdown of Singaporeans and PRs? 14% who don’t settle are foreigners then?

It is highly questionable why Ministers such as the Health Ministers give answers in such convoluted manner that the figures hardly answers the questions or raise more questions at the end.

It is furthermore devious in a sense when you consider how members of public or political parties try to extrapolate the numbers so as to make sense of the numbers and then Ministers throw POFMA upon them for publishing “fake news”.

Going back to the original question of the post, if foreigners who owe an supposed amount of S$87.39 million is around 14 per cent of patients with arrears of two months or more — assuming if the value from 2015 holds true, can we therefore suggest that the unsubsidised amount charged to Singaporeans — assumed 86 per cent — who couldn’t pay to be at S$624 million between 2017 and 2021?

Arguably, shouldn’t a parliamentary question about how much Singaporeans owe on their medical bills, be asked, instead of just the amount by foreign LTVP holders?