Wednesday, January 21, 2009

Singapore faces the abyss and what I can do about it!

January 21, 2009
Singapore faces devastating exodus of foreigners
Leo Lewis, Asia Business Correspondent
From Times Online

Singapore faces an exodus of 200,000 foreigners as the financial services and manufacturing industries scythe through their workforces and the city-state grinds towards the worst recession in its 43-year history.

The expected exodus, predict analysts at Credit Suisse, could see the number of people living in the tiny but economically powerful island shrink more than 3 per cent to just 4.68 million by 2010 in a shift that would severely undermine the government’s 22-year efforts to boost the population through immigration.

A broad rule of thumb, said analysts at UBS in Singapore, is that nearly every new job created over the last few years went to a foreigner. The economic policies of the city state have overtly relied on its ability to attract talent and skills from abroad.

The departure of thousands of ex-pat bankers, lawyers and accountants between now and 2010 is expected to lead a secondary exodus of manufacturing, construction and service sector foreign workers.

Job losses will hit Singapore hard, said Credit Suisse economist Cem Karacadag, “because they affect more highly paid workers and could result in a semi-permanent drip in the population”. He added that the potential drop “would have far-reaching implications for the economy” including a possible sharp contraction in private consumption.

The knock-on effects of a Singapore exodus, some real estate analysts believe, could also see property prices fall by as much as 30 per cent from their current levels.

Credit Suisse’s grim population forecast comes amid warnings that among non-Japan Asian countries, Singapore’s open economy may be hit hardest by the global downturn. Consumption growth, said the report, could fall to almost zero.

Analysts at believe that the country’s GDP may contract by 2.8 per cent in 2009 as rising unemployment hammers domestic growth and the collapse of consumer confidence around the world hits exports.

Mr Karacadag raised a further red flag for Singapore’s economy by warning that there was a risk that forecasts were still underestimating the effects of a broad Asian downturn and further terrible news from the financial sector.

Singapore – the world’s busiest port by tonnage handled and the home of some of the world’s largest shipping companies - is already feeling the pain of an alarming slump in global trade.

With the credit crunch still affecting trade finance and the demand for Asian manufactured goods in acute decline, hundreds of container and dry-bulk ships now sit unneeded and at anchor outside Singapore. The stagnation, say brokers, is matched onshore.

In tandem with the warnings over a possible population crunch, concerns are growing among investors over the health of Singapore’s domestic banks. The “benign asset quality” environment in which Singapore banks have thrived, say analysts, has now reached an inflection point.

The ratio of non- performing loans is expected to rise sharply as the construction boom that has filled the Singapore skyline with towers and cranes begins to deflate.

Between 2003 and 2008, the population of the city state soared nearly 18 per cent in an increase driven predominantly by foreigners hired to meet Singapore’s endemic shortage of workers during the good times.

When global trade, investment banking and Asian stock markets were booming, Singapore successfully fashioned itself as a financial hub to rival Tokyo and Hong Kong and the expatriates flooded in – around 200,000 jobs were created in the financial and business services sector over the last four years.

A large number of jobs are expected to be lost in manufacturing, which accounts for about a quarter of Singapore’s GDP.

My comments:

Hi friends,

The article above makes grim reading.

On a first glance of the title, my initial response was,”So what’s so devastating about foreigners leaving?”

In my naiveté, I thought that Singaporeans (especially the lower income group) would benefit from less competition for jobs.

How wrong and how stupid I was as a more careful examination of the author’s analysis show that the exodus of all strata of foreigners will have profound implications to our GDP.

As anyone who has a rudimentary knowledge of Economics will tell you that in an open economy,

Gross Domestic Product (GDP) =C+G+I+X-M (read here)

C=Private consumption
G=Government spending

The author,Lewis, thinks, and I do not think anyone will disagree, that Singapore’s C, I and X will fall. I am also sure that although M will fall but it will be to a lesser extent than X, hence leading to smaller net export (X-M).

It is a given that no matter how much G (the last component) will be (and I wait with bated breath for Tharman’s budget speech on Friday 23 Jan 09 ), GDP growth will be negative ( duh?!).

Tax breaks there undoubtedly will be (eg decreased income/property tax) and these breaks would leave more money in the consumer’s pockets who, hopefully, will have less reason not to spend. Just as importantly, tax breaks will also lead to less companies turning “turtle up” or having to lay off workers.

I know many were cynical when SM Goh Chok Tong mentioned the “Paradox of thrift” and encouraged those who could afford to spend. In the coffeeshops, many were saying," Of course it's easy for SM to spend as he has million-dollar salary" etc . But he was just alluding to a Keynesian truism that is taught to all economics students. (read here)

Personally, I try not to be too miserly and do try to support small traders and shopkeepers.For example, I bought some "ba chang" dumplings and Meat “paus” yesterday even though I was not hungry (and was trying desperately and with little success to get back my BMI (Body Mass Index) below 27 much less the recommended 23!). (read here)

The elderly man and middle-aged woman from these 2 adjacent stalls were really looking forlorn and despondent. I didn’t think my few dollars would make their day but still, I think every bit helps. I have a soft spot for underdogs (as many of you would have surmised by now). I am also a chaser of lost causes - so be forewarned if you need my support for any worthy causes.

So guys (and gals), let us survive this recession together.

Keep your chins up. Keep your jobs (if possible). Spend ( if you can afford it).


Dr.Huang Shoou Chyuan

Friday, January 16, 2009

To Jeremy

Hi Friends,

I am sincerely happy for Jeremy Tan and his parents. ( see Breaking News on Family Wins Suit)

Jeremy and parents have endured too much!

Mindef should not appeal the judgement.

Mindef should do serious soul searching.

Whose decision was it to avoid compensation for Jeremy's injuries? -the injuries that Justice Tay Yong Kwang ruled were 'attributable to service' and hence "entitled to a payout".

Heads must roll. Singapore has been shamed!

Dr.Huang Shoou Chyuan

PS: I have a message for Jeremy and his parents.

To Jeremy:

Jeremy, if you ever get to read this- get well soon, pal! Almost the whole of Singapore has been rooting for you.

You have done more than your share for Singapore.

Even though she has failed you miserably and does not deserve your sacrifice!

Singapore's Mindef has shamelessly tried to evade its responsibility to one of its own sons.

Jeremy,you may be just a storeman- one that seldom attracts much attention except from your superiors- but usually for all the wrong reasons!

Forgive them-they do not know who you really are.

To Mindef, you are just a digit to be deployed- to fill an Orbat chart.

But to your parents and friends, you are a human being. A son and buddy.

You once harboured such high hopes that now seem mere illusions.

Despite what you have gone through, please know that not all of Singapore is bad. Not all of Singapore are like those who you now rightly hate.

Don’t give up hope for yourself. Don’t give up hope for Singapore.

From a Friend.

Family Wins Suit ( Straits Times online 16.1.09) Selina Lum

THE parents of a former full-time national serviceman, comatose for more than three years after an incident in camp, have won their lawsuit against the Defence Ministry.

The High Court decision paves the way for the family of Jeremy Tan, now 26, to seek disability compensation and medical benefits from Mindef.

On Aug 3, 2005, Mr Tan, then a corporal rostered as duty storeman at Seletar East Camp, was found unconscious at the foot of a building where his bunk was located on the third-level.
The ministry classified Mr Tan's injuries as non-service related and stopped paying for his medical treatment at Tan Tock Seng Hospital from March 2007.

But Justice Tay Yong Kwang ruled at the end of a four-day hearing that Mr Tan's injuries were 'attributable to service' and he was therefore entitled to a payout.

The case hinged on the interpretation of a provision in the Singapore Armed Forces (Pensions) Regulations, which provides for payouts to disabled servicemen.

Lawyer Lau Teik Soon, acting for Mr Tan's parents, argued that when he was found with injuries at 6pm, Mr Tan's tour of duty had not ended.

But government lawyers argued that even though Mr Tan was performing his national service, he was not doing anything related to his duty at the time. He was not at his place of duty and was last seen resting in his bunk.

But Justice Tay said that the words 'attributable to service' can cover injuries caused while a serviceman is on standby duty and was not doing any particular work.

Thursday, January 15, 2009

Will my country just do the Right Thing?

Hi Friends,
A letter to the editor about a general non-specific topic!

Dear editor,

Re:Doing the Right Thing!

I am not referring to any case that is before our courts for that would constitute “sub judice” and anyone making inappropriate public comments may be deemed to be guilty of contempt of court.

With hand on heart, I feel that it is an honour for any young man to serve his country especially in the prime of his youth. I have done it and many who came before and after me did too!

On the same token, Singapore should feel honored to help or compensate adequately any person who has suffered as a direct or indirect result of this service.

There should be no splitting of hairs and the resorting to fine prints about what does or does not constitute actual service.

For the sakes of all our fine young men past, present and future, will Singapore just do the Right Thing!

Thank you

Dr.Huang Shoou Chyuan

Tuesday, January 13, 2009

Suggestions to improve specialist healthcare to subsidised patients

Hi friends,

I have written to the forum page with copy to Ministry of Health on how delivery of specialist healthcare for subsidised patients can be improved.
(It has been printed in one paper and MOH has also replied- see below)

Being from the private specialist sector, this letter is from that perspective. Some parts of the letter gets a bit "deep" and involved. I apologise for that.

Private specialists have taken flak ( and deservedly so) for being aloof and being far removed from the masses who are suffering and have difficulty in making ends meet.

Despite this, I feel that the Public (govt) and Private healthcare sectors can work together to better serve all Singaporeans.

Yes, there are many doctors ( not just in private sector) who may have forgotten their Hippocratic oath.

However, I do know many private specialists who have big hearts ( and I am proud to call them "friend" )and who treat poorer patients at reduced rates ( or even waive charges). Sometimes we put on leotards and become Robin Hoods.

We in private practice, often try to find ways to beat the Private hospital system in order to reduce patients' charges. The more obvious means include pleading with the hospital for discounts ( for patients) or even going to cheaper hospitals. Other ways cannot be divulged publicly.

Private specialists are human too- Most of us chose private practice for Work-Life Balance or just could not take the "office politics"anymore. Of course the money (usually) was not too bad also.

Dr. Lee Wei Ling has already mentioned some of the shameful acts of the Black Sheep of the profession. As a fellow doctor, I fully agree with what she has said ( on most things).


Dr.Huang Shoou Chyuan

The Letter to the Forum page ( cc MOH)

Dear editor,

Re:Enhancement of Public Private Partnership (PPP) in Singapore’s healthcare

I would like the Ministry of Health to consider expanding the partnership between the public and private healthcare to include specialist care in addition to primary healthcare (family medicine).

1.The present situation

From 1st January 2009, General Practitioners (GP) were roped in to see mainly needy elderly patients who were Community Medical Benefit (CMB) cardholders or Public Assistance (PA) scheme cardholders. This highly innovative scheme (called Primary Care Partnership Scheme- PCPS) is popular as it allows patients to be seen by their neighbourhood GP’s who receive similar or equivalent subvention from the government as when these patients go to the polyclinic. The patients co-pay either by cash or from the Medisave accounts (subject to caps).

Acute conditions (eg coughs and colds) and 3 chronic medical conditions viz.Diabetes Mellitus, Hypertension and Lipid disorders, are included in the PCPS.

Although Singapore’s healthcare has a well-deserved reputation for being of a high standard, there are gaps in the delivery of specialist care for subsidised patients. These are the patients referred by the polyclinics and (from Jan 2009) the PCPS-GP’s.

The main bugbear is the long waiting time to get an appointment at the government specialist clinics (eg SGH/NUH etc) which in turn translates to overworked specialist doctors who may not be able to provide optimal patient care.

2.My suggestion to plug the gaps in specialist care delivery

I advocate an expansion of the system to include private specialists and to expand the patient pool to include not just CMB and PA cardholders seen by PCPS-GP’s but also all polyclinic-referred patients.

These patients, when they have complicated conditions requiring specialised care, would have been referred to government hospitals where they will be seen by specialists.

However, when the specialist clinics have filled up all appointment slots and these patients cannot be seen by the recommended waiting time, my suggestion is that these patients be channelled to those private specialists who are willing to see them at subsidised rates.

For this to work, the government should ( as in PCPS) continue to pay similar or equivalent subvention ( with reasonable addition for different cost structure in private practice). This could even be made to work in private hospitals when these patients need surgery or other institutional care. Co-payment is as per the PCPS.

3.Benefits of PPP for specialist care

There are many benefits for considering this Public-Private-Partnership (PPP) for the whole chain of healthcare delivery in Singapore.

i.All patients (be they subsidised and non-subsidised) will get timely and optimal care from both primary care doctors or specialists.

ii.Specialists in government hospitals will have more time for teaching medical students and trainee specialists and for treating more sophisticated “tertiary-care” cases.

iii.There is no increased government spending as subvention remains almost similar. In fact less government hospitals may need to be built in the future.

iv.Allows private specialists to better participate in the treatment of all classes of Singaporeans. Believe it or not, most doctors (even private specialists) perceive Medicine as a calling and not as a way of “getting rich” .

For sure, all stakeholders in Singapore healthcare will need a paradigm shift in mindsets so that all ( esply needy Singaporeans) can benefit from this mini healthcare revolution.

Getting a pool of willing private doctors in each specialty and getting private hospitals to participate in the scheme should not be too difficult in view of the dire economic climate and the impending glut of private hospital beds in the near future.

Perhaps the government hospitals should remain gatekeepers and the system can be implemented in stages with close monitoring to prevent abuses.

Needless to say, private specialists who only want to cater to select class of patients need not apply.

Yours Sincerely,

Dr.Huang Shoou Chyuan

Addendum (14.1.09) 4.50pm: Reply from MOH

Dr. Huang:In essence, MOH ( or Alxxx who represents it ) said, " Ya, sure" but in 98 words!

So here goes ( for those who enjoy standard bureaucratic "cut and paste" answers).

I wonder if this letter even got past the first guy who read it? Am I just wasting my time and energy trying to write a succint and cogent piece about how the system can be improved?


Oh- BTW, one paper has printed the letter, one rejected it and one has not said anything (yet).

Reply from MOH (Reply - PQ-09-000116):

Dear Dr Huang,

We refer to your suggestion to include interested private specialists under the PCPS.

As you are aware, GPs are able to refer patients who require specialist care to the restructured hospitals' specialist outpatient clinics (SOCs) under the current PCPS.

Although there are no plans to involve the private specialists at this point in time, we are definitely open to explore such collaborations in the future when the need arises and we would hope to garner your support then.

Thank you for your suggestion.

Yours sincerely,

Alxxx Hx
for Quality Service Manager
Ministry of Health,