Singapore

About 10,000 years ago, sea levels in Singapore were at least 20m lower than today.

But with the ice age coming to an end, melting land ice fuelled the oceans and sea levels rose over the next three millennia.

Eventually, rising waters flooded and killed a mangrove forest along Singapore’s southern coast, according to a new study by climate scientists at the Republic’s leading Nanyang Technological University (NTU).

On June 4, their findings were published in the scientific journal The Holocene. They offer insight into how rising sea levels at present could impact the country in the years to come – especially when the accelerating rate of sea-level rise due to human activity is taken into consideration.

Researchers found that from 10,000 to 5,000 years ago, sea levels were rising at rates as high as 10mm to 15mm a year.

Sea-level data for the subsequent two millennia is patchy and NTU researchers are looking to fill the gaps.

Preliminary data, however, indicates that modern sea levels were reached about 3,000 years ago and remained relatively constant until the start of the Industrial Revolution in the 18th century.

In the 20th century, a warming planet due to human emissions caused sea levels to rise 1mm to 2mm a year as water expands when heated.

Today, the rate is between 3mm and 4mm a year – thermal expansion is still happening but land ice is also melting faster.

Scientists say sea levels would only rise faster, as mankind continues to burn fossil fuels and fell forests, putting more and more heat-trapping gases into the atmosphere.

Study lead author Stephen Chua, who did the research as part of his doctoral work at NTU’s Earth Observatory of Singapore and the Asian School of the Environment (ASE), said understanding how sea levels have changed in Singapore could lead to more robust and accurate local projection of sea-level rise.

A better understanding of the fluctuations will help scientists here come up with models that can more accurately predict sea-level rise in this part of the world instead of relying on global forecasts.

Dr Chua added: “The study offers a strategic insight for Singapore as it moves to adapt to climate change.”

Looking back to look ahead

To figure out what sea levels were like all those years ago, the researchers had to dig deep into the earth.

They looked through thousands of available borehole logs – records of holes that have been drilled into the ground for infrastructure projects – to find an area with deposits such as marine mud and mangrove peats.

Such deposits accrete, or accumulate, layer by layer and contain pollen and microfossils of foraminifera – tiny organisms found in marine environments.

Their presence can help researchers determine how sea levels have fluctuated in Singapore.

For instance, the presence of foraminifera in one part of the core indicates that seawater had likely inundated the area then. On the other hand, if pollen from trees is found in another segment of the core, it could mean seawater did not extend that far inland at that point.

Radiocarbon dating – a technique also used by archaeologists – can be used to determine the exact age of the deposits.

The climate scientists at NTU discovered abundant mangrove pollen 20m below the current sea level, indicating that a mangrove shoreline existed in southern Singapore almost 10,000 years ago.

The findings show the limitations of using mangroves as a nature-based solution to keep out the rising tides, according to the researchers.

Because the complex root systems of mangrove trees can trap sediment from the tides as they ebb and flow, they can, to an extent, keep pace with sea-level rise and are considered a natural defence against rising waters.

Despite mangroves’ adaptability and effectiveness as a coastal defence, the study highlights their limitations in the event of rapid sea-level rise, said the NTU researchers in a statement.

Professor Philip Gibbard, a geologist from the Scott Polar Research Institute at the University of Cambridge who was not involved in the study, said sea-level records from places far from the ice sheets were important, as the processes driving sea-level changes in such areas would be different from the processes nearer to the poles.

“This important contribution from Singapore and the region provides a valuable record… This record can then be further refined as more studies become available in the future,” he said.

This story, provided by The Straits Times, has been shared as part of World News Day 2021, a global campaign to highlight the critical role of fact-based journalism in providing trustworthy news and information in service of humanity. #JournalismMatters.

The Intergovernmental Panel on Climate Change warns humans are unequivocally warming the planet, and that is triggering rapid changes in the atmosphere, oceans, and polar regions, and increasing extreme weather around the world.

The IPCC released the Sixth Assessment Report on August 9th, 2021. The report from 234 scientists from around the globe summarized the current climate research on how the Earth is changing as temperatures rise and the impacts for the future. I was one of these scientists.

The facts about climate change have been clear for a long time, with the evidence just continuing to grow. The warning signs of climate change have been clear over the last decade, with each new emergency topping its precedent.

The earth as we know it has become radically altered by our misuse of fossil fuels and natural resources. Our lives and livelihoods are in danger of forever suffering from the consequence of our own actions.

Global temperatures are rising, producing more droughts and wildfires, increasing the intensity of storms, causing catastrophic flooding, and raising sea levels.

Rising seas increase the vulnerability of cities and the associated infrastructure that line many coastlines around the world because of flooding, erosion, destruction of coastal ecosystems and contamination of surface and ground waters.

Future sea-level rise will affect every coastal nation. But in the coming decades, the greatest effects will be felt in Asia, due to the number of people living in the continent’s low-lying coastal areas. Mainland China, Bangladesh, India, Vietnam, Indonesia, and Thailand are home to the most people on land projected to be below average annual coastal flood levels by 2050. Together, those six nations account for roughly 75% of the 300 million people on land facing the same vulnerability at mid-century.

Global sea level is rising at a rate unmatched for at least thousands of years.

Global sea level is rising primarily because global temperatures are rising, causing ocean water to expand and land ice to melt. About a third of its current rise comes from thermal expansion — when water grows in volume as it warms. The rest comes from the melting of ice on land.

In the 20th century the melting has been mostly limited to mountain glaciers, but the big concern for the future is the melting of giant ice sheets in Greenland and Antarctica. If all the ice in Greenland melted, it would raise global sea levels by seven metres.

Antarctica is the existential threat to coastal nations. It is twice the size of Australia (over 20,000 times the size of Singapore!), two to three kilometres thick, and has enough water to raise sea levels by 65 metres. That is more than the height of the Singapore Art Science Museum and the Super Tree of Gardens by the Bay. If just a few per cent of the Antarctic ice sheet were to melt, it would cause devastating impacts.

Ominously, satellite-based measurements of the Greenland and Antarctic ice sheets show that this melting is accelerating. Greenland is now the biggest contributor to global sea-level rise. Greenland went from dumping only about 51 billion tonnes of ice into the ocean between 1980 and 1990, to losing 286 billion tonnes between 2010 and 2018.

That is a staggering 76 trillion gallons of water added to the ocean each year, which is equivalent to 114 million Olympic-size swimming pools.

Sea-level rise through 2050 is fixed.  Regardless of how quickly nations can lower emissions, the world is looking at about 15 to 30 centimeters of sea-level rise through the middle of the century due to the long timescales response of the oceans and ice sheets to warming. Sea-level rise is expected to continue slowly for centuries, even under a stable climate. This so-called ‘commitment to sea-level rise’ leads to a long-term obligation to adapt to sea-level rise, which coastal policy and practice is only just beginning to recognize.

Beyond 2050, sea-level rise becomes increasingly susceptible to the world’s emissions choices. If countries choose to continue their current paths, greenhouse gas emissions will likely bring 3 to 4 C of warming by 2100, and sea level rise of up to 1 meter. 

Under the most extreme emissions scenario, rapid ice sheet loss from Greenland and Antarctica is possible leading to sea level rise approaching 2 meters by the end of this century. At this point sea-level rise is not an existential threat but a reality to coastal nations such as Singapore.

But there is hope to survive sea-level rise.

The IPCC report has shown a growing understanding of the causes of climate change and their solutions. 

A 2 C warmer world, consistent with the Paris Agreement, would see lower sea level rise, most likely about half a meter by 2100.

What’s more, if the more the world limits its greenhouse gas emissions, the chance of triggering rapid ice sheet loss from Greenland and Antarctica is much lower.

But time is running out to meet the ambitious goal laid out in Paris Agreement to limit warming to well below 2 degrees Celsius above pre-industrial levels. 

We must hold our elected official accountable to the promises they have made on climate change. Indeed, we may require reductions far more than those that have been pledged by nations in the run up to COP26, the United Nations climate summit to be held in Glasgow in November.

Fortunately, attitudes across the world towards climate change have shifted in the last decade. Where once there was ignorance, inattention, and disbelief about climate change, now there is concern. 

Individually, rather than depriving ourselves, we should instead be adding to our lives to contribute to the fight to tackle the climate emergency. These can include things like volunteering, activism, and spreading awareness to other people about the effects that climate change can have on our lives. All these positive solutions coupled with attempting to live a more sustainable life, can make all the difference.

Technological advances are also a cause for hope. Solar and wind energy and battery technology are now far cheaper, and their efficiency is getting better and better. New technologies, including artificial intelligence, now also offer the prospect of huge improvements in the energy efficiency of transport systems, building operations, manufacturing processes and food production. 

Ways to remove carbon dioxide from the atmosphere also offer hope, not only of reaching net zero, but in eventually reversing climate change.  

The planet’s oceans, forests and grasslands take up huge quantities of carbon dioxide through photosynthesis, much of which is stored in plants or in the soil, creating major global carbon sinks.  

By preserving and expanding forests, these sinks could be made larger.  Taking greater care of oceans and land is not only important for preserving biodiversity but is also a key part of climate change mitigation. 

I believe that, for all the challenges that we face, climate change is the one that will define the contours of this century more dramatically perhaps than the others.

Surviving sea-level rise is going to change our lives; it is going to change the way we regard ourselves on the planet; it will lead to a happier, more equitable way of life for all of humankind. 

Only then can we leave behind a world that is worthy of our children, where there is reduced conflict and greater cooperation – a world marked not by human suffering, but by human progress.

This story, written by Professor Benjamin P. Horton, Director of the Earth Observatory of Singapore, Nanyang Technological University, has been shared as part of World News Day 2021, a global campaign to highlight the critical role of fact-based journalism in providing trustworthy news and information in service of humanity. #JournalismMatters.

Click here to see the original story.

SINGAPORE — Since she was five, Ms Kelly Kanaga, 30, and her family moved from one place to another for a roof over their heads before they got a rental flat of their own a year ago.

When she heard about the plight of Malaysian workers sleeping rough near Kranji MRT Station after a nationwide lockdown in their country in March, she did not think twice about opening her home to strangers even though it was already cramped.

Ms Kanaga was among many Singaporeans who offered their homes for free as temporary shelters.

“For many years, after my family lost our home, we would stay at people’s homes, so I know how it feels to be in their position,” said the full-time content creator, who lives with her mother and two siblings in a three-room Housing and Development Board flat in Marsiling.

TODAY reported on the Malaysian workers sleeping rough near Kranji MRT Station after the Malaysian border closure — which took effect on March 18 to tackle the Covid-19 outbreak — left them scrambling for shelter. These workers usually commute daily.

The report garnered more than 116,000 shares and an outpouring of support from Singaporeans, who offered to house Malaysian workers in their homes, or provide them with food and blankets.

Ms Kanaga said she took in two workers who work as cleaners at her sister’s office, providing them with mattresses in her living room for two months.

One of them, Ms Kasturi Karpanan, 48, was at her wits’ end trying to find a place before the offer from Ms Kanaga and her sister.

The mother of four children aged 13 to 23 was away from her family in Kulai, Johor, for the first time, so she could keep working in Singapore.

Alone here, Ms Karpanan said she never expected such hospitality from Ms Kanaga’s family. They went grocery shopping occasionally and she even appeared in an episode of a show Ms Kanaga has on YouTube.

“They spent a lot of money on me over the two months. They bought me a pillow and clothes, and refused to take a single cent.

“I didn’t feel like I was living in a stranger’s house at all… It was like living with family,” she said.

After a tip-off by activist Gilbert Goh, TODAY went to Kranji MRT Station on March 19 at about 9.30pm.

The first sign of the homeless Malaysians was warehouse storekeeper Armel Sharil, who was leaning on the station’s metal gates, his face buried between his legs.

Mr Armel had only his wallet, a phone with no internet access, a portable charger, a small tub of hair wax and mouthwash with him. He had no time to pack more belongings before the lockdown.

He was hesitant to share his story at first, but when he did, many followed suit as they wanted their stories told.

TODAY’s reporter and photographer stayed at the station till almost 2am approaching worker after worker, although some refused to talk and many were already snoring.

IMPACT ON COMMUNITY

The Ministry of Manpower said 14 workers were picked up from the station later in the night and taken to a temporary relief centre in Jurong East managed by the Ministry of Social and Family Development.

A check at the station by TODAY the next evening found no Malaysian workers looking to spend the night there.

Instead, this reporter was met by groups of volunteers carrying boxes of sleeping bags, bread and blankets. Officers from the High Commission of Malaysia and the Malaysian Association in Singapore also turned up at the station after reading TODAY’s report.

Within a week, property portal 99.co started an initiative matching homeowners to workers in need.

To date, 99.co has worked with 40 homeowners and residential firm MetroResidences to match workers with temporary housing. Nine workers have been matched.

Mr Darius Cheng, its chief executive officer, told TODAY: “99.co salutes Malaysians working in Singapore for their sacrifice and dedication in earning a living for their loved ones back home,  especially in challenging conditions imposed by the lockdown.”

One of its sign-ups was Ms Michelle Loi, 48, who had a vacant flat she wanted to rent out.

Instead, she used it to house two workers for free — one stayed a month before returning to Malaysia and the other moved in with his colleague after two months.

Ms Loi is still in touch with one of them, who kept her updated when he changed his job and moved into his new accommodation.

Bonds flourished between homeowners and the workers they housed.

For outdoor instructor Ruby Tan, who housed two workers for two months, the workers made co-living easy, as they were respectful of the space and kept it clean.

“I’m happy to be able to help, and at the same time, make new friends. It was bittersweet when they left,” said the 32-year-old, who lives in a three-room flat with her husband.

“I felt like we hadn’t built enough of a connection and they were gone.”

The workers left in May when they found a place to stay.

Similarly, human resource executive Joy Choo, 32, who opened her home to a worker, said the pair keeps in touch.

“She still has a plush toy in the room… She told me that she would come back for it before she returns to Malaysia,” said Ms Choo.

She recalled having to make adjustments when sharing her home with the Muslim worker, such as ordering in Halal food.

TODAY did not speak to the workers involved, as they did not wish their employers to know of their circumstances.

Ms Kanaga said she would open up her home to anyone who needs a place to stay, no matter the circumstances.

Ms Karpanan said she tries to visit Ms Kanaga’s family whenever she has time as she misses them.

“When I am alone, I think about the things we did together or I will watch Kelly’s shows (on YouTube).”

This article was written in conjunction with World News Day, which raises awareness of journalism’s role in helping people to make sense of and improve the world around them. The campaign, on Sept 28, will showcase the best work from newsrooms around the globe and how they have brought about positive change in the community. 

This story first appeared in Mothership on July 25, 2020.

Lee Zhong Han tells us how he started a community initiative from scratch, garnering tens of thousands of views online.

What comes to mind when you see the letters WTS?

For 23-year-old Lee Zhong Han, what may normally stand for a crude expression of incredulity, is actually the name of his brainchild, WTS Community, a visual storytelling initiative.

“Yes, WTS is an abbreviation for We Tell Stories,” he told Mothership.

The initiative started as a social media campaign seeking to tell stories about how everyday Singaporeans were affected by the Covid-19 pandemic but quickly evolved into a platform that also features other ground-up efforts addressing community needs.

Today, a quick look at the initiative’s Facebook page shows that the initiative’s videos have clocked up tens of thousands of views on average with WTS Community’s latest video bringing to light the struggles that local food and beverage businesses are experiencing.

Another video was devoted to the SGUnited Buka Puasa Initiative, a community effort which provides free Buka Puasa meals to underprivileged families during Ramadan.

OVERWHELMED BY STRUGGLES FACED BY COMMUNITIES

“Storytelling as a force for good”, Lee explained, is at the core of what his community initiative does.

Through WTS, we aim to bring more stories to light and increase the awareness of social issues faced in Singapore through exploring the micro and macro aspects of society.”

The project, which started in March this year, was the product of an “accumulation of experiences” from working on nonprofit and social enterprise initiatives and learning about societal and environmental issues.

The 23-year-old, who is currently studying counselling at the Singapore University of Social Sciences, recalled being overwhelmed when he first started learning about society and the environment.

“I was shocked by the vast amounts of information. There was so much I didn’t know. I was also overwhelmed by the struggles faced by several communities,“ he said.

I wanted to continue my learning journey and build a community where we learn and support one another together. To satisfy my desire to learn more about different issues in society and bring others along on this learning journey, I decided to embark on WTS Community.”

SELF-DOUBT AND THE FIRST VIDEOS

The team today is made up of a dozen youth volunteers, united in their passion for storytelling and digging deeper into the struggles facing Singaporeans.

However, Lee told us that the initial stages of the initiative were difficult; volunteers were hard to come by and organisations that they wanted to work with were quite distrustful.

“They [doubted] our intentions and professionalism. As a young person, I do sense that we need to work harder to gain the trust of our partner organisations,” he mused.

But it wasn’t just organisations that hesitated, Lee faced doubts from his friends and even his parents.

Then there was also the act of actually producing a video and uploading it for audiences to see.

“When I posted our first video on our social media platforms, my heart was palpitating,” said Lee.

I felt very nervous as if I was on stage giving a speech.”

That first video saw WTS Community hitting the streets and talking to youths about the Covid-19 pandemic.

“Actually, I did. Just a bit,” admitted one interviewee when asked about the panic-induced buying that beset some Singaporeans at the supermarkets.

The vox-pop ended with participants sending well wishes to Singaporeans and frontline workers before directing viewers to different organisations in need of volunteers.

While Lee said that he felt a sense of accomplishment and joy shortly after the video went up, self-doubt and uncertainty soon crept into his psyche.

It would be another two months before WTS Community would post a second video.

Yet soon, things began to pick up steam for Lee and his group of volunteers soon grew to include friends of friends who were interested in what WTS Community was doing.

“WE TAKE OUR WORK VERY SERIOUSLY”

The initiative’s second video was also more substantive, featuring the executive director of Zero Waste Singapore — a non-governmental organisation dedicated to helping Singapore eliminate the concept of waste, and accelerating the shift towards zero waste and the circular economy.

The video sought to encourage viewers to reduce their single-use food packaging.

Now, a better-oiled machine, Lee approaches prospective partner organisations by telling them “we might be a volunteer initiative but we take our work very seriously”.

When deciding on a new video topic, Lee’s team looks out for projects or issues that are under-reported and can offer new perspectives.

They then spend a few weeks doing research, talking to people familiar with the issues at hand, and sourcing for interview profiles.

The team, he explained, is keenly aware that viewers today have shorter attention spans.

There are many societal issues that deserve attention but are often not reaching the masses. We want to make it easy. Allow others to learn about society in an experiential and fun way. We condense what we find from research into short-form video content, designs and social media posts.”

The result is a slickly edited, snappy video delivering bite-sized information on issues targeted at young Singaporeans, before directing them towards an avenue to act on their newfound curiosity.

GETTING HELP AND FUNDING

All this would not be possible without the initial funding that Lee received from the Our Singapore Fund (OSF).

Supporting the Singapore Together movement, the fund seeks to support meaningful projects by passionate Singaporeans that build national identity and a sense of belonging or meet social and community needs.

Funding, explained Lee, took a week to get approved after he sent in a proposal to OSF’s online portal.

The partial grant helped WTS Community “get off the ground” by paying for marketing and production costs.

More than just providing financial support, the team managing OSF also gives Lee feedback on the team’s videos and offer advice on how to make the initiative sustainable in the long run.

“THE TYPE OF SHIFT WE WANT PEOPLE TO HAVE”

The support provided by OSF has allowed Lee and his team to focus on delivering fresh and impactful content. Speaking about impact, Lee was reminded of a comment left by a friend on WTS Community’s social media:

I have a friend who commented on one of our social media posts about how some people need regular blood transfusions due to conditions like leukaemia. His comments were: ‘Nice that’s quite a perspective I have never come across before.’

When I saw this, I felt a sense of satisfaction as we are inching towards creating content that serves our vision.”

Ultimately, that incident offered a glimpse into what WTS Community hopes to achieve.

While Lee has grand plans to expand the initiative into a sustainable non-profit organisation, the mission — to bring change through storytelling — will remain unchanged.

It’s even exemplified in the playful pun in WTS Community’s name, said Lee:

[WTS is] typically exclaimed when the person comes across something they didn’t know before that is usually incredible or hard to believe. And yes, that’s the type of shift we want the people to have when you consume our content… in hopes that they take action and contribute to the common good.”

Getting old and paying for healthcare is an increasing worry for many people around the world, but the elderly in Singapore could be forgiven for thinking their country had it sorted. After all, its healthcare system ranks among the best in the world, delivering basic, affordable treatment for those who qualify. And this is not all on the taxpayer, either, with individuals paying an initial amount and then a national health insurance scheme kicking in.

The compulsory health insurance scheme, called Medishield Life, was introduced in 2015 to help cope with the needs of a rapidly ageing population, with families worried about the large medical bills that can arise with a loved one becoming frail.

But the recent case of 83-year-old Mr Seow Ban Yam revealed that for some, the worry had not gone away. He was shocked by a medical bill well over a thousand dollars higher than he expected, and for which he received only a S$4.50 (US$3.24) insurance payment. The bill was for treatment at the Singapore National Eye Centre (SNEC).

The normally mild-mannered Mr Seow took it upon himself to challenge the bill, writing to hospital authorities and insurance administrators to get to the bottom of the issue.

However, the explanations, which essentially said no mistake had been made, merely confused him further. That’s because the maximum amount that he could claim under for his surgery was S$2,800, yet he was charged S$3,664  by the public institution (after taking into account government subsidies).

The puzzled retiree, worried that maybe it was he who had got his sums wrong, contacted The Straits Times in a neat, handwritten letter saying:

“Hopefully, you can find my case worth looking into, not only for myself, but also for the sake of the many people like me who otherwise are not aware of what a Medishield Life claims entails.

“We all think that Medishield Life is to subsidise large hospital bills. It is only when one goes through some kind of operation will one know it may not be true.”

What The Straits Times discovered thanks to Mr Seow shocked even those in the upper echelons of the Ministry of Health – that at least one public health institution had raised fees to levels much higher than those covered by the national health insurance scheme.

In Mr Seow’s case, the reason for his paltry insurance payout was that the subsidised bill from the SNEC was 50 per cent higher than the claim limit for that procedure.

The wider implication was that thousands of patients in Singapore were probably finding themselves in the same situation each year as Mr Seow, facing bills from public institutions which were higher than what the government allows MediShield Life to cover.

As a result of Mr Seow’s determination and the newspaper’s inquiries, the issue was raised in Parliament in January this year (2019).

The government has now decided to review national health insurance claim limits every three years instead of five.

And there was more good news for those who rely that the system will deliver basic, affordable healthcare – in March, the SNEC cut its fees for 20 procedures by between 15 and 32 per cent. This could reduce each bill by up to several hundred dollars for about 14, 500 procedures done a year at that institution.

What The Straits Times discovered thanks to Mr Seow shocked even those in the upper echelons of the Ministry of Health – that at least one public health institution had raised fees to levels much higher than those covered by the national health insurance scheme.

WHY IT MATTERED

What got Mr Seow so riled up and made the issue such a talking point was that when Medishield Life was introduced, the trade-off for making it compulsory was that the government made a promise: lower-income people now need never fear having to foot big medical bills entirely themselves for treatment at public hospitals.

The aim was that 90 per cent of patients would have 90 per cent of their bills covered, beyond an initial amount – which insurers call a “deductible” – and co-payment over that.

But Mr Seow’s complaint led to the discovery that, in the years since Medishield Life was launched, coverage had in fact dropped to 80 per cent of fully subsidised bills.

And these are patients who need a helping hand – about a third of 4 million Singapore residents rely entirely on MediShield Life for their health insurance. The rest can afford policy add-ons from the private sector.

HOW THE PROBLEM CAME TO LIGHT

So how did Mr Seow, who is retired and lives in a subsidised government apartment, end up caught between high medical fees and low insurance payout, sending him on the road to being an unlikely healthcare hero for the needy?

It all began in 2017 when he went to the Singapore National Eye Centre for two operations involving unblocking his tear ducts in both eyes in preparation for cataract surgery. He certainly wasn’t prepared for the financial shock that followed.

Mr Seow knew he would have to pay 10 per cent of the bill after the deductible, which is capped at S$3,000 a year, but only expected to only fork out a total of S$3,148 himself. However, he ended up paying S$4,472.30 – a figure S$1,329 more than he had anticipated. To a retiree, this is no small sum.

The main problem was that the bill was S$1,472 over the claim limit of S$3,005 including room and board as well as the operation. The latter alone was limited to S$2,800. This capped amount is stated in the Ministry of Health’s (MOH) table for surgical procedures, though there is no explanation how the amount is arrived at.

Said Mr Seow: “The whole idea of MediShield Life is to meet heavy bills. I don’t understand why it is limited to S$2,800 when the bill is more than S$4,000. This defeats the purpose of insurance.”

Another was that while S$3,005 was claimable, as Mr Seow is over 80, the insurance scheme requires him to pay the deductible amount of S$3,000 himself. As for the remaining $5, the helping hand of Medisave Life paid the 90 per cent, alright – a grand sum of S$4.50. Mr Seow’s 10 per cent co-payment was still required, of 50 cents.

Fortunately, Mr Seow did not need to take out a bank loan for the overall big bill – he could pay the amount from a long-established scheme the government operates where workers pay into designated savings accounts that include a healthcare one called MediSave.

In January, addressing ST’s report over Mr Seow’s plight, Senior Minister of State for Health Edwin Tong not only announced more regular reviews of claim limits that cap national health insurance coverage, but also promised: “We will continue to review, refine and strengthen MediShield Life and other components of our public healthcare financing system, and just as importantly, manage our healthcare costs to ensure that public healthcare remains affordable for all Singaporeans.”

As for Mr Seow, his dogged pursuit of his SNEC bill will benefit those who undergo similar procedures: in particular, patients who need the same surgery as him – called dacryocystorhinostomy (duct drainage surgery) – as well as procedures such as glaucoma surgery with implant and retinal detachment surgery, “will see subsidised bill sizes lowered by an average of 25 per cent”, said a spokesman for the centre..

And what of the amount that Mr Seow had to cover himself? SNEC has since offered Mr Seow a goodwill payment of S$1,300 – or near the amount MediShield Life would have covered if the entire bill had been within the limits set.

This story is a compilation of a series of articles by Salma Khalik published by The Straits Times from Dec 31, 2018 to Jan 16.

When his father needed treatment for a prostate problem in 2008, property developer Yudi Rahmat Raharja got a recommendation for an agent who could arrange for it to be done at a public hospital in Singapore.

The Jakarta-based agent organised everything, from an ambulance pick-up at Changi Airport to doctors’ appointments.

“I don’t remember being charged any agent’s fee, and generally had no issue with how much we were charged by the hospital,” Mr Yudi, 50, said.

“We understood the agent’s work was reflected in the total bill.”

Instead of Mr Yudi being charged for it, the agent’s commission was paid by the hospital.

This practice of paying foreign agents to refer patients had been going on for years in some public healthcare institutions, with agents earning potentially thousands in referral fees. But the institutions have now been told to terminate such contracts.

The Health Ministry (MOH) issued the order after the practice in hospitals including National University, Singapore General and Changi General was highlighted by The Sunday Times in September.

MOH told The Sunday Times the priority of public healthcare institutions was to serve Singaporeans’ healthcare needs.

While foreign agents were not tasked to market the hospitals’ services and served mainly to facilitate visits by foreign patients, the ministry said it wanted hospitals to cease such contracts, “to avoid potential misinterpretation and misrepresentation.”

Foreign patients did not get subsidies and could be charged a premium for procedures performed by senior doctors, so agents’ fees, as a percentage of the total bill, could be very lucrative. In one case, an Indonesian agent contracted to provide NUH “administrative services” was paid eight per cent of the hospital bill, excluding doctors’ fees, for every foreign patient accepted by NUH.

The agent would get an additional percentage if the patient bill exceeded S$500,000, and even more if it exceeded $1 million.

Among the agent’s duties was to provide information and help arrange appointments with specialists.

Jakarta-based hospital agent HCM Medika said it had helped to facilitate medical visits for 15,000 patients to Singapore and Malaysia, since it was established in 2007.

HCM Medika would recommend the hospitals and specialists, and send patients profiles of the doctors recommended.

Potential clients would be asked for their medical records.

“For Singapore public hospitals, an appointment could take one to two weeks. For private hospitals, patients can get a confirmation and meet a doctor as quickly as the next day,” Ms Lena, a relationship officer with HCM Medika, told The Sunday Times.

“No additional fees. We have agreements with the hospitals we send clients to,” she added. “We don’t charge patients. We are getting fees from the hospitals.”

She declined to disclose how much hospitals paid her company.

Other agents in Indonesia and Vietnam told The Sunday Times they too had arrangements with SGH and CGH.

Among other hospitals, Tan Tock Seng said it did not engage such agents, while other public hospitals did not reply to queries.

SingHealth, which runs SGH and CGH, and NUH told The Sunday Times they would cease the agreements by the end of October.

“NUH’s foremost priority is to provide care for Singaporeans,” an NUH spokesman added. “NUH reviews all referrals to ensure that it has the capacity, capability and resources to provide treatment that will be beneficial to the patient. Singaporeans are given priority, for appointments and hospital beds.”

SingHealth said the primary role of agents, which it termed “medical associates”, is to help overseas patients navigate the healthcare system, including advising them on the relevant health records needed, and assisting with administrative processes, paperwork and travel arrangements.

“Medical associates are non-exclusive to SingHealth and they charge an administrative fee (per patient) for their services,” said SingHealth.

Doctors interviewed by The Sunday Times expressed their concern about such fees.

“This practice of giving a ‘referral fee’ to ‘medical agents’ is unethical,” said Dr Keith Goh, consultant neurosurgeon of International Neuro Associates, bluntly. The 8 per cent commission on a hospital bill of S$500,000 would be S$40,000 – “which is more than the annual salary of a staff nurse,” he noted.

Some doctors pointed out that under the Singapore Medical Council’s (SMC) ethical code and guidelines, they are not allowed to offer a percentage of a bill as a referral fee to third parties.

Dr Tan Chi Chiu, chairman of SMC’s Medical Ethics Committee, said there is nothing wrong with public doctors treating foreigners. But foreign patients may pay more, and “doctors need to ensure that this does not set up a financial incentive” to favour such patients over subsidised ones, he said.

The concern about foreigners crowding out Singaporeans in restructured hospitals has surfaced before and was raised in Parliament in 2010.

After The Sunday Times published its report, comments flooded social media, with many people demanding to know how many overseas patients were being treated at public hospitals, and if they had contributed to the long waiting time for appointments.

As a result, two MPs raised the issue in Parliament in November.

Responding, Senior Minister of State for Health Lam Pin Min said public hospitals attended to 10,900 foreign patients in 2017. Those whose referrals were supported by contracted service providers made up about 0.4 per cent of attendances in public health institutions.

He also said the proportion of foreigners admitted as inpatients or for day surgery at public institutions was about 1.5 per cent in 2017, lower than the 2.4 per cent admitted in 2008.

Following the MOH’s instruction to end contracts, public healthcare institutions also removed or blocked webpages containing information for overseas patients.

This story is a compilation of articles by Joyce Lim and Wahyudi Soeriaatmadja from Sept 30 to Nov 21 last year.