How did Gan Kim Yong keep his appointment as Health Minister through latest Cabinet reshuffle?

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Several ministers retained their appointments in the latest Cabinet reshuffle that was announced earlier this week, despite the shake-up being touted to give fourth-generation leaders more exposure and responsibilities so they can better support Prime Minister Lee Hsien Loong’s successor.

While three Ministers stepped down from their posts, 10 Ministers held on to their appointments. Health Minister Gan Kim Yong is among the ruling party politicians who are staying put in their respective ministries.

This may be curious to some, considering the chequered history the Ministry of Health (MOH) had under the watch of Gan. The ruling party parliamentarian, who was elected into office in 2001, began serving as Minister for Health in 2011 – a post he has held for nearly 7 years so far.

Under Gan’s watch, top officers at the Health Ministry and senior staff at hospitals failed to intervene early during Hepatitis C outbreak in 2015. Poor infection control ultimately led to 25 patients being affected, 8 of whom died.

An independent probe of the outbreak shows gross lapses in the handling of contaminated equipment, the hygiene of wards and the reporting of infectious diseases. The investigation revealed that Singapore General Hospital – the nation’s oldest hospital that is operated by SingHealth – was tardy in recognising the outbreak and that it delayed escalating the incident, besides leaving its own internal investigations incomplete.

A year after the outbreak, four director-level MOH officers and 12 staff in leadership positions at SGH were disciplined by the hospital and Ministry respectively. Curiously, Gan Kim Yong refused to disclose the names and the specific punishments meted out to the staff involved.

Arguing that such disclosures would not contribute to better care of patients, Gan claimed that focusing on naming the individuals will develop a “blame culture in our healthcare institutions.”

That same year, MOH was again accused of being sluggish in its response to the Zika virus. Infectious diseases expert Leong Hoe Nam, who diagnosed Singapore’s first Zika case, took the ministry to task for not starting investigations earlier:

“Every single mild case of fever, they should have investigated, it was a chance to break the cycle. Kudos to the GP who picked up the trend. We must remember that Zika is very mild, compared to dengue. Patients may not be sick enough to go to hospital but to the GP instead. So the GP now is the gatekeeper.”

The next year, in 2017, the Auditor-General’s Office (AGO) flagged MOH for spending S$4.08 million dollars on “supervisory staff” for the construction of Ng Teng Fong Hospital without verifying the need or reasonableness for this expenditure. MOH also did not seek appropriate approval from its approval authority for this expenditure.

MOH’s payment of another S$30.09 million to hospital contractors made for contract variations was marked by the AGO for being inadequately scrutinised by the appropriate authorities. The AGO said, “The lack of required level of checks increased the risk of fraud. The fact that MOH was not aware of the agent’s non-compliance indicated that it did not exercise adequate oversight on the agent.”

The AGO also faulted MOH for irregularities in managing 40 variation works in 10 other projects. Again, approval for these works was not sought from the appropriate authorities and in many instances, work commenced before formal approval was given. The variation works amount to S$3.76 million.

Besides this, the Ministry was flagged for wrongful payments made under the ElderCare Fund which is meant for subsiding nursing homes run by Voluntary Welfare Organisations. MOH had overpaid S$48,000 to two service providers and underpaid two other service providers by S$12,300.

This year, Gan Kim Yong drew flak from several quarters after he said in Parliament this week that co-payment in healthcare is important as it ensures the sustainability of the healthcare system. Noting that some private insurance policies offer zero co-payment coverage the Minister said that such coverage “dilutes the personal responsibility” of patients. He added that this prompts a “buffet syndrome” in patients, in which they overly consume services just because they are free:

“They are called full riders. Such riders encourage a buffet syndrome as patients do not need to pay anything for their treatments. It undermines the co-payment principle and dilutes the personal responsibility to choose appropriate and necessary care.
“This will encourage unnecessary treatment, leading to rising healthcare costs not only for those with such riders, but for all of us.”

That same day, Senior Minister of State for Health Chee Hong Tat announced that patients must bear a 5 per cent minimum co-payment for new Integrated Shield Plan riders with immediate effect. Only new policy holders will be affected by the policy, not those who have already bought zero co-payment insurance policies.

The Minister’s implication that patients are to be blamed for overly consuming healthcare services because it is free riled several Singaporeans and drew sharp criticism from socio-political commentators, activists and opposition politicians.

With such an eventful history, some are curious that Gan managed to hold on to his highly-paid post as Health Minister.