September Stew

You have barely settled into watching Amazon’s Rings of Power before you realise you are now threatened by that one Power that is more all-consuming than even the One Ring. Indeed, there is that One Ring to rule them all, but there is also that One Power that can drive sound-minded people to become teeth-clattering, nerve-wrecked, fingernails-chewing idiots.

No, we are not talking about the crippling effects of high inflation.

Yes, we are talking about PSLE.

But better days await because there is that most important post-PSLE question that needs to be answered very soon, “where are you going for the year-end holidays?” Are Singaporeans going to conquer Japan (or at least Shinjuku) in a tit for tat for what they did to us 80 years ago in 1942? Except that instead of shouting “Banzai”, Singaporeans will scream “Cheap” and then splash the cash from Sapporo to Kagoshima. At current exchange rates, we can have two bowls of ramen with full spread of toppings in Tokyo for the price of that one bowl in Singapore that is accompanied by a sliver of an apology for chashu. In case you haven’t noticed, Singapore is the most expensive place in the world for Japanese cuisine. It’s another world-first for the little Red Dot

IP Premium Freeze

While we are talking about inflation and the rising costs of living, this hobbit has some good news. In the last post, this hobbit noted that on 15 Aug 22, it was reported in the Business Times that “Strong profits for most insurers’ Integrated Shield portfolios, but brace for premium hikes”. In that same report, it was announced that 5 out of 7 will raise Integrated Shield Plans (IP) premiums this coming year. These raises were made in the name of keeping the IP sector “sustainable”, despite making good profits in 2021 and 2020.

Well, well, it appears that in Singapore, pigs can indeed fly. On 2 Sep 22, the Life Insurance Association of Singapore (LIA) announced that IP insurers were freezing IP premiums for about a two-year period – 2 Sep 22 to 31 Aug 24.

Wow, what happened? Did the IP insurers stumble on some Ring of Benevolence or Cloak of Kindness to offer this two-year reprieve? This hobbit is stunned like vegetable.

This hobbit thinks it’s probably some ogre-sized fella sat on these soulless and faceless IP people and forced them to regurgitate some of the profits from 2020 and 2021. Its either that or some fire-breathing dragon finally woke up and breathed on these IP folks.

Whoever you are, Mr Ogre-size Fella(s) or Fire-breathing Dragon(s), this hobbit thanks you.

Widespread IT system outage x 2

Unless you are completely delinked from public sector healthcare, you would have experienced the deleterious effects, or at least heard, of the IT system outages that occurred recently. This happened not just once, but twice, on 25 Aug and 5 Sep 22. These two events were attributed to “node failures”, which in turn were caused by bugs in the firmware of devices supplied by a company called Cisco (not the local security services company). It was reported in the Straits Times on 12 Sep 22 that these “devices have been patched”. This information was revealed in response to parliamentary questions.

It was also reported in the answer given to these questions that in the IT arm of MOH Holdings, called Integrated Health Information Systems (IHIS), which supports the IT needs and operations of public sector healthcare institutions, has a headcount of ~3500. I must say, this is quite a staggering number and this hobbit is stunned like vegetable, again. Some smaller general hospitals may not even have a headcount of 3500. This hobbit wonders how many headcounts does GovTech, the agency that supports the rest of government, has? More or less than 3500?

Anyway, beyond headcounts, what is important is that IT availability nowadays is almost as important as utility-availability in the traditional sense. If there was a power outage or if the water taps ran dry for just a few hours on almost a nationwide scale, you can be sure that the authorities will be tasked to investigate thoroughly what happened and to make recommendations as to what steps can be taken to prevent the recurrence of such events. With our heavy reliance on IT to deliver healthcare today, IT availability is no less important than power or water availability.

For example, life-sustaining critical equipment such as ventilators are plugged into Uninterrupted Power System (UPS) power sockets. The batteries for these UPS systems are maintained and replaced fastidiously and they will kick in when there is a power outage.

As a second line defence, backup power generators are tested regularly in hospitals to ensure they are always ready in case of a power blackout. Even water supply grids have redundancy built-in for some general hospitals.

So do we have the same level of resilience built into our IT systems supporting our public healthcare institutions?

Pre-employment Grants for Singaporeans Studying Medicine Overseas

Currently, Singaporeans studying Medicine overseas in recognised universities can apply for a MOH Pre-Employment Grant (PEG) to partially fund their studies. In return, they are bonded to serve the government for up to 4 years, depending on the number of years the grant was given to the student. The grant is given on merit. But it is not known publicly as to what are the exact meritocratic criteria involved here. This grant is very popular and has brought back many a Singaporean doctor to our shores over the years to work as a house or medical officer. This hobbit may be wrong, but anecdotal evidence suggests that slightly less than half of Singaporean medical students are successful in getting this grant.

It is said that folks who don’t get this grant often end up seeking employment and training overseas and there is a higher risk that they will never come back.

On the other hand, recently, on the MOH Holding website, there was an announcement that it was conducting a Request for Proposal (RFP) for the Appointment of a Recruitment Agency to Provide Services for the Recruitment of Doctors in India (announced 6 Sep). This was followed up by another RFP 10 days later for Request for Proposal (RFP) for the appointment of recruitment agencies to provide overseas recruitment services to MOHH and its Affiliate(s) for a period of two years with an option to extend for another one year.(

The earlier RFP was for the recruitment of 60 Medical Officers from India from 2022 to 2024 with an option also to extend for another year, while the later RFP was for recruitment of nurses, enrolled nurses, nursing aides and healthcare assistants

Let’s just focus on the doctors bit for a while. If we are so short of medical officers and we have to appoint agencies to help us recruit them from overseas, wouldn’t it be easier if we just awarded more PEGs? It is estimated that annually we produce about 500 doctors locally and another 200 Singaporeans go abroad to study medicine. Wouldn’t this shortage of 60 medical officers be easily plugged by giving out more PEGs? It would be nice if we knew, excluding those that don’t bother to apply for the PEG, how many unsuccessful PEG applicants there are roughly in a year so that stakeholders can take this discussion further. It would be very useful if stakeholders also knew, of the unsuccessful PEG applicants, how many indeed remained overseas for their HO and MO employment and training.

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