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WANTED: transparency in social and health services

We’re ignorant people. Either that, or we’re too trusting. We’re ignorant when we talk about how the poor need help, without knowing whether they already got help or the types of help that are available. Or we trust that somehow help will get to them. Or we’re just lazy thinkers, accepting that something is good for us because someone says so.

I got to thinking like this because of two articles that appeared in The Straits Times recently. Since both are “premium”, I’ll take the liberty of summarising the key points. The first is a piece by a veteran in the social work scene, Mr Gerard Ee. He wrote a commentary published on Jan 3 calling on a change in the way we – or rather the 4G leadership – view poor people (I am eschewing all forms of political correctness here). They’re not problems to be fixed, but assets, he said.

“Social services, when positioned to help those who have fallen behind, are inherently communicating that their users have failed to fit in or to contribute to the larger scheme of things.This is reinforced when the process of accessing resources requires service users to accentuate their needs. This makes the people involved feel like they or their situations are problems. They constantly surface “needs”, which are the raw materials for the proliferation of service provision,” he wrote.

You’d ask then how help should be “delivered”? He doesn’t have a definite alternative but expounds on the idea of getting the community itself together to see what they can do: like getting orders for large baking contracts which the poor can fulfil during festive seasons. You get the idea? It’s about helping people helping each other and themselves, and creating a kinder, gentler neighbourhood not just about schemes and means-testing.

The G should be the Guardian which safeguards this space, he wrote. It should be the convener of gatherings that allow the community to come together. It should allow problems to be aired transparently so that people know what they have to solve. ”

“Unless concerns are clearly defined and acknowledged, people cannot or will not see the need to cooperate and resolve them. Usually when concerns are raised, our leaders cite a programme or scheme that is already dealing with it. This says that the status quo is good enough and no improvements are necessary,” he added.

This line above resonated with me. You can’t deny that we have an effective bureaucracy with a myriad of help schemes. When asked, it will say how many people have been “reached” or “helped” through this or that scheme. It’s almost as if some KPIs have been met although we wouldn’t know since we have no basis of comparison or assessment. Is the “reach” is wide enough or should we just go oooh over big numbers? Is it “meaningful” help? Instead of telling us that the schemes are being “reviewed regularly” or “monitored closely”, can we have proper audits?

Or maybe, we should be asking ourselves why the G is so much front and centre in this sector. Is this about the G giving “more” help or about the people taking back the responsibility we have for each other with the G as a facilitator? Mr Ee doesn’t seem to be telling the G to butt out or stop discounts, grants and subsidies. Instead he wants the G to protect the community space in which good things can happen.

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He raised this issue which has cropped up time and again:

“I find it disturbing to see community centres being leased out to fast-food operators and other businesses. Surely, residents can go to the mall in the town centre should they desire such products, and surely the community centre management can utilise its facilities to reach out to residents who may find it difficult or not gratifying to visit the mall as a routine. In any case, community development and resident engagement can certainly be more than making it convenient for people to get fast food.

“The optimising of community resources for rental revenue gives the impression that the Government is subsidising business at the expense of meaningful community engagement and development, as it is not transparent how the revenue is ploughed back into the community, apart from maintaining infrastructure. It also signals the depreciation of the community as its space is being encroached upon or even colonised by commercial interests. If this is not the correct impression or intent, the leaders should reassess some of their positions or decisions in these areas.”

Now, Mr Ee is not some opposition politician ranting away about the use of People’s Association resources. He is a respected member of the Establishment who is uncomfortable about how increasingly, the community space is being “colonised by commercial interests”. The G, I’m sure, has sound economic reasons for letting the PA collect rent – which maybe goes into subsidising courses? You see, as Mr Ee pointed out, we don’t know.

I’d think that the best method is to let the MP in charge of the area, or the community groups’ adviser as is the case in opposition wards, decide on how to use the space. And how they use the space would be a useful reflection of their priorities to voters, much like town council management.

The second article was written by Senior Health Correspondent Salma Khalik who talked about the kinks (or is this systemic?) in the Medishield Life scheme and whether it lived up to its promises. For one man, it didn’t.  Medishield Life allowed Mr Seow Ban Yam, 83, to claim only $4.50 cent for two eye operations at the Singapore National Eye Centre which cost more than $7,500. This had to do with claimable limits set by the CPF, which is much lower than the subsidised bill. Mr Seow was, in fact, hit with a double whammy. He had a second operation a few months later  but because it was in the next “insurance” year, he had to pay  deductibles twice.

Below is the breakdown of one of Mr Seow’s bills published in ST.

So is  this merely an anomaly or is this something that affects more people we don’t know of? Ms Khalik thinks that thousands of patients are affected going by the difference between claim limits (low) and subsidised fees (high). This calls into question how claim limits were set and why public healthcare institutions seem to be charging such high fees.

Again, this has to do with transparency but I’d bet my bottom dollar that when Medishield Life was first discussed, most of us just glazed over the numbers even if we could follow the arguments. This is when experts should step in and point out the flaws. But it also means that we should never allow ourselves to swallow comforting phrases like how Medishield covers nine in 10 subsidised patients.

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As Ms Khalik said: “It would be interesting to know, three years after the launch of MediShield Life, if it does truly fully cover nine in 10 subsidised patients as it was meant to, or if the number has been eroded over time. This is information the Government owes the public a duty to disclose.”

Trust must be accompanied by transparency.





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An ex-journalist who can't get enough of the news after being in the business for 26 years

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