Workers' Party chairman and Non-Constituency MP Sylvia Lim said the suggestion was 'quite a bad indication of affordability of our own health care services here, and also a reflection of our national values'.

Fellow WP member Low Thia Kiang (Hougang) asked: 'Is the Minister suggesting that Singaporeans who cannot afford medical treatment or step-down care here should now consider such facilities in Johor?'

If so, is the minister 'outsourcing the Government's responsibility to provide affordable health care service to Malaysia', he asked.

This riled Mr Khaw Boon Wan.

'I'm not saying that if you are poor I will put you in an ambulance, send you across the Causeway to a Johor nursing home. That is not what I said and please don't twist my words,' he retorted.

In fact, the Johor option is not for the poor, who are heavily subsidised in Singapore.

'Everybody can afford health care in Singapore whether acute care or long-term care,' said Mr Khaw.

The suggestion was aimed at middle-income families who need to pay for the care themselves. It gives them choice.

'I just wanted to point out to Singaporeans that there are options like this,' Mr Khaw said.

The cost of nursing home care will always be more expensive in Singapore, as doctors and nurses are paid more, and construction cost is also higher.

Since many people visit the elderly in homes only on weekends, it makes little difference whether the person is housed here or in nearby Johor.

It's part of globalisation and this is already happening with Singaporeans going to Bangkok for Lasik to treat short sightedness and Americans and Russians coming here for treatment.

It is also not something that should, or can, be prevented, said the minister.

Singaporeans are already crossing the causeway for cheaper petrol and medicine.

'By allowing the flexibility of consumers walking across the Causeway... they benefit. I don't think we should constrain them from doing so.'