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连氏基金长期护理研究(2)– 终身护保索赔条件严苛 学者:依级别赔付扩大安全网

连氏基金会和国立大学社会科学研究所两位助理教授何琳贻黄瑞莲,针对我国长期护理前景进行研究。

除了昨日《海峡时报》所报导,强调更多年长者选择居家或中心式看护服务,且成本高昂,显示有必要提升现有社会保障机制。有关研究报告也针对现有医疗保健政策提供建议,特别呼吁应改善终身护保计划(CareShield Life)的受保赔付条件,让保户获得较广泛的保障。

报告列举出一些新的看护政策或计划逐步涌现,例如整合式居家和日顾计划(IHDC),让那些无法离开住家的年长者,中心能暂时派看护人员到家服务,至于那些在家护理者,则被鼓励在行动便利下能转移到中心接受看护。

至于“活跃乐龄中心”也在新的公共组屋区提供整合式乐龄看护服务,例如日顾、复健和代送日用品等。

“近年来,私人领域填补了乐龄看护领域的空洞,特别是针对想获得更多元和专属服务的中产和中上阶级。自愿福利组织也开始与私人业者合作。”

该研究发现,缔造获颁关系是实现规模经济和专业化的有效手段,同时也能落实提供全方位和持续性服务的目标。研究也认为,社会与家庭发展部把社会关怀任务,转交给卫生声部,使得看护领域获得更集中的规划和精简化,有望使该领域受惠。

研究报告欢迎政府推出终身护保计划,在应对长期护理成本日益攀升,提供民众保障。然而研究也点出其问题,包括终身健保符合赔付的条件严苛、相对较低的保赔和妇女需支付出更高保费。

去年仅6.6巴仙长者严重伤残

保户需符合严重伤残资格,即日常起居至少三项无法自理,才能领取每月600新元的赔付。然而,报告指出在2017年,只有6.6巴仙长者34千人面临严重伤残情况。这意味着,有大部分人都在符合申请赔付的范围外。

Elaine Ho指出,许多新加坡人的长期护理可能面对保障不足。在2017年,有三分之一年龄介于4084岁人士,仍未购买基础乐龄健保(ElderShield)。

年长者可选择是否参与终身健保,但有多少人愿投保也有待观察。例如女性基于较高的保费有可能选择不投保。再者,每三位购买乐龄健保的国人,只有一位有另购私人保险。

学者建议:终身健保依伤残情况赔付

终身护保规定,日常生活至少三项不能自理,才符合严重伤残定义以申请赔付。对此Elaine Ho也建议,可以改为根据有多少项日常起居无法自理,分等级给与相对的赔付,以此把保障范围也扩大至一些身患一定程度残障的国人。

慈善领域在长期护理仍扮演重要角色,我国有170个护理服务单位,其中三分之二都是自愿福利组织。虽有政府拨款和补贴,但政府发放拨款所依据的平均“标准成本”,和长期护理服务的实际成本仍有差距。

卫生部“标准成本”和实际居家看护成本差异,介于2037巴仙

服务类型

卫生部标准成本

实际成本

居家看护(一次拜访)

109

139.43

居家疗程(一次拜访)

129

205.09

居家个人护理(每小时计)

22.67(第一级)

22.78(第二级)

28.67

这是因为不同类型服务,例如居家护理的成本都有差异,其中一家服务提供者表示,即使已有政府津贴,提供低收入家庭的开销有29-41巴仙仍来自善心人士捐款。这也致使福利组织花更多时间筹募善款,显然不是长久之计。

除了透过保险分担风险,研究呼吁政府增加社区或居家护理的拨款。有鉴于人口加速老化和家庭微型化,我国各界更需要重新检讨改革社会契约,并提供更有保障和涵盖更多阶层的社会安全网。

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