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社论:与其变成“津贴国” 何不普及化医疗服务?

by Yee Loon
11/03/2019
in 健康, 时事, 舆论, 观点
Reading Time: 1 min read
0

图源:社保援助计划官网

日前,荣誉国务资政吴作栋在脸书发文指出,新加坡虽然避免了福利国的隐患,但他认为必须慎防陷入“津贴国”的潜在危险。

他认为,英国在70多年前推行福利国制度时,无法预料到今天会承受的巨大负担。“这种制度的根本风险在于–现在看起来对的事情,将来可能出错。”

他说,随着国家的需求、挑战和特征会改变,我们无法预知几代人过后,津贴国会面对怎样的潜在负担。

故此, 他认为必须在政府的责任、社区、家庭和个人之间取得平衡,确保新加坡能持续发展、进步。

换言之,或许新加坡为了避免陷入“福利国”陷阱,反倒成为“津贴国”,一方面国人继续承受各种生活压力,一方面政府则必须这里津贴一点,那里发一些填补,使得整个系统更为繁琐、复杂化,这反倒增加行政上的成本和负担,许多民众也感到混淆,去问问看有多少年长者,究竟能分辨出立国一代配套和建国一代的差别?

医疗乃基本人权

之前,工人党秘书长毕丹星在参与国会辩论时,就曾呼吁落实永久性的乐龄医疗护理配套,让国人只要年满60岁,就能自动享有一系列的基本医疗津贴。

这并不是要我国成为“福利国”,而是保障国人最基本的医疗保健权利,让他们免于无法看病、看不起病的忧虑。如果真得体恤国民,珍惜年长者对国家的牺牲和奉献,那么就应该把看病视作人民的基本权益。

过去,曾有报导指一名年长者因感到无法排尿,到陈笃生医院急诊部门求助。但他申诉,医院职员不让他使用建国一代卡,结果他还要为看诊付105元的费用。

这事件发生在2015年,当时的卫生部的答复是这样的:建国一代卡可用在CHAS社保计划诊所、综合诊所和医院专科门诊,但不包括急诊部门。

这是因为,公共医院急诊部门为紧急意外伤患、有生命危险者服务,为确保病人得到所需紧急治疗,所以急诊部的手费都是划一的。

如果需要住院,出院时可以用保健储蓄或健保双全付医药费。至于无法支付紧急部门入院费用者,则可寻求医院社工帮忙。

虽然政府最近宣布,无论收入多少,让所有患慢性病国人都能获得CHAS社保计划给予的津贴。但目前持有CHAS卡,从家庭诊所转介到综合诊所照X光和验血,都无法享有津贴。

针对性津贴不够普及、全面

同样的, 津贴是有顶限的,而且不同收入获得的津贴也不同,反而增加了要维系整个社保计划的复杂程度和成本;再者也不是每一种疾病、或者在特定医疗设施使用CHAS津贴,例如上述年长者前往急诊部就诊的个案。

针对性津贴或许可以依据国人不同的收入能力,分配资源,但照现有的医疗津贴制度,国人想要看病,还得“精打细算”,同时也难以预计自己的医疗开销,例如如果被诊所转介到公共医院,则可能要动用自己的健保储蓄。

根据怡安2017/18年保健趋势调查报告,新加坡的2018年的医疗通膨预计达10.9巴仙,在东南亚的怡安医疗通膨指数,得分95.1(得分最高的国家为越南:164.5)。

住院开销是主要的通膨因素,其中治疗费调涨最大,占了病患医疗开销的一半,而其余四大经历通膨的部分为:看诊程序、药物、义肢和病房。

这显示卫生部更应该在最关键的问题:医疗费用问题着手。如果现在的津贴和健保制度,仍然让国民看病时还要忧虑自己的储蓄是否足够、自己是否“看得起病”,那么就说明现有的医疗安全网,仍有很大的改善空间。

*以下参考资料:社保计划CHAS 诊所医疗津贴

图源:《8视界》
截图自CHAS宣传传单
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