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终身健保自付额高、索赔程序繁琐 民主党冀政府重视

by 林殊
22/10/2020
in 健康, 政治, 新闻, 时事
Reading Time: 2 mins read
0

民主党呼吁重视终身健保(Medishield Life)高自付额问题,冀能获得改善,欢迎公众积极参与咨询,提供建设性意见。

终身健保检讨委员会日前受到卫生部指派,针对终身健保方案进行检讨,并展开公众咨询,欢迎公众提出相关建议。

针对终身健保的公众咨询,民主党也提出终身健保中常见的问题,以及相关建议。民主党认为终身健保中最常见的问题即高自付额度(deductible),并引述82岁老翁萧万延的案例。

萧万延去年初到新加坡眼科中心进行白内障手术后,其医药费为4千477元,原想动用自己的保健储蓄(Medisave)存款来支付其中的3000元,然而经申诉后终身健保仅赔4元5角,其余的费用只能靠自行承担。

终身健保跟不上医疗保健通胀

从萧万廷案例中,民主党认为,事实上终身健保只是涵盖了新加坡总医疗费用的一小部分,例如2018年终身健保从180医院的医疗支出中仅占了10亿元。尽管其额度也不断在修正,但其余变化似乎是微小的调整,并无太大的变化。

“列入药物滥用和自杀未遂的治疗费用是相当好的用意,但其余调整似乎都相对微小,几乎跟不上新加坡的医疗保健通胀。”

此外,民主党也发现到整体医疗保健的索赔极其繁杂,例如终身健保在不同的疗程都有其不同标准,甚至在精神疾病治疗的索赔远远低于其他医疗种类。

“即使有终身健保的保障,但还是有病重的国人每年仍需支付逾15万元,迫使患者必须通过其他管道来支付庞大的医疗费用。”

民主党质疑保费上涨的意义

民主党表示,为了改善福利和减少自付额度,人民只能通过升级成为Premium会员获得更多相关福利,但其代价却是需要增加保费。

值得关注的是,我国迄今为止最大的医疗服务提供者均为隶属卫生部旗下,占尽大部分的医疗费用。再比较我国2016至2019年的赔付率,在过去五年间,76亿元所收取的保费中,仅占35亿元,亦是迄今为止全球公共强制性医疗保险计划里赔付率最低的国家。

然而,国人即使在升级了终身健保,但他们可能面临每隔几年上涨的保费。对此,民主党质疑既然已升级终身健保,为何仍需每隔几年上涨保费。

“除去一些未来的保障,例如长期治疗和未来保费回扣,对于升级终身健保的会员,还要在每隔几年上涨保费是不合理的行为。因为就算是长期治疗也已被纳入未公开的精算之中。”

整体医疗保健的索赔程序过于繁琐

民主党也留意到整体医疗保健的索赔程序过于繁琐,认为最合理的方法,即以单一付款人的方式承担医疗保健计划(single-payer national health insurance scheme),详情可参考民主党所提出的国家医疗保健计划(SDP’s national healthcare plan)。

该计划以政府管理医疗投资基金,根据人民的提供所得税分配,提供了基本的医疗服务、意外和怀孕保障。国人的自付额度将设限,其余的费用则根据新加坡医药学费(SMA)的收费标准,不仅仅包括外科手术、住院费等。

实证医学决策将会获得小额共同支付资金,而无论是公共或私人部门将会一视同仁,而且根据收费准则进行报销。

实证医学医疗决策(即病人的处理,治疗指南和医疗政策的制定等)应在现有的最好的临床研究依据基础上作出,同时也重视结合个人的临床经验。

对民主党而言,人民的健康应是最关键的问题,而不是单纯的基金盈利。因此民主党呼吁应重新思考复杂的医疗融资模式。

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