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MOH's Reply (English)
Lian He Zao Bao, 23 June 2015
In the letter “保健储蓄应只设限不设用”, Mr Zhao Wan Xing asked if the Government could make Medisave use more flexible while setting limits.
Medisave was first introduced to help Singaporeans with their inpatient hospital bills, especially in old age. Over the years, Medisave has been expanded to cover expensive outpatient treatments such as cancer treatment and renal dialysis, as well as chronic diseases treatment that can help to reduce the probability of complications and more expensive hospitalisation down the road. Currently, Medisave can be used for recommended screening and vaccinations, where proven to be clinically and cost-effective, such as colonoscopies and mammograms for those aged above 50, and was recently expanded to cover non-cancer outpatient medical scans (up to $300 a year). Similar to what Mr Zhao suggested, beyond these prescribed uses, we have allowed more flexible Medisave use for outpatient treatments in general. Under this Flexi-Medisave scheme, the elderly aged 65 and above can use up to $200 a year for their outpatient treatment.
Medisave savings are sized based on the expected uses of Medisave. As the Ministry continues to review Medisave use regularly, we need to strike a balance between allowing more uses and ensuring Singaporeans have enough Medisave for their inpatient hospitalisation needs and health insurance premiums during retirement.
To help Singaporeans manage the costs of outpatient care, the Government has enhanced subsidies for lower- to middle- income Singaporeans at the public hospitals, polyclinics and participating private GP and dental clinics under the Community Health Assist Scheme (CHAS). Pioneers receive additional subsidies. Medisave, MediShield and Medifund work together with Government subsidies to make healthcare more affordable for all.
We would like to add that while MediShield Life will provide better benefits and coverage for large hospital bills and outpatient treatments, we need to be careful not to encourage over-consumption of healthcare services, which will ultimately lead to higher bills and premiums. Patients will find themselves having to pay more Medisave or cash for their co-payment, and all Singaporeans will also have to bear higher health insurance premiums.
Ms Lim Bee Khim
Director, Corporate Communications
Ministry of Health
MOH's Reply (Chinese)
保健储蓄已逐步扩大用途
联合早报, 2015年06月23日
答复
谨答复《联合早报·交流站》于6月15日刊登的赵万兴读者投函《保健储蓄应只设限不设用》:
保健储蓄开始实行时,目的是为了协助国人支付住院费用,尤其是在年老的时候。这些年来,政府扩大了其用途,允许人们用保健储蓄来支付昂贵的门诊治疗开销,比如癌症、洗肾和慢性病治疗(可以减少将来出现并发症或更昂贵住院费用的可能性)。
目前,保健储蓄也可以用在经临床证明有效和符合成本效益的健康检查与注射疫苗。比如,满50岁国人的结肠内窥镜检查和乳房X光检测。最近,保健储蓄进一步扩大到包括非癌症的门诊扫描(一年不超过300元)。正如赵先生所建议,除了上述,整体上,政府也允许国人更灵活使用保健储蓄来支付门诊费用。根据名为灵活保健储蓄(Flexi-Medisave)的新计划,满65岁的年长者每年可以使用保健储蓄来支付最多200元的门诊费用。
保健储蓄的数额是以人们可能需要的医疗费用为依据。卫生部不时检讨保健储蓄的用途,也必须在扩大其用途和确保国人在退休时有足够储蓄支付住院费和医疗保险费之间,取得平衡。
为了帮助国人支付门诊费用,政府提高了低中收入人士在公共医院、综合诊疗所和参与社保援助计划的私人和牙科诊所可以享有的津贴。建国一代更是享有额外津贴。保健储蓄、健保双全和保健基金这个保健体系,加上政府津贴,让国人都能负担得起医疗费用。
对于巨额的住院和门诊账单,终身健保可以提供更多的好处和保障。但我们必须谨慎以免造成人们过度使用医疗服务,最终面对更高的账单和保费。若出现这样的情况,病患将发现必须动用更多保健储蓄或现金来支付自付额,而所有新加坡人也得支付更高的保费。
卫生部
行政传播司司长
林美琴
Forum Letter (Chinese)
保健储蓄应只设限不设用
2015年06月15日
实行多年的医疗保健体系“3M”,即保健储蓄(Medisave)、健保双全(Medishield)和保健基金(MediFund),三种之中以保健储蓄为最常出现的热门话题,几乎每一年总理的国庆群众大会演说以及国会辩论财政预算案时都会提及。
主要原因相信是这项强制的医疗储蓄计划,只能局部提取来支付指定疾病的医疗费,加上诸多使用限制,让国人质疑它存在的目的,而公积金局总是以“为了避免国人的保健户头过早耗尽,因此就得限制使用”来答复。
针对“过早耗尽”的忧虑是否属实,我们未曾看到公积金局公布实例和相关的统计数字以作证明。如果只占少数,也许是时侯全面检讨和再放宽现行的限用条例了。
即将实行的终身健保计划(MediShield Life)进一步扩大其覆盖面和更高的索偿额,在人人受保、终身受保、先天性疾病也受保,又没有健康状况的限制及取消终身索偿顶限下,终身健保基本上为国人提供更全面的医疗保障,因此政府应该允许各种非住院的疾病(慢性或不慢性以及牙科服务),在私人诊所戓政府诊疗所看家庭医生或牙医的费用,全由保健储蓄来支付,因为“过早耗尽”的可能性已大大降低。
虽然终身健保计划的保费会因此提高,但李显尤总理在去年6月结束访美后在纽约向随行记者说,政府会确保它永远是每一个国民都能负担得起的,没有人会因经济困难而断保。在推出初期,政府将为所有国人提供津贴,之后,所有健国一代和中低收入的家庭,将分别获得永久和15%至30%的津贴,这样一来,动用保健储蓄的数额必大大减少。
因此,只要我们为各不同的病症设年顶限(以防止保健储蓄被滥用或过度消费),例如门诊费用200元、癌症类扫描600元、非癌症类扫描200元、慢性疾病400元等等,“只设限不设用”是行得通的,既使因特殊情况要把病医好而用完所有的保健储蓄,往后无法再用保健储蓄来支付医疗账单的国人,则可从保健基金获得帮助。若担心被滥用,可设限只让中低收入者(配合建国50年,建议从50岁开始)提用。
在等待更多详情出炉前,期盼政府也能让国人动用保健储蓄来支付常年健康检验费(体检)。所谓病从浅中医,越早从体检中诊断出病情,其痊愈的机会就越高。有了健康的身体,更多上了年级的国人就能继续留在工作岗位上,这无疑能舒缓我国所面对的劳工短缺问题。
赵万兴