新加坡衛生部長王乙康：醫療成本上升的原因

2024年3月6日，新加坡衛生部長王乙康答複議員

以下内容為新加坡眼根據國會英文資料翻譯整理：

主席：林偉傑醫生

林偉傑醫生（三巴旺）：主席先生，我有兩點需要澄清。

首先是關于日間手術。我們知道，與住院後并進行手術相比，日間手術可以降低成本。衛生部是否願意探讨如何擴大并改變日間手術的模式？這意味着沒有目前實行的 24 小時限制。如果我們能将日間手術延長至 36 小時或 72 小時，這能讓我們以日間手術的方式開展更多的手術，而日間手術确實可以降低成本，我想這點已經有長時間的證明。

第二項補充質詢是關于醫療成本。我們關注醫療成本的增長，因為無論是保險費、保健儲蓄還是自己付費，家庭醫療支出都會增加，不管這三者以外的費用如何，這三者都會繼續增長。新加坡目前的私人醫療保險費用在全球排名第三。我們僅次于美國和香港。我希望我們費用不再攀升，不要超越香港。

據我所知，”終身健保計劃 “的保費現正接受檢讨。保費将會增加。我想請問部長，該項檢讨将于何時完成，何時會公布保費的增幅，以及保費的增幅會否引緻其他私人保險的保費亦相應增加。私人保險費每年上漲約 20%，我認為這不是一個可持續的比率。

最後，對于保健儲蓄（MediSave），這還是我們的錢。保健儲蓄的用途現在已經擴充了很多，包包覆院、門診使用以及健康篩查費用。在考慮到人口老齡化和預期壽命延長的情況下，目前的保健儲蓄金額是否足夠？

主席：王乙康部長。

王乙康部長：我完全同意林醫生關于日間手術重要性的看法。我們的公共衛生機構一直在努力将盡可能多的手術轉換為日間手術，如同林醫生提到的，如果可能的話，我們将繼續進行門診手術。

我提到住院時間在疫情前後增加了，達到了六到七天。如果沒有我們推動将許多手術轉換為日間手術或縮短住院時間，影響實際上會更大。但我們設法将其控制在六到七天。即使如此，正如我提到的，這也意味着工作量增加了15%。我們将繼續在這方面努力。

首先，關于保健儲蓄。保健儲蓄的用途已經擴大。目前是否足夠？我們最近做了一個研究。目前我們認為是相當充足的。但我們會繼續關注這個情況，尤其是在我們無法控制保費上漲的時候。我認為這将對保健儲蓄造成相當大的消耗。但這是我們必須監控的事情。

林醫生還問了幾個關于終身健保（MediShield Life）、私人保險以及保費的問題。我直說了吧。我剛才宣布和讨論的目的是降低醫療成本。醫療成本上升不僅是因為保險保費，主要是因為住院賬單，特别是重大醫療事件的賬單，年年在增加。是以，如果我們想控制家庭的醫療成本，就需要提高索賠限額。這次調整的主要目的是提高終身健保的索賠限額，這意味着它适用于有重大醫療事件補貼的患者。提高索賠限額，這樣他們的醫療成本就可以控制在可管理的範圍内。當然，這會對終身健保保費産生影響。但正如我提到的，我們會盡力通過保健儲蓄來幫助他們支付。我提到了一些我們可以做的事情：增加補貼，為特定群體進行補貼，如果可能的話找到辦法讓我們都能管理好。我認為這是管理醫療成本的更好方法。

林醫生提到私人保費。這些是私人和商業運作的保險保費，它們一直在上漲。我不知道我們有世界第三高的保費。我認為我們必須比較相同類型的保險，蘋果對蘋果，橙子對橙子，因為這取決于是什麼樣的保險計劃。它們涵蓋什麼？适用于哪個群體？我不知道，但我們可以看看。但我必須說，正如我剛才在演講中提到的，盡管保費在上漲，我仍然看到保險公司在争奪市場佔有率，提供明顯不可持續的條款。我真的希望他們能在某個時候控制住，采取更規範的做法，這樣我們也能調控私人保險保費。

以下是英文質詢内容：

The Chairman: Dr Lim Wee Kiak.

Dr Lim Wee Kiak (Sembawang): Sir, I have two clarifications.

First is on day surgery. We know that day surgery lowers the cost, as compared to an in-hospital case, if they do some form of surgery. Would MOH be willing to explore to see how to expand day surgery, to change it to an outpatient surgery model instead? Which means that they do not have that 24-hour limit that is currently in place now. If we can extend it to 36 hours or 72 hours, that will actually allow us to have a bigger range of procedures to be done as day surgery. And day surgery really cuts costs. I think that is proven for a long time already.

The second supplementary question is on healthcare cost. We are concerned with healthcare cost increases because the total household medical expenditure will go up, whether it is premium from insurance, whether it is their MediSave or whether it is out of pocket, because out of all these three, these three will continue to go up. Our current private healthcare insurance premium now in Singapore is the third highest in the world. We are just after the US and Hong Kong. I hope that we will not climb further and overtake Hong Kong.

I understand that MediShield Life premium is under review now. It will go up. I would like to ask the Minister when the review will be completed, when this increase in premium will be announced and whether this increase in premium will also lead to other private insurance premiums to go up as well. Private insurance premium has gone up by about 20% per year and this is not a sustainable rate in my opinion.

Then last of all, for MediSave, it is still our money. MediSave uses have been expanded a lot now, including hospitalisation, clinic uses now, health screening cost. Is the current MediSave amount that we have now sufficient in consideration of an ageing population, as well as increased lifespan?

The Chairman: Minister Ong.

Mr Ong Ye Kung: I fully agree with Dr Lim on the importance of day surgery. Our public health institutions have been trying to convert as many surgeries as possible to day surgery and, like the Member mentioned, outpatient surgery if possible. We will continue to do that.

I mentioned length of stay increased pre- and post-pandemic, six to seven days. Without our push to convert many surgeries to day surgeries or even shortened stays, the impact actually would have been far worse. But we managed to contain it to six to seven days. Even that, as I mentioned, is a 15% increase in workload. And we will continue to work on this front.

First, on MediSave. The uses of MediSave have expanded. Is it currently enough? We did a study recently. As of now, we think it is quite adequate. But we will continue to monitor the situation, especially if we cannot contain the rise in premiums. Then, I think the drain on MediSave will be quite significant. But, it is something we will have to monitor.

Dr Lim asked a couple of questions on MediShield Life, private insurance as well as premium. Let me put it straight. What I just announced and talked about is to reduce healthcare cost. Healthcare cost is increased not just because of insurance premium. It has an impact mostly because hospital bills, especially for significant episodes, are getting larger and increasing year by year. Therefore, if we want to control healthcare costs for the families, we need to raise claims limits. That is the whole purpose of this exercise. Increase the claim limits of MediShield Life, which means it is for subsidised patients when they have a major healthcare episode. Increase the claim limits, so that healthcare cost for them is manageable. Of course, this comes with an impact on MediShield Life premiums. But as I mentioned, we will try our best to help them pay for it through their MediSave. And I mentioned a few things that we can do: increase subsidies, do top-ups for specific groups if possible, find ways so that we can all manage. And I think this is a better way to manage healthcare costs.

The Member mentioned private premiums. These are private and commercially run insurance premiums and they have been going up. I am unaware that we have the third highest premiums in the world. I think we have to be comparing apples to apples, oranges to oranges, because it depends on what kind of insurance plans are they. What do they cover? Apply to which group? I am not aware, but we can take a look. But I do have to say, as I mentioned, with some frustration in my speech just now, despite rising premiums, I still see insurance companies competing for market share, offering terms that are obviously unsustainable. And I really hope that, at some point, they will rein this in and exercise more discipline so that we also moderate private insurance premiums.

CF丨編輯

CF丨編審

新加坡國會丨來源

新加坡國會丨圖源

1.凡本網站注明文章類型為“原創”的所有作品，版權屬于看南洋和新加坡眼所有。其他媒體、網站或個人轉載使用時必須注明：“文章來源：新加坡眼”。

2.凡本網站注明文章類型為“轉載”、“編譯”的所有作品，均轉載或編譯自其他媒體，目的在于傳遞更多有價值資訊，并不代表本公衆号贊同其觀點和對其真實性負責。