新加坡卫生部长王乙康：医疗成本上升的原因

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2024年3月6日，新加坡卫生部长王乙康答复议员

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以下内容为新加坡眼根据国会英文资料翻译整理：

主席：林伟杰医生

林伟杰医生（三巴旺）：主席先生，我有两点需要澄清。

首先是关于日间手术。我们知道，与住院后并进行手术相比，日间手术可以降低成本。卫生部是否愿意探讨如何扩大并改变日间手术的模式？这意味着没有目前实行的 24 小时限制。如果我们能将日间手术延长至 36 小时或 72 小时，这能让我们以日间手术的方式开展更多的手术，而日间手术确实可以降低成本，我想这点已经有长时间的证明。

第二项补充质询是关于医疗成本。我们关注医疗成本的增长，因为无论是保险费、保健储蓄还是自己付费，家庭医疗支出都会增加，不管这三者以外的费用如何，这三者都会继续增长。新加坡目前的私人医疗保险费用在全球排名第三。我们仅次于美国和香港。我希望我们费用不再攀升，不要超越香港。

据我所知，"终身健保计划 "的保费现正接受检讨。保费将会增加。我想请问部长，该项检讨将于何时完成，何时会公布保费的增幅，以及保费的增幅会否引致其他私人保险的保费亦相应增加。私人保险费每年上涨约 20%，我认为这不是一个可持续的比率。

最后，对于保健储蓄（MediSave），这还是我们的钱。保健储蓄的用途现在已经扩展了很多，包括住院、门诊使用以及健康筛查费用。在考虑到人口老龄化和预期寿命延长的情况下，目前的保健储蓄金额是否足够？

主席：王乙康部长。

王乙康部长：我完全同意林医生关于日间手术重要性的看法。我们的公共卫生机构一直在努力将尽可能多的手术转换为日间手术，如同林医生提到的，如果可能的话，我们将继续进行门诊手术。

我提到住院时间在疫情前后增加了，达到了六到七天。如果没有我们推动将许多手术转换为日间手术或缩短住院时间，影响实际上会更大。但我们设法将其控制在六到七天。即使如此，正如我提到的，这也意味着工作量增加了15%。我们将继续在这方面努力。

首先，关于保健储蓄。保健储蓄的用途已经扩大。目前是否足够？我们最近做了一个研究。目前我们认为是相当充足的。但我们会继续关注这个情况，尤其是在我们无法控制保费上涨的时候。我认为这将对保健储蓄造成相当大的消耗。但这是我们必须监控的事情。

林医生还问了几个关于终身健保（MediShield Life）、私人保险以及保费的问题。我直说了吧。我刚才宣布和讨论的目的是降低医疗成本。医疗成本上升不仅是因为保险保费，主要是因为住院账单，特别是重大医疗事件的账单，年年在增加。因此，如果我们想控制家庭的医疗成本，就需要提高索赔限额。这次调整的主要目的是提高终身健保的索赔限额，这意味着它适用于有重大医疗事件补贴的患者。提高索赔限额，这样他们的医疗成本就可以控制在可管理的范围内。当然，这会对终身健保保费产生影响。但正如我提到的，我们会尽力通过保健储蓄来帮助他们支付。我提到了一些我们可以做的事情：增加补贴，为特定群体进行补贴，如果可能的话找到办法让我们都能管理好。我认为这是管理医疗成本的更好方法。

林医生提到私人保费。这些是私人和商业运行的保险保费，它们一直在上涨。我不知道我们有世界第三高的保费。我认为我们必须比较相同类型的保险，苹果对苹果，橙子对橙子，因为这取决于是什么样的保险计划。它们涵盖什么？适用于哪个群体？我不知道，但我们可以看看。但我必须说，正如我刚才在演讲中提到的，尽管保费在上涨，我仍然看到保险公司在争夺市场份额，提供明显不可持续的条款。我真的希望他们能在某个时候控制住，采取更规范的做法，这样我们也能调控私人保险保费。

以下是英文质询内容：

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.

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