2024年3月6日，新加坡卫生部高级政务次长拉哈尤·玛赞女士回答议员有关弱势群体如何获得更多医疗补助的问题。
拉哈尤·玛赞
卫生部
高级政务次长
裕廊集选区议员
以下内容为新加坡眼根据国会英文资料翻译整理：
提供有针对性援助的另一个方面是确保负担的起，特别是对于那些更需要的人群。我们感谢各位议员提出的关于我们如何做到这一点的问题。
首先，在早前的预算辩论中，陈舜娘女士要求澄清我们对长期护理补贴的资格审查标准。这些补贴是通过人均家庭收入和房屋的年价值进行资格审查，以确保补贴给那些更需要的人。虽然这些指标并不全面，但它们是目前可用的最佳衡量个人财务状况的方式，只有极少数长期护理客户由于年价值标准而不符合资格获得补贴。
为确保那些有更大需求的人能够持续获得援助，政府最近提高了申请援助的人均家庭收入和房屋年价值门槛。面临支付长期护理费用困难的老年人可以申请援助。
其次，陈有明医生提出了两项建议：一是授权更多机构协助进行医疗基金申请，二是对外籍家庭看护工减免征收的全面性方法。
我们同意为有需要的患者简化求助流程。这就是为什么今天，由社会服务中心确定为接受社区关怀计划援助的新加坡人，在批准的医疗机构自动获得保健基金计划援助。我们最近制定了指导方针，允许机构在更多类型的情况下相互认可保健基金计划的评估。
各个机构也已经建立了以患者为中心的流程，并利用IT平台来简化申请过程。虽然利用其他机构可以提高一些患者申请保健基金计划的便利性，但这在流程中引入了额外的部门，因此需要进一步研究，以避免无意中延长申请过程。
至于外籍家庭看护工减免征收的情况，日常生活活动（ADLs）仍然是评估这些申请的一个关键因素。具有多种疾病或处于生命末期的虚弱患者往往至少需要长期护理，并且将符合减免资格。个别情况将逐案评估例外情况。我们将继续审查资金支持方案的充分性，以支持照顾者和他们的长者。
关于陈医生提出的案例，陈医生应该知道护联中心和徐女士一起的通信。在护联中心重新与她联系后，取得了积极的结果。不幸的是，在此之前有一次误解，护联中心被误以为徐女士的表弟是外籍家庭看护工的雇主，而实际上是徐女士。最终，她符合资格并获得了减免和家庭照护补助，两者都追溯到她符合资格的时候。
第三，针对严燕松先生的问题，我们通过各种资金支持计划，包括补贴、国家保险计划、医疗储蓄、补助和安全网（如保健基金计划），来支援残障人士和特殊需求人士的需求。我们最近增强了其中一些计划。例如，在2023年，家庭照护补助的支付额增加到每月最高400新元，以进一步降低照护成本。一般而言，医疗补贴不是基于特定条件，而是根据收入水平分层设定，以便更有针对性地帮助那些需要帮助的人。
第四，针对王华瀚先生关于支持患有脊髓性肌萎缩症（SMA）患者的问题，目前有几种治疗方法，包括药物和细胞和基因疗法产品。我们正在审查这些治疗方法的临床和成本效益，并与制药公司进行沟通，以达成合理的价格。正如部长所提到的，终身健保委员会正在考虑将符合条件的细胞和基因疗法产品纳入覆蓋范围，并研究必要的保障措施，以确保是可持续的。在此期间，面临困难的患者可以通过保健基金计划或罕见疾病基金申请自愿资金支援。
最后，一些议员也询问了针对计划生育人士提供的支援。在设计融资计划以更好地支持这一群体时，有几个考虑因素。这些包括生育检查和治疗的临床安全性和有效性，确保那些需要的人负担得起，并保持我们的融资计划的可持续性。
以下是英文质询内容：
(In English): Another dimension of providing targeted support is ensuring affordability, particularly for those who need it more. We thank Members for your questions on how we are doing so.
First, at the earlier Budget Debate, Ms Jessica Tan requested clarifications on our means-testing criteria for long-term care subsidies. These subsidies are means-tested using Per Capita Household Income and Annual Value of residence to ensure that subsidies are targeted at those who need it more. While these are not perfect proxies, they are the best available to measure an individual's means and family support, and only a small minority of long-term care clients do not qualify for subsidies because of the Annual Value criterion.
To ensure that those with greater needs receive continued support, the Government recently raised the Per Capita Household Income and Annual Value thresholds for all means-tested social support schemes and grants. Seniors who face difficulties paying for their long-term care expenses may apply for the discretionary financial assistance.
Second, Dr Tan Wu Meng has made two suggestions on empowering more organisations to assist with MediFund applications and taking a holistic approach to Migrant Domestic Worker Levy Concession applications.
We agree with the intent to smoothen help-seeking processes for needy patients. This is why, today, Singaporeans identified by Social Service Offices to receive ComCare assistance automatically receive MediFund assistance at approved healthcare institutions. We have recently introduced guidelines to institutions to allow mutual recognition of MediFund assessments for more types of circumstances.
On the ground, institutions have also put in place patient-centric processes and leverage IT platforms to smoothen the application process. While tapping on other organisations could improve convenience of applying MediFund for some patients, it introduces an additional layer in the process and, therefore, needs to be studied further to avoid lengthening the application process inadvertently.
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As for the Migrant Domestic Worker Levy Concession, Activities of Daily Living (ADLs) remain a relevant basis for purposes of assessing these applications. Frail patients with multiple conditions, or those at end-of-life, tend to require some assistance with at least one ADL and would qualify for the concession. Exceptions will be assessed on a case-by-case basis. We will continue to review the adequacy of financing schemes to support caregivers and their seniors.
Regarding the case raised by Dr Tan, Dr Tan would be aware of the correspondences together by the AIC and Ms See. There was a positive outcome after she was re-engaged by AIC. Unfortunately, there was an earlier miscommunication where AIC was led to believe that Ms See's cousin was the employer of the migrant domestic worker when it was, in fact, Ms See. She eventually qualified for and received the concession and Home Caregiving Grant, both backdated to when she qualified.
Third, to Mr Gerald Giam's question, we support the needs of Persons with Disabilities (PwDs) and Persons with Special Needs through various financing schemes, including subsidies, national insurance schemes, MediSave, grants and safety nets, such as MediFund. We have recently enhanced some of these schemes. For example, in 2023, the payouts under the Home Caregiving Grant were increased, from $200, to up to $400 per month to further reduce caregiving costs. In general, healthcare subsidies are not based on specific conditions and are instead tiered based on income level, to target those who need more help.
Fourth, to Mr Ong Hua Han's question on the support for patients with spinal muscular atrophy, there are a few treatments available currently, including drugs and a CTGTP. We are reviewing the clinical and cost-effectiveness of these treatments and are engaging pharmaceutical companies to achieve reasonable prices. As the Minister mentioned, the MediShield Life Council is considering extending coverage to eligible CTGTPs and studying the safeguards needed to ensure that any such extension is sustainable. In the interim, those who face concerns may apply for discretionary funding support through MediFund or the Rare Disease Fund.
Lastly, a few Members have also asked about the support that is provided for those who are planning for a family. There are a few considerations that guide our approach in designing the financing schemes to better support this group of Singaporeans. These include clinical safety and effectiveness of fertility tests and treatments, ensuring affordability for those who need it and keeping our financing schemes sustainable.
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