2024年3月6日，新加坡衛生部高級政務次長拉哈尤·瑪贊女士回答議員有關弱勢群體如何獲得更多醫療補助的問題。
拉哈尤·瑪贊
衛生部
高級政務次長
裕廊集選區議員
以下內容為新加坡眼根據國會英文資料翻譯整理：
提供有針對性援助的另一個方面是確保負擔的起，特別是對於那些更需要的人群。我們感謝各位議員提出的關於我們如何做到這一點的問題。
首先，在早前的預算辯論中，陳舜娘女士要求澄清我們對長期護理補貼的資格審查標準。這些補貼是通過人均家庭收入和房屋的年價值進行資格審查，以確保補貼給那些更需要的人。雖然這些指標並不全面，但它們是目前可用的最佳衡量個人財務狀況的方式，只有極少數長期護理客戶由於年價值標準而不符合資格獲得補貼。
為確保那些有更大需求的人能夠持續獲得援助，政府最近提高了申請援助的人均家庭收入和房屋年價值門檻。面臨支付長期護理費用困難的老年人可以申請援助。
其次，陳有明醫生提出了兩項建議：一是授權更多機構協助進行醫療基金申請，二是對外籍家庭看護工減免徵收的全面性方法。
我們同意為有需要的患者簡化求助流程。這就是為什麼今天，由社會服務中心確定為接受社區關懷計劃援助的新加坡人，在批准的醫療機構自動獲得保健基金計劃援助。我們最近制定了指導方針，允許機構在更多類型的情況下相互認可保健基金計劃的評估。
各個機構也已經建立了以患者為中心的流程，並利用IT平台來簡化申請過程。雖然利用其他機構可以提高一些患者申請保健基金計劃的便利性，但這在流程中引入了額外的部門，因此需要進一步研究，以避免無意中延長申請過程。
至於外籍家庭看護工減免徵收的情況，日常生活活動（ADLs）仍然是評估這些申請的一個關鍵因素。具有多種疾病或處於生命末期的虛弱患者往往至少需要長期護理，並且將符合減免資格。個別情況將逐案評估例外情況。我們將繼續審查資金支持方案的充分性，以支持照顧者和他們的長者。
關於陳醫生提出的案例，陳醫生應該知道護聯中心和徐女士一起的通信。在護聯中心重新與她聯繫後，取得了積極的結果。不幸的是，在此之前有一次誤解，護聯中心被誤以為徐女士的表弟是外籍家庭看護工的僱主，而實際上是徐女士。最終，她符合資格並獲得了減免和家庭照護補助，兩者都追溯到她符合資格的時候。
第三，針對嚴燕松先生的問題，我們通過各種資金支持計劃，包括補貼、國家保險計劃、醫療儲蓄、補助和安全網（如保健基金計劃），來支援殘障人士和特殊需求人士的需求。我們最近增強了其中一些計劃。例如，在2023年，家庭照護補助的支付額增加到每月最高400新元，以進一步降低照護成本。一般而言，醫療補貼不是基於特定條件，而是根據收入水平分層設定，以便更有針對性地幫助那些需要幫助的人。
第四，針對王華瀚先生關於支持患有脊髓性肌萎縮症（SMA）患者的問題，目前有幾種治療方法，包括藥物和細胞和基因療法產品。我們正在審查這些治療方法的臨床和成本效益，並與製藥公司進行溝通，以達成合理的價格。正如部長所提到的，終身健保委員會正在考慮將符合條件的細胞和基因療法產品納入覆蓋範圍，並研究必要的保障措施，以確保是可持續的。在此期間，面臨困難的患者可以通過保健基金計劃或罕見疾病基金申請自願資金支援。
最後，一些議員也詢問了針對計劃生育人士提供的支援。在設計融資計劃以更好地支持這一群體時，有幾個考慮因素。這些包括生育檢查和治療的臨床安全性和有效性，確保那些需要的人負擔得起，並保持我們的融資計劃的可持續性。
以下是英文質詢內容：
(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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