自願醫保大變樣 高官一語露真相

<轉載自2018年3月2日 明報 社評>

政府公布自願醫保計劃詳情，然而市民對計劃能否提供足夠醫療保障，卻是滿腹狐疑，就算財政預算案提供扣稅優惠，恐怕亦未能顯著提高吸引力。自願醫保計劃籌備長達十年，本意是改善公私營醫療失衡，減輕公立醫院壓力，惟政府向保險業界一再妥協，自願醫保嚴重走樣，淪為雞肋。市民明白公院爆煲危機，也明白公私營醫療系統平衡的重要，可是強積金的經驗卻令市民擔心，怕年年花錢購買自願醫保，到頭來卻得不到所需保障，徒然益了保險公司和私家醫院。市民信心不足，自願醫保計劃能否達到預期目標，令人懷疑。

大病「可去公營醫療體系」未設高風險池成醫保死穴

自願醫保計劃歷經3屆政府構思籌備，終於有望明年正式推出市場，保險公司將提供兩類認可產品，分別是「標準計劃」及「靈活計劃」，供消費者選擇。食衛局長陳肇始強調，政府與保險業界磋商多時，自願醫保的保障範圍已大大提升，然而陳局長一句市民如有大病「可以去公營醫療體系」，卻清楚暴露了自願醫保計劃的不足，一旦市民不幸罹患重病，就算買了自願醫保，也未必能在開支方面幫上大忙。

本港公私營醫療系統嚴重失衡，公營醫療系統僱用本港四成醫生，卻要照顧全港九成住院病人，私家醫院收費昂貴，只有小撮人負擔得起。自願醫保的原意，是鼓勵一些中產市民選用私營醫療服務，從而減輕公院負擔，問題是現在政府推出的自願醫保，跟最初構思差距實在太大，既沒有「高風險池」，也不是「來者不拒」，對市民吸引力大減。

自願醫保計劃若要成事，必須保險業的配合，結果卻是整個計劃由諮詢、草擬到推動，政府處處都受制於保險業界，不斷讓步。例如政府為了幫助老弱和長期病患人士買到醫療保險，提出設立高風險池，由政府注資數十億元，幫病人的保費「封頂」，要求保險公司必須承保，可是業界認為政府注資金額不足，擔心蒙受損失，拒絕配合。最終高風險池建議束諸高閣，落實無期，投保人要麼選擇不包括已有疾病的保單，藉以減少保費開支，要麼接受保險公司開出的高昂保費。對於長期病患者來說，這等同叫他們繼續依靠公共醫療服務。雖然陳肇始大力淡化未設高風險池的影響，可是自願醫保少了這個賣點，吸引力已大打折扣。

無可否認，自願醫保計劃在保單標準化、提升醫保產品質素等方面，仍有一定作用。政府為求唱好自願醫保，一邊表示承保範圍會擴展至未知的已有疾病、先天疾病、非手術癌症及精神疾病治療等， 一邊又強調無論「標準計劃」還是「靈活計劃」，均保證可以續保至100歲，不設「終身保障限額」，然而投保年齡其實設有限制，逾80歲者不可以投保。這跟10年前政府提倡「來者不拒」，存在明顯落差。政府沒有為續保時的保費增幅設定上限，更有可能令投保人大失預算。最需要醫療保險的人，從來不是年輕力壯的一群，而是體弱多病健康欠佳的人。自願醫保不斷收縮「走樣」，不禁令人質疑，計劃究竟是以市民還是保險公司的利益先行。

政策遷就業界利益 強積金前車惹憂慮

政府希望自願醫保計劃能減輕公院壓力，為了鼓勵市民購買，財政預算案提出保費扣稅措施，每名投保人每年扣稅金額上限為8000元，然而投保人實際可以少付的稅款，平均也不過是數百元，誘因不大。對政府來說，當前自願醫保計劃最弔詭之處，是計劃如果成效不彰，固然無法改善公私營醫療失衡，減輕公院壓力；可是如果計劃反應很理想，私院生意大增，也有可能引發一場「醫護挖角潮」，導致公院流失大批醫生，不勝負荷。要改善本港公營醫療系統壓力，關鍵始終是大幅增加醫護人手和公院牀位，自願醫保計劃充其量只能起到輔助作用。

推動公私營合作，本是改善民生服務的好方法，問題是政府太過容易向業界利益妥協，令政策走樣變形，市民只見大企業趁機發財，卻未覺自己得到合理回報，強積金正是典型例子。強積金理應是保障市民退休生活的制度，然而實際卻變成基金公司賺個盆滿缽滿的工具，強積金行政管理費（基金開支比率）平均達到1.56%，遠高於外國的管理費用，打工仔血汗錢不斷遭蠶食，政府欲管無從。強積金前車可鑑，市民難免擔心，自願醫保計劃執行起來，會否重蹈覆轍。自願醫保計劃面對的最大問題，是保障未如理想、保費又不便宜。政府估計自願醫保一年保費平均需要4800元，可是保險業界人士已即時指出，實際金額恐怕不止於此，就算預算案保費扣稅大幅加碼，恐怕也未必能顯著提高市民購買意欲。

Misshapen health insurance scheme

THE GOVERNMENT has announced the details of the voluntary health insurance scheme (VHIS), but citizens are very doubtful that it will give them adequate health care protection. The Budget measure of providing a tax deduction is unlikely to make it markedly more appealing. It took as long as ten years to make preparations for the VHIS. It is supposedly designed to alleviate the imbalance between the public and private health care sectors so as thereby to reduce the pressure on public hospitals. However, because the government has repeatedly made concessions to the insurance industry, the VHIS has gone very much out of shape and become what is like "chicken ribs".

Secretary for Food and Health Sophia Chan stressed that the scope of protection under the VHIS has been broadened after repeated negotiations with the insurance industry. However, the Secretary commented that citizens "may go to public hospitals" if they have a major illness. It has clearly exposed the shortcomings of the scheme. The industry's support is essential for such a scheme's success. Because of that, the government has all along been hamstrung by the industry during the consultation, its formulation as well as its promotion. It has kept giving way. For example, to help the aged, infirm and chronically ill to get health insurance, the government proposed that a high-risk pool be set up into which it would inject several billion dollars so that their premium payments could be capped and insurers could be required to offer them policies. However, the industry considered the government's injection inadequate and refused to cooperate with it for fear of sustaining losses. The high-risk pool proposal has eventually been shelved and will not be carried out in the foreseeable future.

The government hopes the VHIS will help reduce the pressure on public hospitals. To encourage citizens to take out VHIS, the government has announced in the Budget a tax reduction. The annual tax ceiling of premium for tax reduction is $8,000 per policyholder. As a policyholder will on average pay the Inland Revenue only a few hundred dollars less, the measure is not much of an incentive. If the VHIS does not produce remarkable results, the imbalance between the public and private health care sectors will remain as it is, and the pressure on public hospitals will not ease. If it is quite well received, private hospitals will do much more business. That may lead to major efforts to lull away doctors and nurses from public hospitals. If public hospitals lose large numbers of doctors, they will become unbearably overloaded. That is to the government the most marked singularity of the VHIS. The key way of reducing the pressure on Hong Kong public hospitals is after all to increase in a big way the number of doctors, that of nurses and that of public hospital beds. The VHIS will at most have a supplementary effect.

It is actually a good way of improving daily-life services offered to citizens. The problem is that the government is so prone to make concessions to industries that its policies are likely to become misshapen. Instead of feeling they will get reasonable returns, citizens see big companies seize opportunities to make piles of money. The Mandatory Provident Fund (MPF) Scheme is a case in point. Seeing the overturned MPF cart ahead, citizens cannot but worry the VHIS may go the same way. The biggest problem of the VHIS is unsatisfactory protection and not-at-all-low premium payments. The government estimates a policyholder will on average have to pay his insurer $4,800 a year. But insurers have promptly pointed out the actual amount is likely to top that. Even if the government offers a much bigger tax reduction, it can hardly hike citizens' propensity to get VHIS coverage.

自願醫保大變樣 高官一語露真相

政府公布自願醫保計劃詳情，然而市民對計劃能否提供足夠醫療保障，卻是滿腹狐疑，就算財政預算案提供扣稅優惠，恐怕亦未能顯著提高吸引力。自願醫保計劃籌備長達十年，本意是改善公私營醫療失衡，減輕公立醫院壓力，惟政府向保險業界一再妥協，自願醫保嚴重走樣，淪為雞肋。

食衛局長陳肇始強調，政府與保險業界磋商多時，自願醫保的保障範圍已大大提升，然而陳局長一句市民如有大病「可以去公營醫療體系」，卻清楚暴露了自願醫保計劃的不足。自願醫保計劃若要成事，必須保險業的配合，結果卻是整個計劃由諮詢、草擬到推動，政府處處都受制於保險業界，不斷讓步。例如政府為了幫助老弱和長期病患人士買到醫療保險，提出設立高風險池，由政府注資數十億元，幫病人的保費「封頂」，要求保險公司必須承保，可是業界認為政府注資金額不足，擔心蒙受損失，拒絕配合。最終高風險池建議束諸高閣，落實無期。

政府希望自願醫保計劃能減輕公院壓力，為了鼓勵市民購買，財政預算案提出保費扣稅措施，每名投保人每年扣稅金額上限為8000元，然而投保人實際可以少付的稅款，平均也不過是數百元，誘因不大。對政府來說，當前自願醫保計劃最弔詭之處，是計劃如果成效不彰，固然無法改善公私營醫療失衡，減輕公院壓力；可是如果計劃反應很理想，私院生意大增，也有可能引發一場「醫護挖角潮」，導致公院流失大批醫生，不勝負荷。要改善本港公營醫療系統壓力，關鍵始終是大幅增加醫護人手和公院牀位，自願醫保計劃充其量只能起到輔助作用。

推動公私營合作，本是改善民生服務的好方法，問題是政府太過容易向業界利益妥協，令政策走樣變形，市民只見大企業趁機發財，卻未覺自己得到合理回報，強積金正是典型例子。強積金前車可鑑，市民難免擔心，自願醫保計劃執行起來，會否重蹈覆轍。自願醫保計劃面對的最大問題，是保障未如理想、保費又不便宜。政府估計自願醫保一年保費平均需要4800元，可是保險業界人士已即時指出，實際金額恐怕不止於此，就算預算案保費扣稅大幅加碼，恐怕也未必能顯著提高市民購買意欲。