政壇：睇社論學英文：索償投訴年年增 推銷醫保枉費心

保險索償投訴局去年共接獲五百三十五宗投訴，較前年大幅上升一成二，在已審結的三百四十三宗個案中，接近五成是涉及住院及醫療保單的投訴，當中三成三涉及保單及條款的詮釋問題，兩成六為不保項目的爭議。保險公司拒賠理由千奇百怪，有投訴人被確診患上心肌梗塞，但保險公司卻以「醫療報告沒有顯示心肌酵素大幅上升」為由拒絕賠償；有在境外求醫的心臟病患者被指「隱瞞高血壓症狀」，申索住院治療費用不果，最終鬧到投訴局才取回公道。

在商言商，保險公司首先考慮自身利益，無可厚非，港府作為監管者，有責任堵塞漏洞，督促保險公司增加透明度，保障消費者權益。荒唐的是，當局對保險業的亂象一直坐視不理，反而千方百計企圖推行醫保計劃，這豈不是亂上加亂？

說穿了，前朝政府一意孤行推行自願醫保計劃，無非以民為笨，企圖推卸醫療責任。當局與其為前朝埋單，不如集中精力搞好保險監管，推動公共醫療改革！

It is useless to push for universal healthcare insurance amidst increasing complaints against the insurance industry

The purpose of taking out insurance, particularly medical insurance, is the protection from risks; to be prepared is to have peace of mind. Unfortunately, the government's inadequate regulation has resulted in an insurance industry intermingled with good and bad insurers. So much so that it is easy to buy insurance, but difficult to make a successful claim. Loads of disputes and chaos have thus been derived.

The Insurance Claims Complaints Bureau received a total of 535 complaints last year, a sharp rise of 12% from 2012. Among the 343 cases on which the investigation was completed, over 50% were about hospitalization and medical policies. On medical policies, 33% were about the interpretation of policy clauses, 26% were about items not covered. There were all sorts of fanciful reasons that insurance companies adduced to refuse compensations. A complainant was diagnosed with myocardial infarction, but the insurer rejected his claim because "the medical report did not show a significant increase in cardiac enzyme". Another complainant with heart disease sought medical consultation outside Hong Kong. The insurer said he "covered up his symptoms of hypertension" and his claim for hospitalization fee was turned down. Eventually he had to complain to the Insurance Claims Complaints Bureau before justice was done.

Insurance companies are in for the business. So it is understandable if they think of their own interests first. As the regulator, the government has the responsibility to plug the loophole by urging the insurers to enhance their transparency so as to safeguard the consumers' interest. It is absurd for the government to just sit and watch the chaos go on in the insurance industry, and at the same time to try to push for universal healthcare insurance by hook or by crook. Isn't that just heaping chaos upon chaos?

The truth is: the former government obstinately sold the idea of voluntary healthcare insurance to the people because it thought they were stupid, and its responsibility of providing healthcare services could be shifted onto them. Instead of footing the bill for the former government, the present administration should better focus on regulating the insurance industry and reforming public healthcare services.

重要生字

take out insurance 購買保險

by hook or by crook 千方百計

heap chaos upon chaos 亂上加亂