| IVOD_ID |
15881 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Full/1M/15881 |
| 日期 |
2024-05-06 |
| 影片種類 |
Full |
| 開始時間 |
2024-05-06T08:30:30+08:00 |
| 結束時間 |
2024-05-06T12:16:00+08:00 |
| 影片長度 |
03:45:30 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://h264media01.ly.gov.tw:443/vod_1/_definst_/mp4:1M/bfaf9b39ac01a685d5d059b51b1cfc7090a0be61fea148183be8d109af184be4261f371f5c0ea4ce5ea18f28b6918d91.mp4/playlist.m3u8 |
| 會議時間 |
2024-05-06T09:00:00+08:00 |
| 會議名稱 |
立法院第11屆第1會期社會福利及衛生環境委員會（事由：舉行「全民健康保險醫療給付費用總額之現況與展望」公聽會） |
| 委員名稱 |
完整會議 |
| 委員發言時間 |
08:30:30 - 12:16:00 |
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公聽會議 |
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好現在開始開會那今天本會舉辦全民健康保險醫療給付費用總額之現況與展望公聽會那謝謝各位我們今天的學者跟專家還有各政府機關代表的蒞臨本次公聽會探討的議題以提綱為準那這個提綱在外面可以自行參閱那接下來我先介紹在場的委員 |
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王育民委員林月琴委員陳昭芝委員王振旭委員廖偉祥委員今天邀請的學者專家 |
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社團法人 臺灣社會心理復健協會秘書長藤希華財團法人 臺灣醫療改革基金會執行長林雅慧長庚大學醫務管理學系教授盧瑞芬盧教授國立陽明交通大學衛生福利研究所教授李育春教授 |
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2265.245 |
| transcript.whisperx[4].text |
臺北醫學大學醫務管理學系教授 邱鴻毅教授財團法人 中華民國消費者文教基金會 名譽董事長 謝天仁 謝董事長國立臺灣大學健康政策與管理研究所兼任教授 楊明清 楊教授臺灣醫院協會理事長 李飛鵬 李理事長 |
| transcript.whisperx[5].start |
2267.818 |
| transcript.whisperx[5].end |
2277.981 |
| transcript.whisperx[5].text |
臺灣私立醫療院所協會 吳明彥秘書長臺灣醫務管理學會 洪子仁理事長臺灣社區醫院協會 朱益洪理事長中華民國護理師護士工會全國聯合會 紀淑敬理事長 |
| transcript.whisperx[6].start |
2294.5 |
| transcript.whisperx[6].end |
2301.922 |
| transcript.whisperx[6].text |
中華民國區域醫院協會陳志忠顧問中華民國開發性製藥研究協會陳全文秘書長國立臺灣大學公共衛生學院鄭守夏院長蘇清泉委員 |
| transcript.whisperx[7].start |
2325.027 |
| transcript.whisperx[7].end |
2346.661 |
| transcript.whisperx[7].text |
邱政軍委員那今天的行政機關代表我們的周之浩次長中央健康保險署石崇亮署長社會保險司劉玉娟司長行政院主計總處基金預算處專門委員黃厚吉專門委員 |
| transcript.whisperx[8].start |
2351.752 |
| transcript.whisperx[8].end |
2365.462 |
| transcript.whisperx[8].text |
公務預算處 廖玉琳 專門委員國家發展委員會 人力發展處 謝嘉怡 處長那接下來請衛福部代表報告時間5分鐘那其他兩個機關各3分鐘 |
| transcript.whisperx[9].start |
2375.29 |
| transcript.whisperx[9].end |
2393.844 |
| transcript.whisperx[9].text |
委員 主席 委員 以及各位專家學者 各位女士先生大家早安 大家好今天貴委員會召開全民健康保險醫療給付費用總額的一個現況以及展望公聽會本部列要應邀 |
| transcript.whisperx[10].start |
2396.784 |
| transcript.whisperx[10].end |
2426.008 |
| transcript.whisperx[10].text |
列席參與,我們非常的榮幸,敬請各位委員不吝指教。全民健康保險實施初期的時候,我們是採取論量計酬的支付制度,也因為醫療院所當時缺乏分擔財務貢獻的這些誘因,因此在健保初期的時候,醫療支出遠高於保險的收入,對於健保的財務造成非常沉重的壓力,未能夠有效地控制醫療的這些費用,於是就導入了 |
| transcript.whisperx[11].start |
2426.608 |
| transcript.whisperx[11].end |
2440.642 |
| transcript.whisperx[11].text |
建保總額支付的制度建保總額支付制度到目前實施已經26年了面臨現在新的一些科技及人口老化等等這些挑戰因此委員也就提出了建保法的第62條的修正案 |
| transcript.whisperx[12].start |
2442.283 |
| transcript.whisperx[12].end |
2454.852 |
| transcript.whisperx[12].text |
現在將現行的健保總額支付制度由支出上限的制度改為支出目標的制度保障健保點值為1.0.95元或者是1.1塊錢經過我們這樣推估的話如果是這樣做大約需要增加預算約750億及1155億元的這些經費 |
| transcript.whisperx[13].start |
2468.582 |
| transcript.whisperx[13].end |
2468.722 |
| transcript.whisperx[13].text |
委員會主席 |
| transcript.whisperx[14].start |
2486.735 |
| transcript.whisperx[14].end |
2486.755 |
| transcript.whisperx[14].text |
公聽會議 |
| transcript.whisperx[15].start |
2510.123 |
| transcript.whisperx[15].end |
2516.13 |
| transcript.whisperx[15].text |
我們認為改革需要社會的共識這次的健保法第62條的修正將會牽動整個相關的健保制度所以說我們必須還是要謹慎以對同盤考量整體的相關配套 |
| transcript.whisperx[16].start |
2526.081 |
| transcript.whisperx[16].end |
2545.676 |
| transcript.whisperx[16].text |
讓總額能夠在適度的成長支援合理的分配維持健保的永續同時也能夠照顧到醫療人員獲得合理的薪資待遇更重要的民眾的就醫品質能夠獲得確保今天的公聽會有4個討論的提綱我就不分別再重複了接下來 |
| transcript.whisperx[17].start |
2547.667 |
| transcript.whisperx[17].end |
2573.945 |
| transcript.whisperx[17].text |
那希望能夠藉由今天的公聽會我們大家能夠聽聽看各界的聲音那最好當然是能夠達成共識那我們承蒙大院各委員和指教和監督我們非常謝謝大家那同時也希望各位委員持續的支持那接下來會有我們健保署的同仁跟各位簡報後面的各提綱的一個簡要的說明以上報告 |
| transcript.whisperx[18].start |
2581.21 |
| transcript.whisperx[18].end |
2605.12 |
| transcript.whisperx[18].text |
蘇長要做報告嗎書面簡報嗎跟主席報告就是我們另外有準備一份簡報那因為不知道有多少人我們只提供給委員所以其他的專家可能沒有所以是不是要放出來還是 |
| transcript.whisperx[19].start |
2609.385 |
| transcript.whisperx[19].end |
2610.507 |
| transcript.whisperx[19].text |
請行政院主計總處代表報告 |
| transcript.whisperx[20].start |
2642.232 |
| transcript.whisperx[20].end |
2656.707 |
| transcript.whisperx[20].text |
主席、各位委員、各位與會的各位專家學者主席總署今天很榮幸應邀來參加這個公聽會那以下就簡要報告那有關健保的整個保險收支其實是106年度就呈現短處 |
| transcript.whisperx[21].start |
2657.788 |
| transcript.whisperx[21].end |
2679.801 |
| transcript.whisperx[21].text |
那為了避免這個安全準備低於我們的下限那改善財務狀況其實已經陸續有進行了很多這個措施例如說提升保費調高我們的健保投保金額上限等等那另外呢政府為了紓減這個健保的財務壓力在112跟本年度都有分別撥補健保的240億元及200億元來改善健保整體的財務紓緩他的壓力 |
| transcript.whisperx[22].start |
2686.105 |
| transcript.whisperx[22].end |
2710.305 |
| transcript.whisperx[22].text |
本次委員提案要修正健保法第62條是要把醫療服務的點值在不低於0.95或1元的狀況下由公務預算來補足這個形同是將我們的健保總額制改成按服務量來計籌涉及整體重大的制度變更另外依衛福部的估算如果把點值 |
| transcript.whisperx[23].start |
2711.305 |
| transcript.whisperx[23].end |
2736.168 |
| transcript.whisperx[23].text |
補足到億元每年需要將近1100多億元那將會大幅增加政府的財政負擔影響我們政府的財政健全那以我們的預算法或是財政收支化分法的規定相關的法律案事實上應該要同時彌補指明這個彌補財源或是有抵出相對的收入那基本上目前這樣的法案是不是違反我們預算法跟財政收支化分法 |
| transcript.whisperx[24].start |
2736.909 |
| transcript.whisperx[24].end |
2737.949 |
| transcript.whisperx[24].text |
接下來請國家發展委員會代表報告 |
| transcript.whisperx[25].start |
2776.438 |
| transcript.whisperx[25].end |
2795.538 |
| transcript.whisperx[25].text |
主席、各位委員、各位女士先生今天貴人會舉行全民健保醫療費用總額的一個現況與展望的公聽會本會應邀出席非常感到榮幸我以下僅就國發會的部分跟各位做一個說明 |
| transcript.whisperx[26].start |
2796.158 |
| transcript.whisperx[26].end |
2813.573 |
| transcript.whisperx[26].text |
大家都知道我們現在的健保總額制度是從87年分科推動到91年全面實施那這整個程序都是衛福部提報了草案然後到經過健保會的一個諮詢之後到行政院核定 |
| transcript.whisperx[27].start |
2814.673 |
| transcript.whisperx[27].end |
2838.568 |
| transcript.whisperx[27].text |
這個行政院合併 承包行政院之後會交易給本會本會會邀請各界的專家學者還有相關的部會主要是來檢視總額範圍草案的一種它的公式的組成 項目協商因素的合理性但也會關注 特別是關注我們人口結構及金社環境變化下的醫療需求對健保財務的影響 |
| transcript.whisperx[28].start |
2842.47 |
| transcript.whisperx[28].end |
2857.295 |
| transcript.whisperx[28].text |
更重要的是我們還要重整考量我們整體社會的一個負擔包括民眾的付費能力還有我們整體醫療資源運用的妥適性然後我們來提供行政院合理的一個總額範圍建議那在我們行政院合定之後還會交由健保會來進行協商那這是整個我們來經過了多年 |
| transcript.whisperx[29].start |
2868.339 |
| transcript.whisperx[29].end |
2891.349 |
| transcript.whisperx[29].text |
通過這樣的一個集體協商還有同儕制約這樣的一個機制那我想這這麼多年來對於合理的來調控醫療費用的成長還有資源的分配已經有相當的成效那這對於民眾一個合理的一個財務負擔也有還有健保的一個穩健都有一個相當大的注意 |
| transcript.whisperx[30].start |
2891.929 |
| transcript.whisperx[30].end |
2891.949 |
| transcript.whisperx[30].text |
公聽會議 |
| transcript.whisperx[31].start |
2910.194 |
| transcript.whisperx[31].end |
2910.214 |
| transcript.whisperx[31].text |
公聽會議 |
| transcript.whisperx[32].start |
2928.735 |
| transcript.whisperx[32].end |
2928.855 |
| transcript.whisperx[32].text |
主席 |
| transcript.whisperx[33].start |
2954.646 |
| transcript.whisperx[33].end |
2955.047 |
| transcript.whisperx[33].text |
行政單位報告 |
| transcript.whisperx[34].start |
2969.12 |
| transcript.whisperx[34].end |
2994.567 |
| transcript.whisperx[34].text |
專家學者還有委員的意見我相信可以列入未來我們行政單位要修法的一個參考那上禮拜在未還委員會已經針對健保法第62條有做充分的討論那今天我相信很多專家學者的這個意見都非常的寶貴那我們希望就是說這個健保點值的 |
| transcript.whisperx[35].start |
2995.007 |
| transcript.whisperx[35].end |
2995.047 |
| transcript.whisperx[35].text |
主席 |
| transcript.whisperx[36].start |
3024.555 |
| transcript.whisperx[36].end |
3032.267 |
| transcript.whisperx[36].text |
本次會議部會及學者專家所提供的相關書面資料均列入紀錄刊登公報 |
| transcript.whisperx[37].start |
3034.029 |
| transcript.whisperx[37].end |
3053.559 |
| transcript.whisperx[37].text |
議會人員發言前先宣告以下事項學者專家及本院委員每位發言時間6分鐘為簡報方便學者專家發言請至主席台右邊的發言台原則上由學者專家先行依簽到順序發言委員如 |
| transcript.whisperx[38].start |
3054.379 |
| transcript.whisperx[38].end |
3070.484 |
| transcript.whisperx[38].text |
要發言請到主席臺登記那現在委員的這個登記順序也列進去了那全部人員發言結束後再請行政機關做整體回應暫定10點30分休息10分鐘好那現在請臺灣社區醫院協會理事長朱義宏理事長發言 |
| transcript.whisperx[39].start |
3083.954 |
| transcript.whisperx[39].end |
3106.158 |
| transcript.whisperx[39].text |
主席 各位委員 各位學者專家 還有我們各位長官 大家早安 大家好我是臺灣社區醫院協會的理事長朱一鴻 也是臺灣醫院協會的副理事長那今天很榮幸受邀來參加這樣子的公聽會那我有準備幾張投影片 下一張 |
| transcript.whisperx[40].start |
3112.065 |
| transcript.whisperx[40].end |
3125.452 |
| transcript.whisperx[40].text |
首先我想這個議題大家都非常清楚就是我們總額現在從民國92年醫院總額開始做那大家常常聽到的說我買一瓶可口可樂現在要36塊錢那事實上醫院的這個藥這個藥大概是葡萄糖水500%cc的葡萄糖不到20塊錢 |
| transcript.whisperx[41].start |
3136.978 |
| transcript.whisperx[41].end |
3160.376 |
| transcript.whisperx[41].text |
真正的是這個幾副的大家比一下就是差了人家的50%這個我們健保下一張再過來一個我這個隨便在網路上找的2018年6月29號的報導通一個水管一尺200塊然後人家去找廠商去通要喊價8000塊我們健保氣管內插管835點 |
| transcript.whisperx[42].start |
3166.774 |
| transcript.whisperx[42].end |
3177.537 |
| transcript.whisperx[42].text |
這個830還是最近這幾年才調的以前它更低830還要乘上所謂的浮動點值所以只有701塊這個就是我們健保現在總額給付的現況那剛剛包括國發會包括我們主計總處講了很多都希望說我們在體制內來進行總檢討進行健保的檢討其實這個話我已經聽了大概20年了 |
| transcript.whisperx[43].start |
3192.728 |
| transcript.whisperx[43].end |
3207.309 |
| transcript.whisperx[43].text |
我已經聽了20年了從來也沒有檢討過阿阿為什麼沒有檢討因為政府沒有財務壓力所有的給付不足的時候全部把這個壓力放在醫療提供者那怎麼就是用這個典詞浮動嗎下一張 |
| transcript.whisperx[44].start |
3211.447 |
| transcript.whisperx[44].end |
3217.029 |
| transcript.whisperx[44].text |
這張是健保署公告的在網路上可以查到公告的所謂的浮動點子大概在0.9到0.92甚至有時候會高到0.9798 |
| transcript.whisperx[45].start |
3224.291 |
| transcript.whisperx[45].end |
3245.384 |
| transcript.whisperx[45].text |
不同顏色是不同分區那下面這個數字那這個資料是臺北業務組在開會的時候他們提供給委員的資料那當然我這個提出來並沒有經過他們同意但是我想這也是一個公開的資料所以我這邊拿出來讓大家看一下看起來好像大概並不是像大家想像的那麼差嘛大概有0.9293 |
| transcript.whisperx[46].start |
3250.441 |
| transcript.whisperx[46].end |
3275.55 |
| transcript.whisperx[46].text |
但是實際上健保署沒有跟大家講的特別是在座幾位立法委員要跟各位報告還有我們召委特別跟大家這個是健保署沒有跟大家講1.1元是個很粗的紅線實際上從106年的第一季開始那大概它的點值只有在0.8到0.85之間浮動點值甚至疫情過後大概低到0.7 |
| transcript.whisperx[47].start |
3277.592 |
| transcript.whisperx[47].end |
3300.598 |
| transcript.whisperx[47].text |
這是我們平常在網路上看不到的東西但是醫界現在實際上面臨的問題就是當你政府不去檢討總額這個越來越大的服務量那麼大的時候點值膨脹點值的成長率大於你的總額的錢的時候政府不去檢討這件事情的時候最後結果就是這樣因為所有的財務責任由醫界承擔 |
| transcript.whisperx[48].start |
3301.818 |
| transcript.whisperx[48].end |
3303.359 |
| transcript.whisperx[48].text |
政府給付總額就是打折 |
| transcript.whisperx[49].start |
3329.909 |
| transcript.whisperx[49].end |
3336.036 |
| transcript.whisperx[49].text |
那這個更驚人的一張投影片給大家看這是臺北分局的資料啦從106 107年開始這個給各位看一下這個這一行的數字這一行的數字 |
| transcript.whisperx[50].start |
3348.257 |
| transcript.whisperx[50].end |
3367.86 |
| transcript.whisperx[50].text |
那從最近的月份就最近的這一年從111年的第4屆到112年第3屆光台北分局被所謂攤扣的金額大概就100億光台北分區被攤扣的金額就100億什麼叫攤扣就是為了要達到 |
| transcript.whisperx[51].start |
3369.401 |
| transcript.whisperx[51].end |
3386.895 |
| transcript.whisperx[51].text |
達到這一張投影片所顯示的數字實際上是這一張為了要公布是這一張所以就用攤扣的方式所以光台北分局一年大概就扣掉快要100億這個其實非常驚人的一個數字我快講完了 |
| transcript.whisperx[52].start |
3387.423 |
| transcript.whisperx[52].end |
3402.397 |
| transcript.whisperx[52].text |
那當然這個事情在這個委員會的時候學務部長講沒有配套健保撐不過兩年我相信啦因為確實沒有配套那個財務會失控財務會失控那我覺得是要配套 |
| transcript.whisperx[53].start |
3403.078 |
| transcript.whisperx[53].end |
3429.298 |
| transcript.whisperx[53].text |
但是總額實施了從我從106年開始 其實更早的資料也都有從106年開始政府沒有任何做任何的配套來檢討這件事情甚至我在健保會都提出來說政府是不是要檢討一下為什麼我們給付的金額跟點數有那麼的大的差距而且在疫情過後差距變得更大事實上政府沒有檢討所以我覺得說這個是我引用這個吳明賢吳院長講的 |
| transcript.whisperx[54].start |
3431.44 |
| transcript.whisperx[54].end |
3448.577 |
| transcript.whisperx[54].text |
因為沒有合理的收益會動搖醫療體系事實上現在醫療體系已經在搖中現在已經是七八級的地震在搖了再過一下可能就要垮了那我想說藉著這次的修法蘇慶堅委員跟國民黨這次的修法藉著這次的修法 |
| transcript.whisperx[55].start |
3449.258 |
| transcript.whisperx[55].end |
3450.139 |
| transcript.whisperx[55].text |
中華民國開發性製藥研究協會秘書長陳全文秘書長 |
| transcript.whisperx[56].start |
3487.502 |
| transcript.whisperx[56].end |
3507.198 |
| transcript.whisperx[56].text |
主席及各位在座的專家學者長官們大家好我是中華民國開發性資料協會簡稱叫IRPMA我是秘書長陳全文我沒有準備簡報資料但是我們要說的話在IRPMA在去年委託的資層有做了一本臺灣健康投資的報告書 |
| transcript.whisperx[57].start |
3508.479 |
| transcript.whisperx[57].end |
3509.4 |
| transcript.whisperx[57].text |
中文版 英文版 |
| transcript.whisperx[58].start |
3523.516 |
| transcript.whisperx[58].end |
3543.428 |
| transcript.whisperx[58].text |
可以到我們IRPM網站來下載那我這邊要講的是說總額的影響不是只有點子打折這一件事情我們在這份健康投資報告裡面有提到其實我們的新藥的可敬性事實上已經落後了國際我們跟日本比較從把2017年到2022年這段時間 |
| transcript.whisperx[59].start |
3546.651 |
| transcript.whisperx[59].end |
3564.327 |
| transcript.whisperx[59].text |
經過查登上市的新藥的給付率在日本是99%臺灣是只有41%其中大家比較關注的是癌症新藥的給付那上市在日本上市的35個癌症新藥裡面日本是百分之百給付臺灣只有37% |
| transcript.whisperx[60].start |
3566.269 |
| transcript.whisperx[60].end |
3587.029 |
| transcript.whisperx[60].text |
受到給付所以在大家在討論這個點子打折同時要保障點子一點醫院的同時其實我有兩點的呼籲有兩個必須第一件事情就是要以病人為中心我們要保障病人得到適切治療的權利所以新藥可靜性落後國際這個問題必須要解決 |
| transcript.whisperx[61].start |
3591.018 |
| transcript.whisperx[61].end |
3616.718 |
| transcript.whisperx[61].text |
那第二件事情就是在總額幾乎不足的情況之下長期的以藥養醫的現象然後造成了對於藥價的壓制對於藥劑的生存空間的壓抑所以已經衝擊到藥品供應的穩定性我想這個問題也必須要解決所以我在這邊呼籲說要解決在討論點子一點議員的同時也要把我兩個必須一起考慮進去謝謝大家 |
| transcript.whisperx[62].start |
3620.724 |
| transcript.whisperx[62].end |
3620.845 |
| transcript.whisperx[62].text |
陳秘書長陳昭資委員 |
| transcript.whisperx[63].start |
3633.9 |
| transcript.whisperx[63].end |
3662.489 |
| transcript.whisperx[63].text |
主席、各位委員及專家代表那2014年總統大選三黨的候選人都對於一個提高臺灣的健康投資有共同的共識那本黨也是支持這個點值要有一定的保障但是由政府來撥補畢竟不是長久之計因為沒有辦法確定這個財源是穩定的那健保第一個十年我覺得是全民皆大歡喜了民眾跟這個醫療大家都滿意度很高那第二個十年其實開始面臨一些財務的挑戰 |
| transcript.whisperx[64].start |
3663.689 |
| transcript.whisperx[64].end |
3663.829 |
| transcript.whisperx[64].text |
委員會主席 |
| transcript.whisperx[65].start |
3684.795 |
| transcript.whisperx[65].end |
3684.815 |
| transcript.whisperx[65].text |
公聽會議 |
| transcript.whisperx[66].start |
3710.396 |
| transcript.whisperx[66].end |
3712.118 |
| transcript.whisperx[66].text |
財務困窮越來越大我現在會用這兩句話來形容臺灣的健保小病保得好 |
| transcript.whisperx[67].start |
3727.375 |
| transcript.whisperx[67].end |
3742.109 |
| transcript.whisperx[67].text |
大病有缺口這是我們要的健保嗎這符合社會保險的精神嗎因此在提高健保的同時健保點植的同時我們主張有幾個配套措施一方面避免因為論量濟酬帶來的無可避免的衝量行為那一方面也是說因為論量濟酬很難免的有時候會有服用濫用的這些事實 |
| transcript.whisperx[68].start |
3754.239 |
| transcript.whisperx[68].end |
3773.011 |
| transcript.whisperx[68].text |
建保支付架構如果不改善包括納入醫療品質衡量這樣做法才是讓整個建保永續而且成為臺灣真正護國神山的保障因此在提高建保點值的同時我們主張有幾點配套措施第一個消除因為專業服務不足 |
| transcript.whisperx[69].start |
3774.892 |
| transcript.whisperx[69].end |
3774.912 |
| transcript.whisperx[69].text |
公聽會議 |
| transcript.whisperx[70].start |
3798.593 |
| transcript.whisperx[70].end |
3801.174 |
| transcript.whisperx[70].text |
整體醫療機構大概只佔GDP的5.5的健保因為它未能及時去對應人口結構的急劇的改變造成醫院普遍的要仰賴這個要價差來做一部分的彌補那當點值提高的時候我們要同時處理 |
| transcript.whisperx[71].start |
3820.245 |
| transcript.whisperx[71].end |
3820.265 |
| transcript.whisperx[71].text |
公聽會議 |
| transcript.whisperx[72].start |
3839.6 |
| transcript.whisperx[72].end |
3865.589 |
| transcript.whisperx[72].text |
第三點就是只需要要依法退出健保給付為了幫助整個醫療資源能夠有效的運用跟合理的分配那落實醫療分級刻不容緩那除了各級醫院的分工之外請記得要將社區藥局納入分療醫級體系全世界早就推行了三四十年的這個自我照護那但是從未落實在台灣我們應該鼓勵小病症交由社區藥局藥師來照顧 |
| transcript.whisperx[73].start |
3867.89 |
| transcript.whisperx[73].end |
3867.91 |
| transcript.whisperx[73].text |
公聽會議 |
| transcript.whisperx[74].start |
3886.781 |
| transcript.whisperx[74].end |
3910.652 |
| transcript.whisperx[74].text |
一旦退場會逐漸改變人民的這個就醫行為會到社區去購買根據健保署的評估只要每人每年每一個人一次就醫我們就可以省下375億點值這個最後的影響會非常的深遠那為了恢復台灣的醫療而且我們曾經是明月前茅的一個榮景但是現在不是了現在包括這個 |
| transcript.whisperx[75].start |
3911.792 |
| transcript.whisperx[75].end |
3920.438 |
| transcript.whisperx[75].text |
平均餘密、癌症存活率、新症候選等等都在OECD國家全盤接輸這不是人才問題而是資源的問題所以我們建議要健保支付要納入有關品質的進步方案例如已經做一半卡住的DRG還有這所謂的論值計酬Pay for performance然後以治療的結果為導向的包括幾副Occam based bundle payment |
| transcript.whisperx[76].start |
3941.454 |
| transcript.whisperx[76].end |
3969.951 |
| transcript.whisperx[76].text |
我覺得健保署應該用獎勵的方式來鼓勵各個醫療機構提出更可行而且可受公平的透明化的醫療品質方案我們用品質來爭取合理的給付這個是在我們把點值提高的這個論量計的方式說一個很重要的配套措施好那麼結論是本黨還有我個人都非常支持醫療點值要受到保障但是我們也要求有以下的配套措施其中有4點第一個 |
| transcript.whisperx[77].start |
3972.014 |
| transcript.whisperx[77].end |
3978.336 |
| transcript.whisperx[77].text |
提高專業服務費讓醫院跟醫師能夠正正當當的來賺錢第二個只是要退出這個醫法要退出這個市場第三個要價差要合理化每年幾百億是不是要做檢考要去面對了不要再一直閃避回躲最後我們要希望能夠有進步法案在我們的醫療制度裡面再以品質為導向來爭取更合理的給付謝謝 |
| transcript.whisperx[78].start |
4001.769 |
| transcript.whisperx[78].end |
4007.433 |
| transcript.whisperx[78].text |
好 謝謝陳昭芝委員的發言接下來請台灣私立醫療院所協會秘書長吳明彥 吳秘書長發言 |
| transcript.whisperx[79].start |
4012.137 |
| transcript.whisperx[79].end |
4034.235 |
| transcript.whisperx[79].text |
主席各位那謝謝大家有機會讓我來報告那我的標題就是健康投資增加WHA一直要求的所謂的醫療韌性那大概大家這兩個圖一定常常看到就是臺灣現在健保都評為世界第一一個是Lambio一個是CEO那我們不反對臺灣的政府拿這個去對外宣因為臺灣的外交處境很困難 |
| transcript.whisperx[80].start |
4034.915 |
| transcript.whisperx[80].end |
4052.164 |
| transcript.whisperx[80].text |
但實際上這位專家寫者實際上你們去看這個問卷是有盲點的因為為什麼第一個CEO我的問全世界跨國公司的CEO哪一個國家的醫療可信性最好哪一個國家的醫療會用富德起當然台灣第一啊台灣的同學就問這個問卡達夫就如果知道就問CEO問題是地塊會不會比較重要嘛是立法委員你們是掌握你們是幫台灣的人民要投資 |
| transcript.whisperx[81].start |
4065.792 |
| transcript.whisperx[81].end |
4080.539 |
| transcript.whisperx[81].text |
這兩個那實際上我們對外先可以但是對內不要了我們自己內部自己都知道很清楚的這是實際上人轉世紀轉改都會比較都有連涉的這些顯示間好的文章都有我們HAQ平均指標 |
| transcript.whisperx[82].start |
4082.441 |
| transcript.whisperx[82].end |
4099.559 |
| transcript.whisperx[82].text |
我們不要去比世界同一個國家,我們比亞洲就好,亞洲就日本,新加坡跟南韓,尤其我們同樣要跟南韓比,因為南韓跟我們差不多,國民所得差不多,不管產業什麼大家都拚下去試,來,我們日本2015年,為這個SAQ的名字,為11名拚到世界第一名 |
| transcript.whisperx[83].start |
4104.313 |
| transcript.whisperx[83].end |
4115.084 |
| transcript.whisperx[83].text |
好啦好啦,你問日本很厲害,我們不要跟日本比啦,新加坡人有21名變到16名,韓國人有22名變到18名,我們多少?我們有45,我們有進步,我們不是說賣,我們要獎勵,我們有45名變到37名而已,我們進步比我們更慢嘛 |
| transcript.whisperx[84].start |
4122.815 |
| transcript.whisperx[84].end |
4147.121 |
| transcript.whisperx[84].text |
不是說不好,我們有進步,不是說不比人更好啊我們的進步幅度不比人更好啊好,再來,我們政府因為一直被我們批評說投資不足6.1%後來加了,他最近的網站加了長照才變7%可是你沒關係,你用長照加進去別的國家也要把長照加進去比啊不要這樣子誤導人家我們確實不夠,我們政府投資不夠再來 |
| transcript.whisperx[85].start |
4148.221 |
| transcript.whisperx[85].end |
4174.61 |
| transcript.whisperx[85].text |
這個是臺灣的醫療投資真的太低嗎你看看我們去把日本自己亞洲自己國家的實際上的GDP去算看齁如果以GDP看我們大概40名如果以PVP當然我們的物價比較低這是我們鼓勵的臺灣這10年來物價很低我們PVP排到第15名欸欸咱幾乎只有我們只有1人人民只有1人啊各個咱平均壽命是4個國家同行嘛捏 |
| transcript.whisperx[86].start |
4176.567 |
| transcript.whisperx[86].end |
4186.859 |
| transcript.whisperx[86].text |
我們平均壽命80.84連我們韓國最喜歡比的人家83.5我們全世界百名31名是我們韓國百名第6名看有漏氣沒有 |
| transcript.whisperx[87].start |
4188.311 |
| transcript.whisperx[87].end |
4210.328 |
| transcript.whisperx[87].text |
我們產業,我們TSMC現在比世界要好,把韓國三星幹掉啦那為什麼我們醫療不能進步呢?為什麼我們醫療不能比韓國好呢?好,這是我們台灣學者很榮幸,我們台灣學者被全世界最好連席的邀請參加美國、加拿大、英國、荷蘭、以色列欸,我們有說喔,我們跟世界統一國家要比高這個醫療指標喔 |
| transcript.whisperx[88].start |
4212.009 |
| transcript.whisperx[88].end |
4233.703 |
| transcript.whisperx[88].text |
AMI 心臟的死亡率30天內的死亡率跟31天到30天的死亡率全部都輸人這兩個國家都倒數第一名這全世界連社的這麼好的文件發表文件這個寫者也不能否認啊這個是都有PA review的這是全世界最好的專家 review我們在這裡的主標都輸人嘛 |
| transcript.whisperx[89].start |
4235.631 |
| transcript.whisperx[89].end |
4250.86 |
| transcript.whisperx[89].text |
對阿再來我們現在跟中共說我們的人力不夠嘛我們的人力 醫生跟護士全世界這百名這四個區域裡面同差的嘛病人沒幾人請醫生沒幾人請護士嘛所以才會關於北層嘛那關於北層受害 受害下去到一般的民眾啦所以我們現在醫療界現在我們今天這麼晚才接電話給病人接到接電話怎樣敲北層啊很可憐的 每天就 |
| transcript.whisperx[90].start |
4265.95 |
| transcript.whisperx[90].end |
4280.784 |
| transcript.whisperx[90].text |
很怕接到這個電話阿來,上一次公聽會或是上禮拜有人講說欸,有人就對我醫生的心緒很好阿好像在污衊我們醫生,我們是解決了他台灣的醫生的心緒是多少,平均19萬 |
| transcript.whisperx[91].start |
4283.647 |
| transcript.whisperx[91].end |
4296.278 |
| transcript.whisperx[91].text |
我們老實說,這是用世界做的嘛,這符合楊志良說的五百到六百年,大學畢業生啊,剩下19萬年,人家韓國也這樣,36萬,還走上街頭抗議,哇,我感覺我們在台灣藝術公會要去韓國學學的,要去學看要怎麼上街頭罷工的,人家韓國國會新兵生都36萬喔,我們19萬年喔,人家36萬,根本沒愛喔,要全國罷工喔,走上街頭,你看我們台灣的藝生多過於 |
| transcript.whisperx[92].start |
4311.597 |
| transcript.whisperx[92].end |
4311.818 |
| transcript.whisperx[92].text |
委員會主席 |
| transcript.whisperx[93].start |
4327.147 |
| transcript.whisperx[93].end |
4335.011 |
| transcript.whisperx[93].text |
臺灣剛才在電視我們比寵物更衰平均的檢察會人寵物5百塊我們3百90塊我們的急救10分鐘755點點還打折喔人家寵物的30分鐘急救6千塊台幣人家是1.1塊看有看有衰嗎我們的人民比寵物差嗎 |
| transcript.whisperx[94].start |
4353.539 |
| transcript.whisperx[94].end |
4367.613 |
| transcript.whisperx[94].text |
阿再來這個是賴總統的老師所做的結論我們有錢阿怎麼會沒錢勒政府只要36%提高到38%馬上一年就增加一兩百億了嘛公務預算有得錢臺灣政府這麼多錢怎麼會沒錢勒沒錢我幫你找錢這個什麼 |
| transcript.whisperx[95].start |
4371.216 |
| transcript.whisperx[95].end |
4389.698 |
| transcript.whisperx[95].text |
這個只要好好修法 商業保險這邊就有60幾億了阿阿來 我們的健康保險有4千億 只給予30%只要你修夠至少給予8成 馬上多2千億進來阿只要你從商業保險拿錢就有了錢多的事只會沒錢欸好 最後結論我們醫療界這是邪怪的 絕對不跟人民為敵 |
| transcript.whisperx[96].start |
4390.519 |
| transcript.whisperx[96].end |
4408.797 |
| transcript.whisperx[96].text |
所以我們這一次都不動會議我們只叫政府出錢公務預算再來所增加的錢並不會編入所謂的國發會的總額所以不會滾出下面不要被誤導再來我們用你們的在野黨的前總統做結論我們就是要衝突要妥協才會進步 |
| transcript.whisperx[97].start |
4409.978 |
| transcript.whisperx[97].end |
4410.018 |
| transcript.whisperx[97].text |
拜託拜託 |
| transcript.whisperx[98].start |
4435.305 |
| transcript.whisperx[98].end |
4438.648 |
| transcript.whisperx[98].text |
主席、委員、各位學者、參加大家早在民宴後面講話壓力很大,他的口才太好了 |
| transcript.whisperx[99].start |
4458.288 |
| transcript.whisperx[99].end |
4475.834 |
| transcript.whisperx[99].text |
好 我想身為學者專家我們還是持平而論我想最重要在今天會有這些議題基本上還是收支上面的gap最大的問題還是在這個可是不可諱言其實我們健保從開辦的2000億到現在也將近9000億也有增加4.5倍 |
| transcript.whisperx[100].start |
4479.075 |
| transcript.whisperx[100].end |
4480.536 |
| transcript.whisperx[100].text |
那從專業的立場來看我覺得有兩件事情就是 |
| transcript.whisperx[101].start |
4501.724 |
| transcript.whisperx[101].end |
4526.2 |
| transcript.whisperx[101].text |
收入確實是要增加只是增加是從公務來撥補還是說我們可以從健保的這個法規裡面去改善那個所謂的匯率這塊呢確實可以思考我覺得匯率應該稍微要打開讓政府他稍微有財政的工具可以來做這件事情那當然匯率打開還是有不同的stakeholder的壓力那這就是政府要負責去把它解決 |
| transcript.whisperx[102].start |
4527.2 |
| transcript.whisperx[102].end |
4546.221 |
| transcript.whisperx[102].text |
其實大部分你可以看這次的COVID-19我們從健保從4.9倍5.17的時候大部分的百姓並沒有反對所以我們還是有一些環境有這個可能可以成功的所以這件事情是讓政府有一些財政手段可以來增加不然健保署真的很辛苦每次在這些協商裡面 |
| transcript.whisperx[103].start |
4546.841 |
| transcript.whisperx[103].end |
4568.059 |
| transcript.whisperx[103].text |
第二件事情就是我要比較著重談到的就是健保可能需要從他的支付的裡面因為現在的大數據其實有很多的data是可以協助健保署去做我簡單舉一個例子我們的所有的給付制度來講我們有很多成熟的檢驗檢查的給付跟新的檢查 |
| transcript.whisperx[104].start |
4568.86 |
| transcript.whisperx[104].end |
4597.068 |
| transcript.whisperx[104].text |
或比較複雜的檢查這些需要重新盤點既有的支付制度裡面某些已經成熟的部分是不是應該做適度的調降而把省下的錢給比較新的部分那這個我想健保署在推了可是呢要加速做所謂的RV、RVS的評估也就是以這個資源為主的這種所謂的這個所謂的這個value的edit來做這件事情是很重要的事情但是要加速 |
| transcript.whisperx[105].start |
4597.768 |
| transcript.whisperx[105].end |
4623.23 |
| transcript.whisperx[105].text |
那第二件事情是國務院最近也做了一些研究就是臺灣的百姓對於我們就用最簡單來講以一般的上呼吸道的感染然後沒有共病的這個部分90%的百姓他大概一年看病的次數大概不到10次看感冒的次數我0到5歲不要看0到5歲小朋友本來就容易感冒可是對於 |
| transcript.whisperx[106].start |
4624.83 |
| transcript.whisperx[106].end |
4626.511 |
| transcript.whisperx[106].text |
全民健康保險醫療給付費用總額之現況與展望 |
| transcript.whisperx[107].start |
4652.819 |
| transcript.whisperx[107].end |
4679.251 |
| transcript.whisperx[107].text |
可能是下背痛跟正式感冒沒有關係這些都要做調整這些是可以讓我們的資源用在更精準的上面這件事情是很重要的那另外一個就是我們剛才我也呼籲趙志偉講的就是我們在就醫的合理性這邊剛剛大家講民營也講過這個就醫的可信性很高可是就醫的可信性可能不能夠完全無限制的自由所以我們要落實分級醫療制度可能 |
| transcript.whisperx[108].start |
4680.572 |
| transcript.whisperx[108].end |
4694.808 |
| transcript.whisperx[108].text |
論人計酬這目前還蠻困難的需要逐步逐步實驗可是論量計酬已經證實他需要做一定的管控所以in between這中間呢我們需要落實所謂的所謂的所謂的分級醫療的慢慢的加入那這個分級醫療包括 |
| transcript.whisperx[109].start |
4695.228 |
| transcript.whisperx[109].end |
4695.248 |
| transcript.whisperx[109].text |
公聽會議 |
| transcript.whisperx[110].start |
4717.142 |
| transcript.whisperx[110].end |
4743.922 |
| transcript.whisperx[110].text |
否則只讓一邊去加大投資他困難點打不到的時候到時候這件事情還是沒辦法打正所以兩邊各要去做調整讓政府在他的現有的9000億的財務裡面其實他可以做一些支出上面的重新的調整之後讓他有更多的多餘的錢來支付這些不足的部分可是呢我們也要適度讓政府可以打開上面的那個那個那個那個CAP讓這個這個天花板要把它打開讓總額的這一塊能夠 |
| transcript.whisperx[111].start |
4746.044 |
| transcript.whisperx[111].end |
4746.164 |
| transcript.whisperx[111].text |
委員會主席 |
| transcript.whisperx[112].start |
4761.021 |
| transcript.whisperx[112].end |
4761.201 |
| transcript.whisperx[112].text |
主席 |
| transcript.whisperx[113].start |
4778.755 |
| transcript.whisperx[113].end |
4779.295 |
| transcript.whisperx[113].text |
中文字幕提供 |
| transcript.whisperx[114].start |
4808.884 |
| transcript.whisperx[114].end |
4810.005 |
| transcript.whisperx[114].text |
謝謝邱教授接下來請林岳晴委員發言 |
| transcript.whisperx[115].start |
4836.032 |
| transcript.whisperx[115].end |
4836.212 |
| transcript.whisperx[115].text |
主席 |
| transcript.whisperx[116].start |
4865.828 |
| transcript.whisperx[116].end |
4866.028 |
| transcript.whisperx[116].text |
一百零七年 |
| transcript.whisperx[117].start |
4882.569 |
| transcript.whisperx[117].end |
4884.01 |
| transcript.whisperx[117].text |
同樣的 我想健保也是這樣 |
| transcript.whisperx[118].start |
4906.289 |
| transcript.whisperx[118].end |
4933.168 |
| transcript.whisperx[118].text |
因為我們的病患過多跟項目過多擠加進去之後那當然就會影響到總額那過去一直以來像104年在我們的合併保費降價然後105年我們的實施短收保費一年後我們的財務就整個萎縮開始出現赤字那所以在這過程當中政府呢大概就是用公寓預算來去做貼補 |
| transcript.whisperx[119].start |
4934.529 |
| transcript.whisperx[119].end |
4962.933 |
| transcript.whisperx[119].text |
那這些公務預算的發揮如果用在政策上的推動上那當然那是計畫中的支出可是如果是在填補虧損的話那就是一個警訊那我們自己再看就是說整個的政府社會保障支出包括社會保險跟社會救助跟福利兩大類那整體的占國家總GDP比重大概從104年到111年的期間逐年增加 |
| transcript.whisperx[120].start |
4963.769 |
| transcript.whisperx[120].end |
4963.789 |
| transcript.whisperx[120].text |
公聽會議 |
| transcript.whisperx[121].start |
4987.566 |
| transcript.whisperx[121].end |
5003.139 |
| transcript.whisperx[121].text |
國家社會福利預算總支出的1.7倍所以健保的占比比較大的時候跟其他各項支出的聯動性就會比較強所以如果比例減少一點點這其他各類的支出就會有些空間可是相反的 |
| transcript.whisperx[122].start |
5003.499 |
| transcript.whisperx[122].end |
5003.519 |
| transcript.whisperx[122].text |
公聽會議 |
| transcript.whisperx[123].start |
5033.168 |
| transcript.whisperx[123].end |
5033.188 |
| transcript.whisperx[123].text |
公聽會議 |
| transcript.whisperx[124].start |
5059.164 |
| transcript.whisperx[124].end |
5059.184 |
| transcript.whisperx[124].text |
委員長 |
| transcript.whisperx[125].start |
5088.422 |
| transcript.whisperx[125].end |
5088.442 |
| transcript.whisperx[125].text |
公聽會議 |
| transcript.whisperx[126].start |
5108.618 |
| transcript.whisperx[126].end |
5137.715 |
| transcript.whisperx[126].text |
如果根據衛福部這樣的初估的話調高保費如果明年2月以後保費所需要調高的幅度就會超過法定的上限甚至到6.4%而且會不斷的提高所以可能今天大家要來想的是配套措施否則增加公務預算或者是說我擔心的是會不會排擠到社福預算那如果調高保費那就是要看每一個民眾到底能不能負擔所以今天就要還望大家給出一個更好的 |
| transcript.whisperx[127].start |
5138.235 |
| transcript.whisperx[127].end |
5138.255 |
| transcript.whisperx[127].text |
公聽會議 |
| transcript.whisperx[128].start |
5159.737 |
| transcript.whisperx[128].end |
5162.458 |
| transcript.whisperx[128].text |
衛福部在長照這個用我們的論案件計酬的架構底下 |
| transcript.whisperx[129].start |
5187.742 |
| transcript.whisperx[129].end |
5187.882 |
| transcript.whisperx[129].text |
一併提升 |
| transcript.whisperx[130].start |
5214.209 |
| transcript.whisperx[130].end |
5224.773 |
| transcript.whisperx[130].text |
好謝謝林月琴委員的發言接下來請臺灣醫院協會理事長林飛鵬理事長發言李飛鵬不好意思主席各位專家學者各位賢導大家好我第一次來參加這個公聽會有機會跟全國的經營一起來討論這個健保的這個制度的問題 |
| transcript.whisperx[131].start |
5244.332 |
| transcript.whisperx[131].end |
5264.499 |
| transcript.whisperx[131].text |
我想健保制度是一個非常好的制度我來自嘉義縣布袋鎮購郭那個很窮苦的鄉下以前我們鄉下有人如果得了洗腎腎臟病的話就要賣女兒然後賣房子所以這個健保制度是一個非常好的制度我們在座大家一定要讓他繼續下去這是我的呼籲 |
| transcript.whisperx[132].start |
5265.851 |
| transcript.whisperx[132].end |
5292.283 |
| transcript.whisperx[132].text |
那我們健保支出思想28年來以前健保的收入跟支出夠的時候大家活得很快樂但是最大問題是現在我們的臺灣的老人70歲、80歲、90歲的老人越來越多了要看病了所以我們支出就增加了那支出的增加以後因為我們臺灣有很好的衛生福利部還有健保署的官員他們就想出一些這個 |
| transcript.whisperx[133].start |
5295.876 |
| transcript.whisperx[133].end |
5316.008 |
| transcript.whisperx[133].text |
各種的方法來把這個制度繼續維持,我非常肯定他們這樣子但是這些方法裡面有一些就是像攤扣、核檢、各種的管理點子我們的點子有保障點子、互動點子的措施來管理 |
| transcript.whisperx[134].start |
5317.458 |
| transcript.whisperx[134].end |
5338.375 |
| transcript.whisperx[134].text |
那臺灣的醫界是臺灣的精英從以前就很會考試你不管出什麼題目他都有辦法把它考得很好像我以前在臺北醫學大學你錢不夠我們就想辦法來募款我們對一些比較好比病人家境比較好給他多看幾次一直看三委邱文導部長跟我講的 |
| transcript.whisperx[135].start |
5339.383 |
| transcript.whisperx[135].end |
5351.902 |
| transcript.whisperx[135].text |
然後他們會募款來支持我們但是我跟大家講一下我是臺灣醫院學會的理事長臺灣的醫院呢公立的是三層那私立的是七層 |
| transcript.whisperx[136].start |
5353.646 |
| transcript.whisperx[136].end |
5376.302 |
| transcript.whisperx[136].text |
那大家不要擔心這七層的市立的醫院公立院的如果也願意當然是繼續支持這個國家的做法但是我們臺灣的私人的醫院基本上七層裡面百分之50以上19大醫療體系都是財團法人的醫院或者學校的醫院他們即使有賺的利潤的話 |
| transcript.whisperx[137].start |
5377.643 |
| transcript.whisperx[137].end |
5402.838 |
| transcript.whisperx[137].text |
通通都拿來繼續建設他的醫院,像學校的就來支持學校所以大家不要擔心這些私人醫院會有利潤的問題你讓他有一個比較好的兼顏條件的時候他事實上把這些資源用來培養我們的醫師人才,繼續照顧我們的國人所以在這點子的部分,我覺得就是我們家裡的老人增加多了,我們一定要增加預算來 |
| transcript.whisperx[138].start |
5405.222 |
| transcript.whisperx[138].end |
5430.203 |
| transcript.whisperx[138].text |
支持才有辦法照顧這些老人將來我也是70歲以上了所以在這保障點子的部分醫院現在事實上已經到了很難經營的程度了我們面臨的醫院裡面面臨的第一個護理人力因為薪水不夠他們被其他行業弄走了很多的科別小兒外科什麼小兒科很多的醫生都因為我們沒辦法給他足夠的資源或者薪水他們也都走了 |
| transcript.whisperx[139].start |
5430.743 |
| transcript.whisperx[139].end |
5447.475 |
| transcript.whisperx[139].text |
那將來這些醫院又關闖了,那我們的醫院怎麼支持下去?北龍的陳偉明院長常常跟我講,這保久才能長長久久,那保久現在也不行啦,因為我們現在有通貨膨脹,又有這個將來又要增碳稅,又要調電稅,我們現在 |
| transcript.whisperx[140].start |
5454.012 |
| transcript.whisperx[140].end |
5476.114 |
| transcript.whisperx[140].text |
點值到0.9我相信也很難支持所以我們的支持就是說在這個剛剛提出來的這個總額的這個制度裏面保障點值在總額裏面能夠保障一塊錢總額以上的來編列預算用這個方式類似我們有一種這個醫院在國家在建有預算以後增加對不對等於是預備金的概念 |
| transcript.whisperx[141].start |
5477.476 |
| transcript.whisperx[141].end |
5490.847 |
| transcript.whisperx[141].text |
所以我是覺得就是說我支持就是說我們呼籲就是說在這個保障點子上面讓醫院能夠持續的經營下去是大家一定要想辦法來解決的這個問題那其實我們不只說點子不夠的問題我們還有這個致富標準醫事人員的勞務費這30年來都沒有調 |
| transcript.whisperx[142].start |
5496.997 |
| transcript.whisperx[142].end |
5520.606 |
| transcript.whisperx[142].text |
如果再調整14年 勞費我們的點子可能到0.6、0.7而已以我額比喲克來講 我們補的額沒大概一萬多點是韓國跟日本的三分之一到五分之一 但是過去在總額支付標準會議裡面你調額比喲克別人就砍了 所以都調不上去所以增加這個預算我覺得就是說 |
| transcript.whisperx[143].start |
5522.049 |
| transcript.whisperx[143].end |
5549.376 |
| transcript.whisperx[143].text |
調整這個醫事人員勞務費包括這個支付標準還有護理人員的費用還有其他醫事人員的費用我覺得這是一個很重要的一個點那最後我是在想這樣的我們每一次在健保會裡面跟這個會議的代表大家都在是非常的難過我們在那邊溢價的感覺我們能不能制定出一個公司就是我們的點子沒有到1的時候我們 |
| transcript.whisperx[144].start |
5550.925 |
| transcript.whisperx[144].end |
5571.668 |
| transcript.whisperx[144].text |
自動有一個公式可以調整我們今天在修法以後能夠制定這條公式以後這點子沒有到一那我們要怎麼樣撥補這樣一個不要再經過朝野協商不要再經過公聽會大家想出一個公式來到的時候自動調整我想這是我的想法謝謝大家 |
| transcript.whisperx[145].start |
5575.343 |
| transcript.whisperx[145].end |
5597.834 |
| transcript.whisperx[145].text |
謝謝李飛鵬理事長接下來請國立臺灣大學公共衛生學院政守下院長發言主席各位委員各位一屆的代表還有我們專家學者當然我們的苦主健保署的同仁今天我有準備一些 |
| transcript.whisperx[146].start |
5599.365 |
| transcript.whisperx[146].end |
5623.1 |
| transcript.whisperx[146].text |
資料給大家參考第一個是目前的制度到底有什麼大問題嗎現在的總額如果說成長率太低那就是我們當初在協商的付費者願意付的不夠嘛那這是一個然後我們的總額現在是分4塊然後6區所以點值都不一樣 |
| transcript.whisperx[147].start |
5623.86 |
| transcript.whisperx[147].end |
5647.266 |
| transcript.whisperx[147].text |
那我們要全部去保障點子是不是要用同一個點子保障這是一個值得考慮的另外一個如果是某年某季因為不可抗速的因素呢造成點子過低現在就已經有補貼的這個辦法比如說補到0.9那分明0.9對醫界而言根本就不夠這可能也是一個事實所以這個部分是可以 |
| transcript.whisperx[148].start |
5648.727 |
| transcript.whisperx[148].end |
5657.579 |
| transcript.whisperx[148].text |
討論可以調整很重要的是政府管醫療市場到底要管到什麼程度健保已經把醫療服務框住了 |
| transcript.whisperx[149].start |
5658.766 |
| transcript.whisperx[149].end |
5684.848 |
| transcript.whisperx[149].text |
那現在掛號費當然雙幫另外一個叫醫療人力醫院要聘醫師、聘護理人員那個到目前為止應該是一個自由市場那如果健保要擴大他的影響力要規範到我們剛剛講醫師薪水或是護理要保證收入那我們就往公醫制度更靠近了那這個是我們要的嗎我想這個是比較大的 |
| transcript.whisperx[150].start |
5685.909 |
| transcript.whisperx[150].end |
5712.121 |
| transcript.whisperx[150].text |
方向應該討論所以上次健保署這是衛福部非常快速的取消過號費沒有任何的座談會、公聽會、批發都沒有消極會就是有人反對但是就上了因為沒有法源依據就一句話也很好啊那另外一個是要補護理夜班費的時候當初政府各個 |
| transcript.whisperx[151].start |
5713.493 |
| transcript.whisperx[151].end |
5713.513 |
| transcript.whisperx[151].text |
公聽會議 |
| transcript.whisperx[152].start |
5738.086 |
| transcript.whisperx[152].end |
5738.587 |
| transcript.whisperx[152].text |
週五我看那個 |
| transcript.whisperx[153].start |
5756.05 |
| transcript.whisperx[153].end |
5775.291 |
| transcript.whisperx[153].text |
國會頻道直播那個趙志偉就特別提說保障點子可以但是要有附帶決議至少剛剛趙志偉有提應該某些我們要解決的要達成的加上去不是只有保障點子這個是可以討論那醫界希望跟韓國看齊那是不是合適我做兩個數字給各位看 |
| transcript.whisperx[154].start |
5777.653 |
| transcript.whisperx[154].end |
5799.24 |
| transcript.whisperx[154].text |
韓國的醫師人數其實他的成長率跟台灣非常非常接近那跟OECD的成長率都一樣因為全世界的國家的發展都一樣我們比較慢嘛所以追得比較慢但是韓國的病床數一直在增加OECD的平均病床數是在下降的台灣的病床數是持平 |
| transcript.whisperx[155].start |
5800.339 |
| transcript.whisperx[155].end |
5828.737 |
| transcript.whisperx[155].text |
因為韓國實施了長照保險他們新增的病床全部都是長照保險床所以我們在懷疑韓國能夠快速的平均餘命成長很可能是長照保險帶來的這是可能因為我們沒有很確確的數字好 那可以看剛剛我們有在看那個醫療保健支出佔GDP的比例其實比較好的是用CHE不是NHE就是把 |
| transcript.whisperx[156].start |
5829.717 |
| transcript.whisperx[156].end |
5857.014 |
| transcript.whisperx[156].text |
國家醫療保健支出扣掉投資就是蓋醫院買設備了所以就是比較準的這個比例呢韓國是有目的的要追上OECD的平均這是他們的目的所以他們的目的呢大力支持醫療生技包括醫美產業然後實施全民健常照保險這是韓國政府有目的的要追上 |
| transcript.whisperx[157].start |
5858.217 |
| transcript.whisperx[157].end |
5858.237 |
| transcript.whisperx[157].text |
臺灣的 |
| transcript.whisperx[158].start |
5872.388 |
| transcript.whisperx[158].end |
5901.287 |
| transcript.whisperx[158].text |
這個比重比起來OECD的平均世界各國都很努力的在控制醫療費用的成長不要太快那如果說我們覺得我們的醫療費用成長太慢投入太少事實上也要先設一個目標值不是一直下去的那韓國其實之所以跑那麼快因為我們的GDP成長過去10年比韓國大所以我們的分母就大所以那個比重看起來就比較少這是其中一個原因 |
| transcript.whisperx[159].start |
5907.451 |
| transcript.whisperx[159].end |
5917.037 |
| transcript.whisperx[159].text |
總額是跟支付制度掛鉤支付制度會直接影響醫療服務的提供所以我個人建議是總額現在是上限制也許可以改目標值 |
| transcript.whisperx[160].start |
5917.597 |
| transcript.whisperx[160].end |
5946.817 |
| transcript.whisperx[160].text |
那目標超過的部分怎麼辦那個就是現在開始來討論讓醫界有一點緩衝的機會那或者直接取消總額可以我個人是贊成那住院就是用DRG門診用包括是支付那我們就不怕量過度的衝讓民眾付費承擔不起這樣子那最近我自己有提一個醫療跟健保改革的方案那這個有發表在一個期刊純粹給各位參考謝謝大家 謝謝 |
| transcript.whisperx[161].start |
5949.978 |
| transcript.whisperx[161].end |
5953.781 |
| transcript.whisperx[161].text |
謝謝正所下院長接下來請王振旭委員發言謝謝主席 |
| transcript.whisperx[162].start |
5970.734 |
| transcript.whisperx[162].end |
5985.195 |
| transcript.whisperx[162].text |
各位委員：各位與會的專家學者：還有我們衛福部的官員們大家好很高興有機會一起來參加今天的公聽會那我身為一屆的代表 |
| transcript.whisperx[163].start |
5986.3 |
| transcript.whisperx[163].end |
6003.988 |
| transcript.whisperx[163].text |
除了感謝大家以外那針對今天的公聽會我想大家也真的絞盡腦汁希望能夠更好那也希望對於其他社會所有的民眾都能夠得到好的更好的幫助尤其是在醫療的部分 |
| transcript.whisperx[164].start |
6005.669 |
| transcript.whisperx[164].end |
6033.828 |
| transcript.whisperx[164].text |
當我身為醫師的時候病人的健康是我首要的顧念我提供最合宜的醫療照護給予我的病人還有他的家人當我是社會公益團體負責人的時候我努力的提出各種倡議來協助我所照顧的癌症病人還有他的家庭可以順利的康復同時有機會得到更好的生活品質 |
| transcript.whisperx[165].start |
6035.768 |
| transcript.whisperx[165].end |
6061.998 |
| transcript.whisperx[165].text |
當我擔任地方醫師公會理事長的時候剛好是COVID最可怕的時間我努力的爭取防疫資源調合各種防疫措施以促成醫療院所共同來參與居家防疫並且致力於分析醫療的落實那現在我很幸運進入了國會殿堂 |
| transcript.whisperx[166].start |
6063.098 |
| transcript.whisperx[166].end |
6063.118 |
| transcript.whisperx[166].text |
公聽會議 |
| transcript.whisperx[167].start |
6084.105 |
| transcript.whisperx[167].end |
6112.852 |
| transcript.whisperx[167].text |
台灣建構健康台灣的同時具有良好的職業環境跟尊嚴而且沒有後顧之憂可是在民眾端我也必須要努力的協助來維持一個看得起看得到進而能夠看得好的疾病而且是一個可長可久的健康保險制度這個就是我們今天正在努力希望那個制度能夠可長可久 |
| transcript.whisperx[168].start |
6114.052 |
| transcript.whisperx[168].end |
6142.363 |
| transcript.whisperx[168].text |
相信今天四個公聽會的主題大家與會的學者都會提供非常精闢的見解來讓我們的行政機關能夠根據大家的見解共同來努力來促成如果健保法第62條的條文修正案獲得通過以後我認為我認為大家必須要非常負責任的來面對下列這四個無法迴避的問題 |
| transcript.whisperx[169].start |
6144.711 |
| transcript.whisperx[169].end |
6165.099 |
| transcript.whisperx[169].text |
這是無好迴避的問題大家必須要負責任的來面對第一個就是分級醫療制度的施行會更難落實社區醫療基層診所社區醫院恐怕會趨於萎縮這個對全民健康的維護有它一定重大的影響 |
| transcript.whisperx[170].start |
6166.883 |
| transcript.whisperx[170].end |
6182.968 |
| transcript.whisperx[170].text |
2.偏鄉醫療、重症醫療、兒童醫療會更顯困境3.醫療審查的密度與強度一定會劇增導致臨床醫師跟病人緊張的關係會日趨嚴重 |
| transcript.whisperx[171].start |
6186.329 |
| transcript.whisperx[171].end |
6208.869 |
| transcript.whisperx[171].text |
這相信對任何的臨床醫師當他面對他的病人需要醫療資源可是受限或者是他擔心往後的審查導致他的這個服務受影響的時候這是必須要請大家共同來思考的那第4點就是剛剛月秦委員所提到的當醫療費用快速成長的時候很有可能會導致社會資源的排擠 |
| transcript.whisperx[172].start |
6210.143 |
| transcript.whisperx[172].end |
6229.254 |
| transcript.whisperx[172].text |
相信對於其他需要各種我們國家資源的這些民眾來講他所受到的影響會是比現在還要讓我們擔心可是如果我們近期能夠有效來擴大健保財務的來源的話在監護社會公平情形之下 |
| transcript.whisperx[173].start |
6230.074 |
| transcript.whisperx[173].end |
6258.755 |
| transcript.whisperx[173].text |
包括我們最近醫療論壇所提到的政府來提供健保費從36%提高到38%第二點部分的總額項目回歸到公務預算來支應第三個在健保總額之外成立癌藥基金讓各種的基金在使用這個重大或者是相對於昂貴的藥物我們有更好的方式來支應第四點政府已經 |
| transcript.whisperx[174].start |
6259.876 |
| transcript.whisperx[174].end |
6288.976 |
| transcript.whisperx[174].text |
當然這個健保會的計算範圍以健保法規來做規範的來做這相關的這個健保的支應而不去影響到這個總額的制度的這個費用第5點就是鬆綁個人補充保險費單筆費用的這個上限第6點調整補充保險費率以符合更好的社會公平原則第7點就是依法來編實保險費率的上限我相信透過這些 |
| transcript.whisperx[175].start |
6289.776 |
| transcript.whisperx[175].end |
6307.59 |
| transcript.whisperx[175].text |
建保各種醫療財源的挹注,再加上健康臺灣深耕計畫經費的導入,就能夠朝著在總統當選人所主張的保障點子每點0.9元,並且朝向1.1元的目標繼續的前進。 |
| transcript.whisperx[176].start |
6310.012 |
| transcript.whisperx[176].end |
6328.971 |
| transcript.whisperx[176].text |
最後有關於各項健保改革的議題包括今天的這個點子問題真的很需要大家有更多元更全面的討論與取得的共識並且得到全民的支持最後祝福大家都能夠順心如意謝謝 |
| transcript.whisperx[177].start |
6332.776 |
| transcript.whisperx[177].end |
6334.499 |
| transcript.whisperx[177].text |
謝謝王振旭委員的發言 |
| transcript.whisperx[178].start |
6353.26 |
| transcript.whisperx[178].end |
6370.839 |
| transcript.whisperx[178].text |
主席 還有我們今天所有與會的貴賓 大家早安大家好我是臺灣大學健康政策與管理研究所兼任老師楊明清我在這邊先跟大家簡單介紹一下我自己就是在早期的時候有參與我們臺灣健保的規劃 |
| transcript.whisperx[179].start |
6373.937 |
| transcript.whisperx[179].end |
6397.947 |
| transcript.whisperx[179].text |
在那個規劃的過程裡面就發現說這個健保的制度其實它很複雜就是你可以想到說每一個制度都需要大家群策群力大家一起來想辦法看怎麼樣把它做得更好可是它其實也很單純為什麼說很單純因為它就是一個字就是錢 |
| transcript.whisperx[180].start |
6399.701 |
| transcript.whisperx[180].end |
6425.14 |
| transcript.whisperx[180].text |
你有錢,很多事情就好辦你沒錢,很多事情就做不了其實今天我想今天這個主題跟錢也是有很大的關係可是我必須說它也是很複雜你不能說錢撒下去好像什麼事情都沒有了當然我們現場剛剛有我們國發會代表我們有主計處代表財政部代表就表示說這個要謹慎以對那確實是 |
| transcript.whisperx[181].start |
6429.394 |
| transcript.whisperx[181].end |
6429.554 |
| transcript.whisperx[181].text |
主席 |
| transcript.whisperx[182].start |
6454.868 |
| transcript.whisperx[182].end |
6476.001 |
| transcript.whisperx[182].text |
規劃全民健保的時候有一項工作就是要到各個地區去宣導健保這個制度這個當然是在民國83年的時候我記得我到一個醫學中心去宣導我已經講了很多次了包括也上新聞媒體講得已經滾瓜爛熟了 |
| transcript.whisperx[183].start |
6477.011 |
| transcript.whisperx[183].end |
6504.077 |
| transcript.whisperx[183].text |
那碰到一個問題我嚇一跳從來沒有碰過這個問題就是我們把它通通講完以後就有一位現場有一位年輕的醫師他就舉手問說請問你們這個制度實施以後有沒有保障我們的薪水在醫院裡面保障他的薪水那當然沒有因為健保我們針對的是就是健保署或者當時的健保局是跟誰簽約是跟醫院簽約 |
| transcript.whisperx[184].start |
6506.84 |
| transcript.whisperx[184].end |
6506.86 |
| transcript.whisperx[184].text |
公聽會議 |
| transcript.whisperx[185].start |
6526.212 |
| transcript.whisperx[185].end |
6526.432 |
| transcript.whisperx[185].text |
主席 |
| transcript.whisperx[186].start |
6549 |
| transcript.whisperx[186].end |
6576.594 |
| transcript.whisperx[186].text |
我是非常贊同就是如果要讓一個醫院能夠穩健健全的營運下去我們的同仁是需要有足夠的這個而且是合理的這個待遇在裡面那第二個當然是他的這些設備也是需要定期去做更新這個是重要的那我再講一下在做我們這個健保的時候那也是有一件很重要的事情就是 |
| transcript.whisperx[187].start |
6578.1 |
| transcript.whisperx[187].end |
6586.169 |
| transcript.whisperx[187].text |
不曉得各位還記不記得在健保開辦的前夕有舉辦所謂的公民會議在場比較我們資深年長的專家學者比較有印象所謂的專家 對不起 我們公民會議 |
| transcript.whisperx[188].start |
6597.881 |
| transcript.whisperx[188].end |
6626.247 |
| transcript.whisperx[188].text |
公聽會議結束以後,當時的總經理他就講了一句名言,然後被新聞媒體引用他就講三件事情他說健保不能倒,大家記得這個事情嗎?那第二句話叫做什麼?就是保費不能漲第三件事情叫做給付不能少我的天我的天吶就是 |
| transcript.whisperx[189].start |
6627.625 |
| transcript.whisperx[189].end |
6656.833 |
| transcript.whisperx[189].text |
你要馬而肥又要馬而不吃草當然但是我覺得這個大家今天在這邊聽覺得說哎呀這個好像有點難就是你又要又要有東西然後又又不想要付太多錢可是你想想看這個是公民會議他們得到的一個結論我們必須要尊重剛剛我們前面那個吳明彥秘書長也對那個手牌也是講了就是民眾對於長保費是有感的但是 |
| transcript.whisperx[190].start |
6658.131 |
| transcript.whisperx[190].end |
6658.792 |
| transcript.whisperx[190].text |
建保不能倒,保費不能少 |
| transcript.whisperx[191].start |
6678.877 |
| transcript.whisperx[191].end |
6679.037 |
| transcript.whisperx[191].text |
主席 |
| transcript.whisperx[192].start |
6699.892 |
| transcript.whisperx[192].end |
6700.493 |
| transcript.whisperx[192].text |
謝謝楊明清教授 |
| transcript.whisperx[193].start |
6726.141 |
| transcript.whisperx[193].end |
6743.389 |
| transcript.whisperx[193].text |
那很榮幸有機會參加這個公聽會那健保總額因為是我一路跟醫界我們各界大家一起就是發展出來的所以今天雖然有其他會還是一定要來參加不過我有一句簡單的總結就是沒有什麼magic我們應該回到basic那這句話其實在20年前 |
| transcript.whisperx[194].start |
6755.155 |
| transcript.whisperx[194].end |
6764.319 |
| transcript.whisperx[194].text |
20多年前那時候民進黨執政那因為健保也面對很多問題所以行政院邀請我跟朱哲銘主席總長去演講我那時候結論就是這個因為其實我們對很多的議題已經討論了快要30年了但是因為我們沒有落實執行所以呢也會面對今天的困境那簡單講今天在講的點子說真的它是一個現象解 |
| transcript.whisperx[195].start |
6783.39 |
| transcript.whisperx[195].end |
6783.791 |
| transcript.whisperx[195].text |
如果點數沒辦法控制好,當然點數會下降 |
| transcript.whisperx[196].start |
6798.092 |
| transcript.whisperx[196].end |
6826.998 |
| transcript.whisperx[196].text |
所以我們如果從點子來解決是解決不了問題的我還是必須以學界的立場提出這個看法那所以回歸還是要回到健保的問題那其實剛剛大家都已經提了很多問題那我也想我也就是做一個稍微summary那目前第一個應該是資源不足第二個分配不均那資源不足當然是在整體健保的投資也包括我們預防保健的投資不足 |
| transcript.whisperx[197].start |
6827.546 |
| transcript.whisperx[197].end |
6837.436 |
| transcript.whisperx[197].text |
所以會落到後端包括慢性病腎型管理不好那分配不均不管是在以藥養醫或者是專業跟非專業等等這些其實有非常多不公平的現象甚至包括基層跟醫院還有各個科別那第三個其實最重要的問題現在大家都會跟外國比那我們只比價格 |
| transcript.whisperx[198].start |
6851.38 |
| transcript.whisperx[198].end |
6869.524 |
| transcript.whisperx[198].text |
可是大家沒有去比量我們的那個利用率還有很多服務的密集度事實上也是全世界數一數二包括我們有全世界最高的洗腎率那有幾乎快要第一的那個門診次數那另外一個問題是支付改革比較慢低價值醫療盛行那這些其實都是構成現在主要的問題所以如果真的還是要回歸 |
| transcript.whisperx[199].start |
6879.873 |
| transcript.whisperx[199].end |
6906.598 |
| transcript.whisperx[199].text |
我們真的面對這些問題點子我個人支持要適度的保障那這個部分其實主要是我們對於醫療院所承諾因為整個總和協商其實是一個願就是願意買一個願意賣如果逼到醫療院所不願意提供服務那這個也不是原來的目的所以必須要適度的保障讓醫療院所可以成長這個我是支持的 |
| transcript.whisperx[200].start |
6907.093 |
| transcript.whisperx[200].end |
6910.716 |
| transcript.whisperx[200].text |
但是要保障到什麼程度我覺得這個應該回歸健保會去協商否則健保會會形同虛設那過去會有這些問題其實健保署分析得很清楚很多其實是因為疫情那還有就是在疫情後供預算停止支付等等這些那我們不能無常正常用不能把異常變成是正常 |
| transcript.whisperx[201].start |
6934.215 |
| transcript.whisperx[201].end |
6940.617 |
| transcript.whisperx[201].text |
一定要去保障到1.1塊這個其實並不合理那我覺得應該還是要回到衛福部跟健保會這邊來去談到一個比較合理的一個保障點子那這可能不應該是1因為否則的話其實後續的會造成更多的誘因讓大家衝量那所有支出目標會面對的問題其實都會存在所以附帶補充一句就是其實當年支出目標是大家共同選的 |
| transcript.whisperx[202].start |
6963.823 |
| transcript.whisperx[202].end |
6976.126 |
| transcript.whisperx[202].text |
那不是衛生署逼大家那主要是因為支出目標沒有適度的誘因讓大家共同努力來提升效率那讓品質能夠提升所以才會有這樣的一個結果那針對這些問題我想我也簡單提幾個建議那第一個當然是擴大投資但是不是只有在健保應該在我們的預防保健疾病管理 |
| transcript.whisperx[203].start |
6991.414 |
| transcript.whisperx[203].end |
6991.814 |
| transcript.whisperx[203].text |
委員會主席 |
| transcript.whisperx[204].start |
7013.988 |
| transcript.whisperx[204].end |
7018.389 |
| transcript.whisperx[204].text |
所以我們必須要擴大投資但這個投資也必須包括剛剛講的預防保健跟在慢性病的管理這部分的投資第二個當然就是精準支付因為如果論量計酬其實是無以為繼所以剛剛講的那個點數一定會持續擴大保證就是再過幾年可能我們要談的是點值要是保障兩塊而不是一塊 |
| transcript.whisperx[205].start |
7040.615 |
| transcript.whisperx[205].end |
7060.632 |
| transcript.whisperx[205].text |
因為這個是不斷膨脹的關係那精準支付可能就要落實剛剛趙志偉也提到包括支付制度的改革DRG那門診尤其更需要改革不管是包括支付APG的支付這些都是原來已經規劃沒有落實的那另外就是精準的給付我們在藥品的討論其實也討論到 |
| transcript.whisperx[206].start |
7064.888 |
| transcript.whisperx[206].end |
7078.58 |
| transcript.whisperx[206].text |
應該具有存金才有空間讓更多新的進來而不是持續擴大預算那另外一個部分當然就是價值支付必須要考量我們提供的服務是不是能夠落實這個價值的提升 |
| transcript.whisperx[207].start |
7081.127 |
| transcript.whisperx[207].end |
7086.33 |
| transcript.whisperx[207].text |
那最後我們必須要控制供給,否則供給量不斷的擴大,也沒有辦法達到目的然後呢,要定期調整支付標準,否則我們醫事人員的薪資是沒有辦法提升的那以上報告,謝謝好,謝謝陽明交通大學衛生福利研究所李育春教授那接下來請王育民委員發言 |
| transcript.whisperx[208].start |
7112.564 |
| transcript.whisperx[208].end |
7126.65 |
| transcript.whisperx[208].text |
謝謝焦偉主持人我們本會的委員還有各位專家學者大家好我想今天這個場合非常的好就是讓大家對於整體我們的健保制度實行這麼久那我們的總額支付制度實行這麼久 |
| transcript.whisperx[209].start |
7130.112 |
| transcript.whisperx[209].end |
7130.913 |
| transcript.whisperx[209].text |
全民健康保險醫療給付費用總額之現況與展望 |
| transcript.whisperx[210].start |
7153.726 |
| transcript.whisperx[210].end |
7176.763 |
| transcript.whisperx[210].text |
那事實上這就是啟動了大家可以來對話跟跨出改變的第一步那為什麼我們上個禮拜四我想在委員會大家朝野立委大家都有共識就是這個草案已經送出委員會接下來就是朝野協商主要是大家對於現行的醫療環境很多醫院承受這樣子七折八扣的情況 |
| transcript.whisperx[211].start |
7177.603 |
| transcript.whisperx[211].end |
7204.533 |
| transcript.whisperx[211].text |
我們的醫護人員沒有辦法獲得好的薪資待遇還有我們有一些基層的院所他要更新醫療設備根本沒有辦法那這些問題我們大家都有共識而且認為是該到了改革的時候了所以我剛才聽到很多的專家學者其實也都有提到我們從這個健保點子的調升到整個健保制度裡面該改革的部分其實大家都指出一些方向 |
| transcript.whisperx[212].start |
7204.953 |
| transcript.whisperx[212].end |
7210.298 |
| transcript.whisperx[212].text |
李玉春教授提到政府的投資不夠如果我們要說我們全民健保這個是臺灣之光臺灣驕傲我們可以在世界上講得很大聲我們有很便利的健保大家在臺灣看病很方便有些人到國外年老之後一定要回到臺灣來 |
| transcript.whisperx[213].start |
7229.877 |
| transcript.whisperx[213].end |
7258.44 |
| transcript.whisperx[213].text |
臺灣的健保制度真的是太好了照顧很多人但是我要講一句臺灣這麼好用的健保絕對不能建立在我們醫護的血汗之上一定是要讓我們的醫療環境構建權談永續才有價值大家都提到說健保要永續沒有人會反對但是如果我們的健保制度建立在那個過程是需要醫護付出血汗 |
| transcript.whisperx[214].start |
7259.201 |
| transcript.whisperx[214].end |
7259.401 |
| transcript.whisperx[214].text |
政府負擔36%健康論壇提出 |
| transcript.whisperx[215].start |
7283.019 |
| transcript.whisperx[215].end |
7283.479 |
| transcript.whisperx[215].text |
全民健康保險醫療及衛生環境委員 |
| transcript.whisperx[216].start |
7299.204 |
| transcript.whisperx[216].end |
7299.224 |
| transcript.whisperx[216].text |
公聽會議 |
| transcript.whisperx[217].start |
7315.686 |
| transcript.whisperx[217].end |
7318.488 |
| transcript.whisperx[217].text |
是我們認為臺灣最值得支撐的一個體系的話為什麼超徵稅額不能優先挹注到我們的全民健保為什麼我們握有權利者不能做出這樣子的一個決定而是看說部長誰大聲誰比較會爭取資源所以人家經濟部部長好棒棒一千億就過去台電了 |
| transcript.whisperx[218].start |
7340.225 |
| transcript.whisperx[218].end |
7340.605 |
| transcript.whisperx[218].text |
衛福部部長 |
| transcript.whisperx[219].start |
7369.489 |
| transcript.whisperx[219].end |
7379.376 |
| transcript.whisperx[219].text |
財源的問題無解嗎?我個人認為是有解的所以在上個禮拜六有一個南寧國有獎的頒獎典禮卓榮泰院長也到了現場那我就當面也跟他說我說這個健保點值要調高的問題大家共同來面對行政院跟國會一起來面對目標只有一個他在現場也說這個他又提到CEO World就是提到我們這個No.1 |
| transcript.whisperx[220].start |
7397.408 |
| transcript.whisperx[220].end |
7417.803 |
| transcript.whisperx[220].text |
但是他忽略一件事情就是我們真正要打造一個優質的健全的永續的健保體系我們才可以真正拿到第一這個第一才有價值所以我當場跟他說是不是新的政府新的上任賴總統提出健康台灣的口號我也非常贊成 |
| transcript.whisperx[221].start |
7418.666 |
| transcript.whisperx[221].end |
7445.868 |
| transcript.whisperx[221].text |
但是健康台灣不能只是一句口號健康台灣如果要付諸實踐那請政府加大自己對於整個健保體系的投資增加我們的預算把這件事情列為是重中之重最優先而最後我要講賴清德總統他其實特別有提到說在總統選舉的時候他說他最有能力來解決這個健保的問題 |
| transcript.whisperx[222].start |
7448.01 |
| transcript.whisperx[222].end |
7449.511 |
| transcript.whisperx[222].text |
我們要跟賴清德總統喊話賴總統520你即將上任我們也相信你最有能力來解決健保的問題那解決健保的問題我們從今天討論的這個調高健保點子開始其他的配套開始 |
| transcript.whisperx[223].start |
7465.32 |
| transcript.whisperx[223].end |
7468.221 |
| transcript.whisperx[223].text |
好 謝謝王育明委員的發言 那我們現在休息10分鐘 |
| transcript.whisperx[224].start |
7506.697 |
| transcript.whisperx[224].end |
7508.138 |
| transcript.whisperx[224].text |
委員會主席 |
| transcript.whisperx[225].start |
7532.683 |
| transcript.whisperx[225].end |
7532.783 |
| transcript.whisperx[225].text |
主席 |
| transcript.whisperx[226].start |
7559.411 |
| transcript.whisperx[226].end |
7559.671 |
| transcript.whisperx[226].text |
主席 |
| transcript.whisperx[227].start |
7579.12 |
| transcript.whisperx[227].end |
7579.581 |
| transcript.whisperx[227].text |
委員會主席 |
| transcript.whisperx[228].start |
7605.938 |
| transcript.whisperx[228].end |
7606.679 |
| transcript.whisperx[228].text |
委員會主席 |
| transcript.whisperx[229].start |
7635.898 |
| transcript.whisperx[229].end |
7636.359 |
| transcript.whisperx[229].text |
委員會主席 |
| transcript.whisperx[230].start |
7665.758 |
| transcript.whisperx[230].end |
7666.198 |
| transcript.whisperx[230].text |
委員會主席 |
| transcript.whisperx[231].start |
7683.348 |
| transcript.whisperx[231].end |
7683.668 |
| transcript.whisperx[231].text |
委員會主席 |
| transcript.whisperx[232].start |
7700.896 |
| transcript.whisperx[232].end |
7701.857 |
| transcript.whisperx[232].text |
法定人數不足 |
| transcript.whisperx[233].start |
8124.807 |
| transcript.whisperx[233].end |
8146.118 |
| transcript.whisperx[233].text |
好 我們繼續公聽會好 接下來請中華民國區域醫院協會顧問是不是請各位安靜請各位安靜 我們要繼續發言請各位安靜 |
| transcript.whisperx[234].start |
8153.32 |
| transcript.whisperx[234].end |
8174.896 |
| transcript.whisperx[234].text |
請回座謝謝好接下來請中華民國區域醫院協會顧問陳志忠顧問發言尊敬的主席以及各位在現場我很多的老師還有我們的同一屆的同仁大家早安大家好 |
| transcript.whisperx[235].start |
8176.884 |
| transcript.whisperx[235].end |
8193.423 |
| transcript.whisperx[235].text |
聽完前面各位學者專家還有我們的主管機構健保署所說的話語好像剩下我能夠講的就不多了不過我還是準備了幾點跟大家做補充第一個 |
| transcript.whisperx[236].start |
8195.71 |
| transcript.whisperx[236].end |
8217.979 |
| transcript.whisperx[236].text |
剛剛有某位專家提到健保今年第30年從1995年美國84年開始前10年大家過得沒有問題第二個10年開始各個部門開始實施總額預算大家覺得好像還行還活得下去可是這10年非常的痛苦 |
| transcript.whisperx[237].start |
8221.574 |
| transcript.whisperx[237].end |
8233.827 |
| transcript.whisperx[237].text |
我們算一下數字就知道我們每年健保總額的成長率經過健保會提出政府核定了以後大概都在5%上下很少超過6% |
| transcript.whisperx[238].start |
8237.019 |
| transcript.whisperx[238].end |
8259.456 |
| transcript.whisperx[238].text |
在5%上下,健保署其實先拿起了一部分來做品質的鼓勵所以真正分到各個醫院各區區的成長大概只有2.5到3%可是我們大家所有有經營醫療機構的人都知道我們醫療機構的 |
| transcript.whisperx[239].start |
8262.145 |
| transcript.whisperx[239].end |
8269.623 |
| transcript.whisperx[239].text |
每所有的收入裡面50%給了人事費用那我們的員工不管醫生 |
| transcript.whisperx[240].start |
8270.953 |
| transcript.whisperx[240].end |
8293.926 |
| transcript.whisperx[240].text |
不算以外其他的員工每年是要調薪的調薪來自兩個事情第一個他的年資到了要往上調護理人員從N1要升N2要升N3所有的技術人員所有的行政人員他有值等值等要往上調另外一個就是政府每年公務人員的調薪最近幾年都在4% 5%那我們 |
| transcript.whisperx[241].start |
8298.769 |
| transcript.whisperx[241].end |
8314.007 |
| transcript.whisperx[241].text |
在公立的機構要調薪私人的機構如果不跟著調薪你的員工就跑了所以這樣算起來這樣的一個健保的成長率我們根本不用考慮別的事情就已經不夠來支付這個人員的成本 |
| transcript.whisperx[242].start |
8314.83 |
| transcript.whisperx[242].end |
8315.991 |
| transcript.whisperx[242].text |
第二件事啊,我要提一下就是 |
| transcript.whisperx[243].start |
8339.08 |
| transcript.whisperx[243].end |
8359.485 |
| transcript.whisperx[243].text |
1.1元是尊重我們的專業想想看如果各位的薪水你上班以後我們健保一季算到第一季結束以後你的老闆或者政府告訴公務人員說對不起我們錢不夠了所以你的薪水我們給你打個0.95打個0.90人民會同意嗎?絕對不會同意 |
| transcript.whisperx[244].start |
8364.69 |
| transcript.whisperx[244].end |
8379.3 |
| transcript.whisperx[244].text |
那我們政府去蓋房子蓋道路蓋橋樑都可以最佳預算為什麼唯獨照顧人民的健康不能最佳預算不能給他補足到1.1元剛剛我們提到這個我們的總額 |
| transcript.whisperx[245].start |
8388.499 |
| transcript.whisperx[245].end |
8397.467 |
| transcript.whisperx[245].text |
有老師說如果保障點資就等於把總額廢掉了我們現在一屆提出的是總額目標制 |
| transcript.whisperx[246].start |
8398.885 |
| transcript.whisperx[246].end |
8420.481 |
| transcript.whisperx[246].text |
不要上限制 如果我們談好一個目標以後 超過的部分應該怎麼處理就請健保署 請政府 請主管機關想辦法用審查的方法 用攤扣的方法 用斷頭的方法甚至怎麼樣來把這個控制在合理的範圍裡面 |
| transcript.whisperx[247].start |
8421.92 |
| transcript.whisperx[247].end |
8434.828 |
| transcript.whisperx[247].text |
那世界各國不管實施公益制度或者是實施總額的一些保險制度的國家它都幾乎都是目標制並沒有說用打折的方法給付 |
| transcript.whisperx[248].start |
8436.175 |
| transcript.whisperx[248].end |
8459.32 |
| transcript.whisperx[248].text |
怎麼做到呢?就是人民要承受在接近年底的時候,在這個fiscal year,在這個快進年度快結束的時候,他錢不夠了,就把一些非緊急的醫療往後延。我們在國外很多人說他到年底去排一個CT scan,可能要花很多的時間,就是這樣的原因。 |
| transcript.whisperx[249].start |
8460.578 |
| transcript.whisperx[249].end |
8482.826 |
| transcript.whisperx[249].text |
然後第三點我必須要替我們基層的醫療機構就是我們廣大的開業的醫師我們的同道講一句話醫院有所謂這個什麼停車場美食街可以增加他的收入來補充他的 |
| transcript.whisperx[250].start |
8484.726 |
| transcript.whisperx[250].end |
8512.443 |
| transcript.whisperx[250].text |
讓他不要虧損但是我們基層開業的同仁是沒有這些的他們完全靠這個而且他們的他們的那個診察費不在保障點子範圍不是固定點子固定點子只有手術費還有藥費這些等等最後因為我是一個泌尿外科醫師剛剛提的都太客氣了吳明彥秘書長我講倒尿 |
| transcript.whisperx[251].start |
8513.936 |
| transcript.whisperx[251].end |
8538.334 |
| transcript.whisperx[251].text |
他說通水管好像要1500塊還是1000塊他講放個氣管導管都有好幾百點導尿通水管一個講導尿導尿是94點從來沒有調過以上報告祝大家身體健康萬事如意健保能夠為臺灣人民帶來最好最健康的社會謝謝 |
| transcript.whisperx[252].start |
8540.936 |
| transcript.whisperx[252].end |
8542.218 |
| transcript.whisperx[252].text |
好 謝謝陳志忠顧問接下來請臺灣社會心理復健協會 滕熙華秘書長發言 |
| transcript.whisperx[253].start |
8557.801 |
| transcript.whisperx[253].end |
8575.211 |
| transcript.whisperx[253].text |
主席 呃 主席各位委員 與會的觀眾 大家午安 因為時間的關係 所以我就不議問候 講快一點 這樣 謝謝好 今天的slide是這樣子 我要講為什麼 呃 點值合以反映品質 我要看 我們要先檢討一下目前的制度 就是第一個 元兇是長期漠視健保收入面的成額 是政府帶頭惡化 |
| transcript.whisperx[254].start |
8576.272 |
| transcript.whisperx[254].end |
8603.644 |
| transcript.whisperx[254].text |
建保廢機過度依賴薪資所得加護總所得10年停滯2004年二代建保的時候就說我們廢機跟合理保費收入的唯一處方就是加護總所得我們現在足跡總數公佈的薪資所得下降我們的人口紅利從2019年再也沒有了所以呢一直用薪資所得來去合理化補充保費再把它調高從1000萬調到5000萬完全沒有理由去合理化資本利的沒有納入廢機這件事情是完全不對的 |
| transcript.whisperx[255].start |
8604.444 |
| transcript.whisperx[255].end |
8622.942 |
| transcript.whisperx[255].text |
政府負擔灌水健保法施行細則在106年修法的時候104年修法的時候45條把高達9項的社會福利的補貼全部都灌水進去我們的政府負擔36%我們好不容易搶救了兩項這個一年至少政府在政府負擔率裡面就至少70億以上的這個 |
| transcript.whisperx[256].start |
8624.343 |
| transcript.whisperx[256].end |
8624.363 |
| transcript.whisperx[256].text |
公聽會議 |
| transcript.whisperx[257].start |
8654.343 |
| transcript.whisperx[257].end |
8654.723 |
| transcript.whisperx[257].text |
公聽委員：完整會議 |
| transcript.whisperx[258].start |
8675.9 |
| transcript.whisperx[258].end |
8702.558 |
| transcript.whisperx[258].text |
總共將近32億都是用我們的保費來支出吸肝全口服新藥在106年納入給付的時候包括醫界代表都共同呼籲公務預算要相對編列可是我們的公務預算只去成立了肝炎防治辦公室沒有在吸肝全口服新藥這麼貴的裡面去支應而且還不斷的擴大輕症以及沒有症狀的治療至今為止花了418億國健署 疾管署 口腔師在預防性治療 公共衛生這一些就以113年為例 |
| transcript.whisperx[259].start |
8704.199 |
| transcript.whisperx[259].end |
8730.601 |
| transcript.whisperx[259].text |
包括狂犬病疫苗在內就已經超過16億這些都是政府灌進來的再來就是政府自行核定總額加碼的項目協商形同虛設所以我們就沒有辦法在協商的時候預估我們的成長率跟我們的保費應該要做多少暫行性支付原本是一件好事可是暫行性支付裡面只有臨床一起的也可以納入這不是形同把恩慈療法跟臨床試驗納入健保給付嗎 |
| transcript.whisperx[260].start |
8731.181 |
| transcript.whisperx[260].end |
8746.805 |
| transcript.whisperx[260].text |
去合理化我們因為外界對於癌症性要審查緩慢的一個理由也讓醫生跟臨床的醫生裡面在使用暫停性支付的時候自己去面對不確定療效跟安全的這個藥物那制度性惡化的問題醫學中心上限數量去除管制化 |
| transcript.whisperx[261].start |
8747.425 |
| transcript.whisperx[261].end |
8771.227 |
| transcript.whisperx[261].text |
導致支出面跟部分負擔就地就起價健保沒有做什麼事情醫療服務也沒有改變當醫學中心升等之後我們的支付支出就完全的上升再來就是失去橫平性的支付標準會炒的孩子有糖吃啊我們就變成RBRVS要檢討的虛幅化跟破碎化因為你沒有辦法按照科學的證據去調整支付標準聲量大的新聞大的先調 |
| transcript.whisperx[262].start |
8772.188 |
| transcript.whisperx[262].end |
8797.526 |
| transcript.whisperx[262].text |
先保障哪邊不夠我就調到這邊因為政治壓力我就先調所以越來越多以年齡別單一疾病新增3歲以下要保障變成6歲以下要保障變成18歲要保障80歲要保障現在變成75歲保障變成65歲要保障這些都破壞給付的橫平性那表面醫療分級但支付標準是分級的亂象就是這樣我再舉兩個例子就好因為藥草有糖吃所以就造成什麼 |
| transcript.whisperx[263].start |
8798.166 |
| transcript.whisperx[263].end |
8813.728 |
| transcript.whisperx[263].text |
醫學中心你要做分級醫療但專科醫師之所以診察費比較高是因為他要做更好的這個品質更專業的治療可是現在調整會造成部分醫學中心的專科醫師診察費低於基層然後我們醫學中心的急診給付一二級竟然低於地區醫院那這是什麼醫療的分級 |
| transcript.whisperx[264].start |
8815.57 |
| transcript.whisperx[264].end |
8841.997 |
| transcript.whisperx[264].text |
責任變獎勵 比如向上轉診應該是基於醫療院所的設備專業能力向上轉診是一種醫療的責任現在我們也拿獎勵在鼓勵向上轉診那再來 停滯不前的支付制度推動改革這個剛剛李玉春老師已經有提到了我就不再講這一些改革支付制度的停滯剛剛鄭首相老師也有說你要做你就要做這一些沒有 現在都沒有做所以我們就會造成說我們現在論量計酬底下有做就有錢跟品質不一定關係 |
| transcript.whisperx[265].start |
8842.737 |
| transcript.whisperx[265].end |
8845.058 |
| transcript.whisperx[265].text |
臺灣民眾跟現場的醫界可以允許那個做得很好的跟做得很不好的你拿一樣的錢嗎拿一樣的價值嗎不能允許嘛 |
| transcript.whisperx[266].start |
8859.565 |
| transcript.whisperx[266].end |
8860.006 |
| transcript.whisperx[266].text |
全民健康保險醫療給付費用總額之現況與展望 |
| transcript.whisperx[267].start |
8874.728 |
| transcript.whisperx[267].end |
8874.848 |
| transcript.whisperx[267].text |
公聽會議公聽會議公聽會議 |
| transcript.whisperx[268].start |
8898.688 |
| transcript.whisperx[268].end |
8906.07 |
| transcript.whisperx[268].text |
地區醫院的一二級急診給付高於醫學中心完全沒有道理然後醫護人員的薪資勞動條件勞動部為什麼無動於衷呢台灣藥廠首發支付為什麼健保署要不計成本扛經濟部沒他的事嗎你不應該經濟部出來獎勵台灣的藥廠嗎再來這是最後一頁這樣根據健保資料2022年平均薪資門診申報點數894加上住院超過1300萬點請問各位醫院老闆 |
| transcript.whisperx[269].start |
8923.454 |
| transcript.whisperx[269].end |
8930.399 |
| transcript.whisperx[269].text |
醫院老闆你們問健保署不對啊醫師們你要問醫院老闆你拿多少錢出來給受雇薪資剛剛姚明欽老師要講問錯人護理費從98年500億護病比都拿光了剛公佈的110年財報最賺錢的前20大醫院護病比表現不突出請問在場的護理師全台灣的20萬職業護理師醫院老闆拿出來多少錢給護理師薪資你要問你的老闆不是問健保署健保署不是直接付錢給你所以你要找誰算帳啊這件事情要找對人 |
| transcript.whisperx[270].start |
8953.195 |
| transcript.whisperx[270].end |
8970.36 |
| transcript.whisperx[270].text |
最後一張建品質等於點子我們都贊成我們追求合理好的品質應該要有好的點子但好的品質跟好的點子唯一的路只有支付制度改革跟健保費機正義而不是論量底下的去責任化謝謝好謝謝藤西黃秘書長接下來請陳金輝委員發言 |
| transcript.whisperx[271].start |
8993.657 |
| transcript.whisperx[271].end |
9008.008 |
| transcript.whisperx[271].text |
主席在座非常多我一屆的前輩以及各位委員還有各位官員大家早安大家好還是必須要回到我們全國人民的健康水平 |
| transcript.whisperx[272].start |
9011.385 |
| transcript.whisperx[272].end |
9024.443 |
| transcript.whisperx[272].text |
所以必須重複健保點值打折就是人民健康打折如果我們是一個連醫事人員都無法善待的政府又如何能夠促進健康台灣呢 |
| transcript.whisperx[273].start |
9026.501 |
| transcript.whisperx[273].end |
9052.843 |
| transcript.whisperx[273].text |
這個大家到媒體就可以抓到這樣子的圖我也希望等等公聽會結束以後我們隨時經過一個醫院從外面的窗戶看看所有的急診室拜託大家感受一下現在是一個禮拜一的上午我們在會議室裡面平靜的開著會但是呢我們看到在座許多專業的醫事人員本來應該要在醫院忙碌的救治這些病患的時間 |
| transcript.whisperx[274].start |
9054.344 |
| transcript.whisperx[274].end |
9056.526 |
| transcript.whisperx[274].text |
他們會來到現場是因為退無可退所以犧牲了自己寶貴的時間站出來發聲是希望爭取自己和同儕的工作權尊嚴還有身為一個人長期被低估的基本的勞務權利就是這麼卑微就是這麼簡單而已 |
| transcript.whisperx[275].start |
9077.327 |
| transcript.whisperx[275].end |
9079.249 |
| transcript.whisperx[275].text |
我們也要門心自問的想想看現在的護理師流動率這麼高我們在座的各位委員我們也都會老啊我們也希望自己的長輩甚至自己在未來台灣面對高齡化衝擊的時候台灣有足夠的護理人員醫事人員可以讓我們得到好好的照顧 |
| transcript.whisperx[276].start |
9097.805 |
| transcript.whisperx[276].end |
9111.119 |
| transcript.whisperx[276].text |
但面臨現在的點子我可以告訴大家說沒有辦法了已經沒有辦法了要不是大家退無可退不可能站出來發聲好我們看到今天報告第14第10第11頁的內容也請衛福部長官不要再跟全國的醫事人員情緒勒索 |
| transcript.whisperx[277].start |
9118.226 |
| transcript.whisperx[277].end |
9124.691 |
| transcript.whisperx[277].text |
你告訴我說點值如果用0.95用1.0來計算的話會出現不足60到500億的財務缺口會排擠到其他政府部門的預算我就想請教了現在衛福部要不要跟大家交代一下光是在去年而已你就增加挹注了全民健康健保基金240億元你自己是不是也在帶頭排擠其他部門的預算 |
| transcript.whisperx[278].start |
9147.146 |
| transcript.whisperx[278].end |
9162.159 |
| transcript.whisperx[278].text |
或者是透過點值條長上的毫無作為來犧牲了全國人民的健康的權利呢衛福部長上週說如果我們要達到點值1.1元必須要漲保費意圖來製造對立 |
| transcript.whisperx[279].start |
9164.321 |
| transcript.whisperx[279].end |
9179.305 |
| transcript.whisperx[279].text |
但是根據臺灣健康投資報告我把臺灣健康表現與醫療支出的關聯真相呈現給大家我們的國家投注在醫療保健用途的支出比例來說臺灣的經常性醫療保健支出僅佔了GDP的6.1%低於OECD國家的9.6% |
| transcript.whisperx[280].start |
9188.087 |
| transcript.whisperx[280].end |
9198.495 |
| transcript.whisperx[280].text |
至於公部門：公部門的醫療支出占比臺灣只有3.9%低於太多大部分我們熟悉的國家韓國4.8%日本9.2%法國9.3%德國9.5% |
| transcript.whisperx[281].start |
9205.641 |
| transcript.whisperx[281].end |
9218.936 |
| transcript.whisperx[281].text |
這個公部門的醫療支出占比就看得出來長期冷血漠視把醫事人員的無私功德付出當成政績來說嘴是多麼的無情 |
| transcript.whisperx[282].start |
9220.417 |
| transcript.whisperx[282].end |
9241.995 |
| transcript.whisperx[282].text |
部長在上週四跟大家講說健保點值調漲的話國庫因此會增加支出同樣的邏輯之下健保點值如果沒有調漲那麼國庫沒有增加的支出也將會讓國人用吃了虧打了折的醫療品質來承擔今天大家也可以思考一下透過我手上的這個圖表 |
| transcript.whisperx[283].start |
9243.456 |
| transcript.whisperx[283].end |
9250.58 |
| transcript.whisperx[283].text |
我們看到健保總額點值一點不足1元的缺口不算去年就累積到2022年為止在醫院的缺口就有4504億點在基層的醫療院所就有886億點總計是5390億點而這些點數支出的同時是被政府 |
| transcript.whisperx[284].start |
9266.147 |
| transcript.whisperx[284].end |
9290.547 |
| transcript.whisperx[284].text |
用打了七折打了八折簡單來說彷彿認為人民的健康是可以有折扣來計算的至於也將因此有打折的結果今天政府不想解決具體的表現呢也將反映在小病就醫看診方便但是癌症大病治不好慢性病活不久這樣子的事實上 |
| transcript.whisperx[285].start |
9291.548 |
| transcript.whisperx[285].end |
9318.379 |
| transcript.whisperx[285].text |
我們最新在去年8月公布了2022年國人平均壽命是79.84歲其中男性76歲女性83歲已經遠遠比日本韓國還來的低各國都非常重視國民的平均餘命是衡量這個國家基本健康標準而我們透過我們健保制度的運作不妨看一下我手上這張圖表大家真的不要再自瞞 |
| transcript.whisperx[286].start |
9319.139 |
| transcript.whisperx[286].end |
9330.629 |
| transcript.whisperx[286].text |
什麼叫做醫療服務第一名應該要更用開放的心胸去看思考一下為什麼我們還不能在平均愚民的提升上能有進一步的空間 |
| transcript.whisperx[287].start |
9332.344 |
| transcript.whisperx[287].end |
9358.91 |
| transcript.whisperx[287].text |
雪漢醫護影響病患的權益 背後的原因來自於健保點值的浮動 長期的低落不足而給付表面上是醫界吃虧沒錯 醫護人員吃虧 但實際上間接影響的到醫療品質真正危害的是全國人民的健康甚至健康於命 癌症五年存活率 新生兒死亡率都遠遠的低於OECD其他國家 |
| transcript.whisperx[288].start |
9359.75 |
| transcript.whisperx[288].end |
9384.685 |
| transcript.whisperx[288].text |
好為了沒有辦法給醫事員合理待遇多少年來護理師錢少事多回家晚必須輪三班離職率居高不下人手不足導致護病比過低嚴重的影響我們的住院品質他們頻繁的加班導致身心俱疲惡性循環下離職率更高最後只得縮減病床關閉病房 |
| transcript.whisperx[289].start |
9386.426 |
| transcript.whisperx[289].end |
9411.6 |
| transcript.whisperx[289].text |
導致急診等住院的病人無法住院這個現在已經是現在進行式的人間煉獄根據國際護理學會統計臺灣護理人員平均職業的壽命只有6到7年為亞洲國家最低跟歐美國家超過20年以上的職業年資是天壤之別因此我也要在這邊呼籲我們所有的朝野委員 |
| transcript.whisperx[290].start |
9412.6 |
| transcript.whisperx[290].end |
9415.021 |
| transcript.whisperx[290].text |
長庚大學醫務管理學系 盧瑞芬教授 |
| transcript.whisperx[291].start |
9449.741 |
| transcript.whisperx[291].end |
9453.842 |
| transcript.whisperx[291].text |
建保的議題其實是一個非常基本的經濟的問題就是說資源有限但是欲望無窮 |
| transcript.whisperx[292].start |
9475.809 |
| transcript.whisperx[292].end |
9475.829 |
| transcript.whisperx[292].text |
公聽會議 |
| transcript.whisperx[293].start |
9505.709 |
| transcript.whisperx[293].end |
9505.729 |
| transcript.whisperx[293].text |
公聽會議 |
| transcript.whisperx[294].start |
9524.013 |
| transcript.whisperx[294].end |
9533.004 |
| transcript.whisperx[294].text |
核心的服務由社會保險來做但是往上可以再去加成這個是目前世界各國都有在處理的方式那我們現在臺灣的國衛院的論壇也花了一年的時間今年年底會出這份報告 |
| transcript.whisperx[295].start |
9538.951 |
| transcript.whisperx[295].end |
9539.051 |
| transcript.whisperx[295].text |
委員會主席 |
| transcript.whisperx[296].start |
9557.091 |
| transcript.whisperx[296].end |
9568.829 |
| transcript.whisperx[296].text |
分配這個錢然後來調整這個薪資這是醫院內部的管理的問題那當然我也知道說醫院覺得錢啊不夠的時候就沒辦法有合理的這個薪資但是這個部分 |
| transcript.whisperx[297].start |
9569.986 |
| transcript.whisperx[297].end |
9594.327 |
| transcript.whisperx[297].text |
有時候因為人力的不足這個是一個市場失靈的問題市場失靈的問題其實是要政府介入政府介入的方式就包括我們的醫事師我們要在保障互併比的前提下面是不是要有其他人力的配套措施這都不是單單健保一個制度可以去修正的 |
| transcript.whisperx[298].start |
9595.56 |
| transcript.whisperx[298].end |
9596.06 |
| transcript.whisperx[298].text |
全民健康保險醫療給付費用總額之現況與展望 |
| transcript.whisperx[299].start |
9614.677 |
| transcript.whisperx[299].end |
9633.063 |
| transcript.whisperx[299].text |
除了財源的問題以外我們可以多元化但是更重要是後面分配的問題也就是它不是只是放在急性醫療它是應該整個醫療體系包括從前端的這個預防中間的急診中間的這個acute care急性醫療跟後面的post-acute這個都是要全面處理 |
| transcript.whisperx[300].start |
9633.743 |
| transcript.whisperx[300].end |
9661.426 |
| transcript.whisperx[300].text |
所以並不是只是說你把錢籌到位不去考慮合理的分配就可以解決這樣的問題回應一下剛才鄭院長有提到韓國現在平均餘命高我們兩年但是有一點要注意就是韓國其實的不健康餘命這些年一直都在增加所以它中間跟台灣大概差距不健康餘命高於台灣一年所以如果把這個扣下來的話其實它高於我們的平均餘命大概是一年左右不到一年 |
| transcript.whisperx[301].start |
9661.946 |
| transcript.whisperx[301].end |
9662.106 |
| transcript.whisperx[301].text |
主席 |
| transcript.whisperx[302].start |
9694.147 |
| transcript.whisperx[302].end |
9718.539 |
| transcript.whisperx[302].text |
就是全面性的去保障這個點值的話其實不管是1.1塊或者是1.0.95都失去總額的精神因為總額就是在一定的額度下面要去發揮同儕制約的這個機制所以你如果這樣做的這個全面的去做這個保障的點值其實呢某個程度上真的是形同廢除總額那 |
| transcript.whisperx[303].start |
9720.04 |
| transcript.whisperx[303].end |
9744.958 |
| transcript.whisperx[303].text |
我們在做總額制度是投入了非常多的人力物力跟社會成本包括我們每年的這個協商所以其實呢不適當在實施總額的制度下再去保障這個點子那這樣的話其實是有點多此一舉總額制度當然不完美有很多改進的空間公視可以修正額度可以合理調整但是呢 |
| transcript.whisperx[304].start |
9745.498 |
| transcript.whisperx[304].end |
9745.518 |
| transcript.whisperx[304].text |
公聽會議 |
| transcript.whisperx[305].start |
9766.457 |
| transcript.whisperx[305].end |
9786.905 |
| transcript.whisperx[305].text |
上限制改成目標制那我跟各位分享在德國門診是設定服務量的上限超過上限的就打折支付就是形同我國的合理門診量如果是醫院的話他採取的是個別醫院預算超過也是打折打幾折打三五折所以每一劑 |
| transcript.whisperx[306].start |
9787.825 |
| transcript.whisperx[306].end |
9787.845 |
| transcript.whisperx[306].text |
公聽會議 |
| transcript.whisperx[307].start |
9803.467 |
| transcript.whisperx[307].end |
9803.787 |
| transcript.whisperx[307].text |
中文字幕提供 |
| transcript.whisperx[308].start |
9827.863 |
| transcript.whisperx[308].end |
9844.818 |
| transcript.whisperx[308].text |
澳洲拿加拿大澳洲跟加拿大是用一般稅收他當然有預算政府就明白的撥裂這麼多錢就是放在這個醫療上面所以呢不會去玩讓這個論量計酬呢這個毫無這個限制的往上去成長 |
| transcript.whisperx[309].start |
9845.498 |
| transcript.whisperx[309].end |
9845.678 |
| transcript.whisperx[309].text |
委員會主席 |
| transcript.whisperx[310].start |
9871.716 |
| transcript.whisperx[310].end |
9871.836 |
| transcript.whisperx[310].text |
總結我剛剛講的話 |
| transcript.whisperx[311].start |
9894.906 |
| transcript.whisperx[311].end |
9897.847 |
| transcript.whisperx[311].text |
好 謝謝盧瑞芬教授接下來請財團法人 中華民國消基會名譽董事長 謝天仁董事長發言 |
| transcript.whisperx[312].start |
9936.306 |
| transcript.whisperx[312].end |
9963.256 |
| transcript.whisperx[312].text |
各位先進我在健保大概待了10年的時間從一代健保待到二代健保那當然點滴在心頭那今天醫界提出來所謂的點子保障那我直接的下的結論就是要搞倒健保醫界很聰明他認為點子保障本身要從公務預算來那就是怎麼樣無限負擔了嘛 |
| transcript.whisperx[313].start |
9968.417 |
| transcript.whisperx[313].end |
9994.288 |
| transcript.whisperx[313].text |
這個不符合我們健保上面大家必須要去面對的現況我們健保的現況是從開始健保開始以後就因為健保的會用快速增加實在受不了所以才開始慢慢建立總額制度那總額制度健保署本身又用所謂的論量計酬所以我們真正的問題是發生在什麼地方發生在我們的充量上面 |
| transcript.whisperx[314].start |
9995.248 |
| transcript.whisperx[314].end |
10018.375 |
| transcript.whisperx[314].text |
那他的問題是在衝量,你用點子給他保障,那意思是怎麼樣?快馬駕鞭嘛,奔向混場所以我認為這個點子保障本身,基本上大概大家的思維裡面可能認為說那我可以由公務預算來分擔,或者是從互惠者這邊來負擔那我認為公務預算要負擔的東西太多了啦 |
| transcript.whisperx[315].start |
10019.369 |
| transcript.whisperx[315].end |
10043.242 |
| transcript.whisperx[315].text |
我們要不要回歸到105年去想想這些問題105年發生了大概4個問題每年就讓健保本身的收入減少了115億以上剛剛我們細花姐有提到幾點比如說政府保障36%政府保派獎從來沒有戶到36%然後股票股息本來5000塊起徵那個好人 |
| transcript.whisperx[316].start |
10046.479 |
| transcript.whisperx[316].end |
10072.133 |
| transcript.whisperx[316].text |
你竟然把它調到兩萬塊起徵我就覺得莫名其妙的事情怎麼會這樣我們不是要保障弱勢嗎我們不是社會保險嗎怎麼會反而降低那些強勢者本身的這個相關的補充保衛的負擔呢那其他當然就是各位可以看到厭倦本來78億住在健保割了20%只剩下50%到健保 |
| transcript.whisperx[317].start |
10073.679 |
| transcript.whisperx[317].end |
10095.234 |
| transcript.whisperx[317].text |
這幾個大概加起來四個一年就至少少了150億少了150億各位想一想105年到現在當然會發生一些問題所以我們要去面對這些問題大家來調整大家來面對就是這個量跟價本身是相隨的 |
| transcript.whisperx[318].start |
10097.432 |
| transcript.whisperx[318].end |
10097.632 |
| transcript.whisperx[318].text |
委員會主席 |
| transcript.whisperx[319].start |
10116.555 |
| transcript.whisperx[319].end |
10136.98 |
| transcript.whisperx[319].text |
補他的不足所以才會造成充量的現象但是我曾經問過健保署說明明每年都有非協商因素醫療服務成本的成長率為什麼這些成長率不調整他們的支付標準讓醫業到現在還很多的意見認為說剛剛呈現出來的那不是量的問題那是價的問題 |
| transcript.whisperx[320].start |
10143.101 |
| transcript.whisperx[320].end |
10167.202 |
| transcript.whisperx[320].text |
價格問題我們要其實應該要很慎重的去面對我覺得這個東西基本上面涉及到他成本都增加了你為什麼在他支付標準上面不去給他增加不去給他調整但是量的問題要回來面對現實我們只有三道控制的防線第一道健保署第二道醫療機構第三道護衛者但是我們最近發現多了一道 |
| transcript.whisperx[321].start |
10168.567 |
| transcript.whisperx[321].end |
10177.619 |
| transcript.whisperx[321].text |
老天爺給你call me 19各位我看了111年我們2億以上的公務2億以上的醫療機構申報的財務資料92%是賺錢的 |
| transcript.whisperx[322].start |
10183.703 |
| transcript.whisperx[322].end |
10204.253 |
| transcript.whisperx[322].text |
百分之八虧錢為什麼 因為看診的少了嘛老天爺給你控制看看說醫療的需求量不應該這麼多啊我們台灣為什麼跟世界各國比起來我們相對怎麼樣 相對不健康我們的平均移民為什麼這樣的不健康啊 這麼長 |
| transcript.whisperx[323].start |
10206.83 |
| transcript.whisperx[323].end |
10229.32 |
| transcript.whisperx[323].text |
這是我們要去面對那當然這些有一些國民健康署本身應該要做的我看國民健康署就會做的就是我補助你去檢查或怎麼樣這樣他不是補助你去預防你的疾病的發生那疾病不發生當然健保的用量就減少了嘛那疾病一發生就在健保上面來所以兩個是相隨的 |
| transcript.whisperx[324].start |
10231.161 |
| transcript.whisperx[324].end |
10249.767 |
| transcript.whisperx[324].text |
所以我們的政府本身到底是要我們的老百姓多去看病還是要我們的老百姓本身要好好讓自己更健康這政府應該要面對的問題當然對健保署來講這不是他的職責但是我們認為在我們立法院的立法助攻裡面你看事情不能這樣去看 |
| transcript.whisperx[325].start |
10252.399 |
| transcript.whisperx[325].end |
10279.734 |
| transcript.whisperx[325].text |
說把政府的這個這個這個公務預算調高到38好像說把所有健保的問題就解決家子這麼好解決勞藏問題就解決了啊對不對剛剛我們的這個健保的言論我們李一春教授也提到欸我們健保其實有很好的機制啊我們事實上有沒有落實我提健保法43條各位看看我們健保法本身門診本身支付額20%的訂例到現在都用訂額 |
| transcript.whisperx[326].start |
10281.107 |
| transcript.whisperx[326].end |
10299.954 |
| transcript.whisperx[326].text |
不去轉診 地區醫院 區醫院 醫學中心 38 48 58 有沒有照做如果有 還有問題 那就倒過來 怎麼樣護衛者本身過度使用 護衛者你應該要怎麼樣 要把他的保費增加 |
| transcript.whisperx[327].start |
10301.209 |
| transcript.whisperx[327].end |
10330.078 |
| transcript.whisperx[327].text |
負擔增加在我的想法50%可能都不夠可能70%才能解決我們整個門診上面可能5000億的這個量產生的這個充量的問題所以我最後要做的一個結論就是健保不能充量資物的標準要合理使用者要合理付費所以我認為健保法上面的6%的上限這個本來就應該要去面對不可能再6% |
| transcript.whisperx[328].start |
10331.638 |
| transcript.whisperx[328].end |
10335.64 |
| transcript.whisperx[328].text |
主席 各位學者專家們大家好 |
| transcript.whisperx[329].start |
10361.363 |
| transcript.whisperx[329].end |
10387.972 |
| transcript.whisperx[329].text |
那個我想齁我先講一個就是剛才謝董事長在講齁我是覺得說我們今天探討的是一個民生的議題啦齁大家都是希望健保好齁方向是一致健康台灣我們希望我們讓民眾更健康所以我想情緒性的字眼其實是不必要因為他剛才講說我們這樣子提出八大一四團體提出典值的保障是所謂的要搞倒所謂的健保 |
| transcript.whisperx[330].start |
10388.973 |
| transcript.whisperx[330].end |
10404.739 |
| transcript.whisperx[330].text |
那但是我要講的是說如果要講情緒化字眼我說如果我們不實施改革可能會搞倒醫護人員血汗醫護會更嚴重這樣講都不好所以我希望謝董事長我們就是好好講因為我們都是八大門派就是說 |
| transcript.whisperx[331].start |
10405.639 |
| transcript.whisperx[331].end |
10406.419 |
| transcript.whisperx[331].text |
先澄清三件事 |
| transcript.whisperx[332].start |
10429.297 |
| transcript.whisperx[332].end |
10440.546 |
| transcript.whisperx[332].text |
點值如果能夠通過我們醫事團體八大醫事團體今天早上已經承諾優先幫醫事人員加薪我這邊就我提出這個保證八大醫事團體說優先幫醫事人員加薪 |
| transcript.whisperx[333].start |
10442.708 |
| transcript.whisperx[333].end |
10465.159 |
| transcript.whisperx[333].text |
所以點子通過的目的要優先幫醫事人員因為醫事人員有好的職業環境有好的待遇他才願意回到我們的職場嘛這是整個健康台灣的最核心動力在這個地方第二個我要澄清我們沒有要改制度沒有要破壞總額預算制度也沒有說總額預算制度就不要了變成論量計酬不是的 |
| transcript.whisperx[334].start |
10466.164 |
| transcript.whisperx[334].end |
10485.059 |
| transcript.whisperx[334].text |
我們是主張從支出上限的那個CAP改成Target就是變支出上限變支出目標好那接下來我就講什麼叫支出上限跟支出目標簡單的講如果今年我們的這是一個概念當然很多我們可以去修正今年的健保總額是8700億8700億這健保一開始核定8700億8700億元就是8700億點在這個範圍內1.1億元的保障 |
| transcript.whisperx[335].start |
10495.882 |
| transcript.whisperx[335].end |
10508.759 |
| transcript.whisperx[335].text |
但是好可能我們會醫療利用率的提高所以我們會超過8700億點超過的部分國外打折給付超過越多打折越多超過10%就打折10%來給付 |
| transcript.whisperx[336].start |
10512.083 |
| transcript.whisperx[336].end |
10528.624 |
| transcript.whisperx[336].text |
超過的部分由誰來支付由公務預算編列來支付所以這個跟民眾調保費並沒有必然性的關係因為超過的部分是由公務預算要來補那這時候大家會講說會長你為什麼要這樣設計這樣一個制度因為我跟各位報告 |
| transcript.whisperx[337].start |
10529.965 |
| transcript.whisperx[337].end |
10555.859 |
| transcript.whisperx[337].text |
過去22年以前的總額預算制度已經實施22年了大家去想走老路到不了新地方啦我們現在手機拿出來都iPhone15了如果我們還在探討過去在用這個固定電話的時代那個是過去的時代我們總要隨著時代環境的變遷與時俱進我們的制度所以我的想法就是說我們過去的這個總額預算就是從零開始就可能面臨打折的問題 |
| transcript.whisperx[338].start |
10556.94 |
| transcript.whisperx[338].end |
10581.196 |
| transcript.whisperx[338].text |
可是新的制度是8700億的合定範圍內先保障1.1元超過的部分我們來打折給付那這個部分來講以公務預算來這個編列這個部分來講的話為什麼要這樣子做的設計是說在過去的健保總額支付制度大家去想一件事政府把總額預算都編好了那編好以後呢反正就在這個範圍內 |
| transcript.whisperx[339].start |
10583.022 |
| transcript.whisperx[339].end |
10600.189 |
| transcript.whisperx[339].text |
衝量新澳新科技的加入全部由誰承擔預算跟需求的差距預算跟需求的差距是誰承擔請教各位醫療提供者70萬的醫事人員跟所有的醫療機構承受著需求跟預算之間的差異 |
| transcript.whisperx[340].start |
10601.55 |
| transcript.whisperx[340].end |
10625.679 |
| transcript.whisperx[340].text |
可是我們在22年前我不瞞各位講醫務本業都還有8-9%的盈餘所以我們可以承擔這個差距可是現在經過22年後這個差距已經沒辦法承擔了所以才會有醫界的最近這一兩年的現象所以要縮小這個差距唯一的辦法就是說我們就是要把這個差距怎麼樣要把它縮小所以這個部分來講我們才會認為是說 |
| transcript.whisperx[341].start |
10628.2 |
| transcript.whisperx[341].end |
10655.578 |
| transcript.whisperx[341].text |
在整個需求跟預算的差距由醫療提供者完全承擔這個是不對的那如果說我們把它改成目標制超過的部分要由公務預算去補的時候我們是要請政府跟我們一起努力拿出一些實質性的作為去控制那個量因為對醫界來講我只有在8700億點裡面我也不會想充量啊盡量在1.1元的範圍內因為超過的部分是要被打折給付的 |
| transcript.whisperx[342].start |
10656.378 |
| transcript.whisperx[342].end |
10677.001 |
| transcript.whisperx[342].text |
所以在這個情況之下我是覺得是說我們這樣的一個做法就希望說讓醫界跟我們的這個主管機關共同合作去處理這樣一個問題所以這是這個部分那另外呢我們都知道那個我們賴總統提出健康台灣的政策啦那健康台灣的政策裡面最重要的是說他 |
| transcript.whisperx[343].start |
10677.421 |
| transcript.whisperx[343].end |
10693.281 |
| transcript.whisperx[343].text |
提到是說希望2030年也能降低癌症的死亡率等等所以我認為是說要達到健康台灣的根本的前提就是要提高對醫療的支出醫療的支出是投資不是成本大家都知道尤其是現在5月27號世界衛生組織即將要召開大會 |
| transcript.whisperx[344].start |
10696.204 |
| transcript.whisperx[344].end |
10714.37 |
| transcript.whisperx[344].text |
那世界衛生組織也不斷的在呼籲世界各國政府在疫情後提高對醫療的支出他說這樣子才能夠建構一個完整的公衛體系跟強而有力韌性的醫療體系所以呢一點一元的這個保障當然這個都可以去討論但重點就是希望讓我們的醫療機構有足夠的什麼財務韌性 |
| transcript.whisperx[345].start |
10718.912 |
| transcript.whisperx[345].end |
10718.932 |
| transcript.whisperx[345].text |
公聽會議 |
| transcript.whisperx[346].start |
10740.888 |
| transcript.whisperx[346].end |
10741.828 |
| transcript.whisperx[346].text |
我們一起來為健康台灣共同努力謝謝 |
| transcript.whisperx[347].start |
10773.188 |
| transcript.whisperx[347].end |
10773.408 |
| transcript.whisperx[347].text |
董事長 |
| transcript.whisperx[348].start |
10792.796 |
| transcript.whisperx[348].end |
10816.511 |
| transcript.whisperx[348].text |
周委、各位委員、還有各位現場的先進大家好那一年前其實醫改會跟在場有許多來自不同領域的專家以及代表其實就已經有出席由委員會主辦在健保制度現況與展望公聽會裡面其實就已經紛紛有提出許多的成額跟建言但是很無奈的一年後健保制度跟困境並沒有帶來太大的改變 |
| transcript.whisperx[349].start |
10817.432 |
| transcript.whisperx[349].end |
10817.452 |
| transcript.whisperx[349].text |
公聽會議 |
| transcript.whisperx[350].start |
10836.479 |
| transcript.whisperx[350].end |
10836.499 |
| transcript.whisperx[350].text |
公聽會議 |
| transcript.whisperx[351].start |
10853.379 |
| transcript.whisperx[351].end |
10853.399 |
| transcript.whisperx[351].text |
公聽會議 |
| transcript.whisperx[352].start |
10877.054 |
| transcript.whisperx[352].end |
10903.44 |
| transcript.whisperx[352].text |
這個醫療費用不再受到約束作為一個醫改團體我們不反對給醫界合理的資源以及待遇但是要健保永續民眾健康跟醫界共好還是應該務實建立在可負擔公平性以及永續性的這個核心精神來理性討論而不是淪為政治支票甚至是政黨惡鬥下競相喊價的這樣一個籌碼那可負擔這部分其實已經有蠻多的 |
| transcript.whisperx[353].start |
10904.64 |
| transcript.whisperx[353].end |
10923.325 |
| transcript.whisperx[353].text |
先進其實剛剛已經有提到其實我們早就已經面臨受不抵之但是我們現在保費成長其實已經來到4倍之多但是我們繳保費的人是越來越少那輕壯族群的負擔是越來越重而且高齡化的人口也已經是健保開辦的兩倍之多那明年就要步入超高齡 |
| transcript.whisperx[354].start |
10924.025 |
| transcript.whisperx[354].end |
10951.094 |
| transcript.whisperx[354].text |
那除了我們面臨到這個超高齡的問題以外還有一半的人口其實是有罹患慢性病的這樣一個情況官方報告也顯示說健保在醫療支出成長最快速的族群其實就是慢性病族群那不僅出現在他們的藥費檢驗檢查費用他們的平均次數就醫次數更高達33次是否應該從這部分來去思考如何來減少甚至提供整合醫療的部分 |
| transcript.whisperx[355].start |
10952.185 |
| transcript.whisperx[355].end |
10971.56 |
| transcript.whisperx[355].text |
在這樣一個趨勢下健保其實早就已經很難加速納進民眾所想要的新藥新科技那民眾在醫療支出上其實也不像過往一樣只有負擔健保費其實更多的還要再負擔部分負擔掛號費還有越來越多的自費醫療那過去健保其實保障民眾不會因病而平 |
| transcript.whisperx[356].start |
10972.56 |
| transcript.whisperx[356].end |
10990.327 |
| transcript.whisperx[356].text |
但現在民眾卻可能因為層層堆疊這個就醫的經濟障礙減少必要就醫尤其是我們有接到不少來自住在醫療資源分配較不足的區域的民眾的來電甚至是還有220萬的近貧人口讓健保可能會影響時大 |
| transcript.whisperx[357].start |
10991.767 |
| transcript.whisperx[357].end |
11009.646 |
| transcript.whisperx[357].text |
那近期也有醫界大嘆國人頻頻就醫但是卻可能未必有更好的醫療結果那剛剛其實也有蠻多先進有提出就是台灣有非常多項的健康指標其實落後國際的所以即便修法通過政府需要投入大量的公務預算但公務預算何嘗又不是來自於民脂民膏 |
| transcript.whisperx[358].start |
11010.367 |
| transcript.whisperx[358].end |
11024.32 |
| transcript.whisperx[358].text |
民眾就醫負擔加重,付出更多的保費,自費項目更多,付出更多的工農,但是政府能夠承諾可以買到更有價值跟具醫療品質的服務嗎?公平性的部分,其實剛剛有提到蠻多公平性的部分,包含說費機不公, |
| transcript.whisperx[359].start |
11026.745 |
| transcript.whisperx[359].end |
11047.33 |
| transcript.whisperx[359].text |
這個也是長年被政府樹枝高歌那剛剛也有蠻多先進有提到說健保其實依法給付費用給特約機構那醫事人員主要的薪資還是由院所來主導分配因此保障點值提高了院所收益是不是就能夠代表第一線的待遇勞動環境就能被改善 |
| transcript.whisperx[360].start |
11048.783 |
| transcript.whisperx[360].end |
11048.803 |
| transcript.whisperx[360].text |
公聽會議 |
| transcript.whisperx[361].start |
11069.913 |
| transcript.whisperx[361].end |
11089.227 |
| transcript.whisperx[361].text |
賺錢的加速其實遠超於過去的加速來到了快190家那在這樣的一個情況下11我們也看到醫院跟西醫的浮動點值來到了0.92到1.09但是在那一年度在區醫院跟地區醫院的人事佔率成本卻是下降的 |
| transcript.whisperx[362].start |
11089.907 |
| transcript.whisperx[362].end |
11113.803 |
| transcript.whisperx[362].text |
所以當我們的點值跟賺錢的情況都比往年來的好我們有看到他們有優先來投入改善人力的這部分嘛那另外其實針對醫療服務提供端至關重要的支付制度改革其實近10年來也都沒有進行通盤檢討所以針對近年醫界有許多不合理的訴求反而是有求必應 |
| transcript.whisperx[363].start |
11115.184 |
| transcript.whisperx[363].end |
11137.422 |
| transcript.whisperx[363].text |
缺乏這樣子一個通盤周圍的檢討反而更加惡現在給付不公的一個情況例如以前醫界主張說不同科別門診加成應該要不同但是各自申請下本來就可能會造成不同專科別的給付失衡但近期醫界又主張說各專科的加成應該要相同最後健保署不僅買單還加錢 |
| transcript.whisperx[364].start |
11139.483 |
| transcript.whisperx[364].end |
11166.432 |
| transcript.whisperx[364].text |
那之前也發生過剛剛藤秘書長有提到的地區醫院的急診、診察費、住院護理費加成竟然比區醫院醫學中心來得更高所以它的同工同酬的理念其實是整個被破壞的也擔心醫療分配的問題健保署其實也在健保改革日記有提到說加成或保障某科的點子可能會因單價上升造成整體點子的下降這個不能打地署來處理 |
| transcript.whisperx[365].start |
11168.109 |
| transcript.whisperx[365].end |
11196.001 |
| transcript.whisperx[365].text |
甚至在一屆沒有提出執行目標沒有評估指標沒有事辦齊成的協商提案的時候政府一樣買單完全忘了他應該要擔任第三方負起管理及監督責任所以近年其實這樣子一個總額精神已經淡然無存其實健保署應該要負起最大的一個責任那永續性其實剛剛其實已經蠻多專家有提了那我們目前為止為止支付方式還是以論量計酬為大宗 |
| transcript.whisperx[366].start |
11197.062 |
| transcript.whisperx[366].end |
11218.987 |
| transcript.whisperx[366].text |
那剛剛各界也有提出許多國際上的管控錯法﹐無論是要回到過去一屆抗疫﹐放大河山回推的制度﹐還是國際上的DRG﹐甚至是論人記仇﹐論病例記仇﹐論職記仇政府都有責任針對各界提出來方案﹐來提出這個財務跟利弊分析﹐才能爭取最大的共鳴共識 |
| transcript.whisperx[367].start |
11220.507 |
| transcript.whisperx[367].end |
11233.59 |
| transcript.whisperx[367].text |
那尤其健康台灣其實重點就是要擴大在預防這個健康預防醫學以及健康促進這個投資上面那另外不好意思可以幫我用下一頁 |
| transcript.whisperx[368].start |
11235.171 |
| transcript.whisperx[368].end |
11253.482 |
| transcript.whisperx[368].text |
其實今天最應該被受邀出席公聽會是賴清德總統以及邱太元部長這個攸關新政府在此案的藍圖到底是什麼可惜在這兩週我們其實一直聽不到但是健保署其實也在日前1114年總額協商方向規劃會議裡面有提到說 |
| transcript.whisperx[369].start |
11254.463 |
| transcript.whisperx[369].end |
11272.235 |
| transcript.whisperx[369].text |
接下來要朝全國全面導入DRG執行RBRBS跟大家一計畫政策目標在這邊也要藉此呼籲保險人應該要盡快公佈相關的期程規劃然後也要請各位立委來用力監督才有力各方來討論 謝謝好 謝謝林雅慧執行長接下來請蘇清泉委員發言 |
| transcript.whisperx[370].start |
11289.6 |
| transcript.whisperx[370].end |
11305.707 |
| transcript.whisperx[370].text |
謝謝 謝謝主席這個修法的案是我提出來所以我來講講可能大家比較聽得懂我覺得今天壓力最小應該是健保局跟衛福部啦所以那個總額做總額啊拚拚給你們不夠就自己互動互動0.5、0.6、0.3都你們做的事情 |
| transcript.whisperx[371].start |
11314.229 |
| transcript.whisperx[371].end |
11333.344 |
| transcript.whisperx[371].text |
但是我想他們怎麼會這樣呢?施主長你們怎麼會這樣呢?他一直找我在講怎麼來解決某些問題他還跟我提出不然的話就是住院來保障保障點子一點一塊我聽了 |
| transcript.whisperx[372].start |
11334.758 |
| transcript.whisperx[372].end |
11356.376 |
| transcript.whisperx[372].text |
很高興齁但是如果你的這裡的保障點子是1.1塊然後去壓榨到其他浮動點子這樣就沒意義了那些浮動點子就三天兩天了就不用浮動了嘛所以你們在總額裡面然後這裡保障那裡保障這裡保障1.1塊錢有啊 藥費就1.1塊錢啊所以2000多億的藥費就這樣呼嚕呼嚕的就沒了 |
| transcript.whisperx[373].start |
11362.813 |
| transcript.whisperx[373].end |
11384.683 |
| transcript.whisperx[373].text |
然後呢反過頭來新藥新科技剛剛我們陳時中前部長他剛剛講了一個良心話他說健保要總額要瘦身那終於講出良心話了總額要瘦身當然要瘦身啊前幾天我們時書長時書長講一個罕病 |
| transcript.whisperx[374].start |
11390.313 |
| transcript.whisperx[374].end |
11411.559 |
| transcript.whisperx[374].text |
每一年每一年付聽了很高興對這些弱勢團體但是你是包山包海你什麼都要包現在長照長照每天每天都在吃健保的豆腐 |
| transcript.whisperx[375].start |
11412.87 |
| transcript.whisperx[375].end |
11436.451 |
| transcript.whisperx[375].text |
我很後悔在第8屆我當召委的時候把長照服務法通過了那個時候馬英九總統說趕快 趕快把長照保險法掃過去他就說李益春在做次長 對不對我們都做那個要緊張不過那個時候我們的蔡英文主席那個時候堅決反對所以那個案就不去 |
| transcript.whisperx[376].start |
11437.452 |
| transcript.whisperx[376].end |
11457.117 |
| transcript.whisperx[376].text |
我剛才在問他說,那個時候的長照保險如果有過,現在會長得什麼樣子?日本就是兩個,有醫療保險跟介護醫療保險,他們有兩個保險那我們在訂長照服務法的時候,我去到那裡,我帶親爸的人去那裡考察兩次 |
| transcript.whisperx[377].start |
11459.148 |
| transcript.whisperx[377].end |
11486.585 |
| transcript.whisperx[377].text |
結果他們說他們的介乎醫療當下那個時候就那一年就9.4兆日元我一去就很囂張他說我已經撐不住了他們的首相那個是安倍剛剛就任他想把醫療保險跟長照保險把它募集在一起看看能不能重複的地方能不能省下來那後來好像有部分募集在一起併在一起 |
| transcript.whisperx[378].start |
11487.355 |
| transcript.whisperx[378].end |
11504.152 |
| transcript.whisperx[378].text |
那我們現在就用一個醫療保險在支撐醫療還在部分支撐長照保險沒有長照保險之名但是我們在付長照保險之時反正有很多人說這個育成育成當然也要照顧 |
| transcript.whisperx[379].start |
11507.625 |
| transcript.whisperx[379].end |
11532.979 |
| transcript.whisperx[379].text |
医疗要有韧性啊 啊医疗韧性是啥韧性就是reserve 要有一股一股肥啦 一股粉啦啊大家都散屁屁啦 要再韧性不只要韧性韧性是要有經濟的支撐所以呢我們學者專家包括政所下 他們都是一路走來伴隨著健保在走飛到 |
| transcript.whisperx[380].start |
11535.193 |
| transcript.whisperx[380].end |
11553.824 |
| transcript.whisperx[380].text |
關頭了,我們不會提出來現在就是無處理不可以的時候民進黨都沒提案,我提一個案,黃毅民提一個案,黨團提一個案民進黨我在等你提案,不敢提,社會不敢提,新的補定不知道要怎麼補總統也不知道要怎麼補,你說得這麼大堆,你自己說1.1元喔搞清楚喔 |
| transcript.whisperx[381].start |
11559.238 |
| transcript.whisperx[381].end |
11560.058 |
| transcript.whisperx[381].text |
三個總統候選人都講一樣0.95朝1.1元購買購買購買購買 |
| transcript.whisperx[382].start |
11573.991 |
| transcript.whisperx[382].end |
11598.905 |
| transcript.whisperx[382].text |
賴總統在唱什麼啊你是腎臟科醫師大家都頭腦都不錯啦我心臟外科啊我們王正熙是腫瘤科的我們好好的來跟他唱啊為什麼在那邊我堅持要出委員會當然也要出委員會不出委員會你就沒壓力啊你就擺爛啊就討論我們主席跟我們講說等一下討論討論我告訴你你再討論三年就沒結果啦 |
| transcript.whisperx[383].start |
11601.607 |
| transcript.whisperx[383].end |
11622.082 |
| transcript.whisperx[383].text |
因為過去10年就是這樣討論在討論所以在疫情的時候我們很感謝衛生部也回過頭來照顧我們的醫界這是事實但是我有跟大家講那些特別預算補助所有醫事人員的全部都照冊照冊照冊醫療院手人一毛錢 |
| transcript.whisperx[384].start |
11624.15 |
| transcript.whisperx[384].end |
11635.657 |
| transcript.whisperx[384].text |
沒人敢因為要付薪酬所以你現在剛剛在講說醫改會在講說醫事人員的薪水都沒有增加等等我可以在這邊要求我們衛福部 |
| transcript.whisperx[385].start |
11636.724 |
| transcript.whisperx[385].end |
11650.169 |
| transcript.whisperx[385].text |
我們以後報財報上去就把醫事這邊老黨很簡單啊這個護理人員這個某某某他一年領多少錢從博恩報給你們給你們一個一個去檢視這個不難這個很簡單的事情我們以後的財報就把連人事費用都報上去我們醫界敢這樣承諾就這樣幹有沒有問題沒有問題啊不能說 |
| transcript.whisperx[386].start |
11666.004 |
| transcript.whisperx[386].end |
11694.526 |
| transcript.whisperx[386].text |
要 最後講30秒有這一書 我的有書 我跟他說藥師調劑費 什麼費 什麼費 什麼費我全部都給你我還加三成給你你們去付你們自己的薪水他們不要因為他們要求的是起薪90萬年薪然後最好每個月要10萬塊不然的話 外面大數藥局一個月就是10萬塊 |
| transcript.whisperx[387].start |
11696.667 |
| transcript.whisperx[387].end |
11713.18 |
| transcript.whisperx[387].text |
所以有錢也欠沒人那我們婦理學院會等一下記者會長會講我說你幫這邊要愛護病肥啊這邊要愛顧心事還要照辦你在裝笑的所以我們只能一樣所以再一次的跟大家報告 |
| transcript.whisperx[388].start |
11714.673 |
| transcript.whisperx[388].end |
11736.166 |
| transcript.whisperx[388].text |
一定要討論一定要好好討論一定要解決不解決不行我們想我們剛剛陳時中前部長講說總額要減量這個或許也是一個考慮的地方以上謝謝好謝謝蘇清泉委員發言接下來請廖偉祥委員發言 |
| transcript.whisperx[389].start |
11747.214 |
| transcript.whisperx[389].end |
11769.083 |
| transcript.whisperx[389].text |
謝謝主席還有我們在場所有尊敬的學者專家還有委員和我們的這個衛福部的所有的長官貴賓們很感謝那健保點值不足問題不可歸就醫界因為醫師開設診所並不知道其他人的服務量能增加多少那醫療法也規定醫師沒有拒絕病人的權利 |
| transcript.whisperx[390].start |
11770.714 |
| transcript.whisperx[390].end |
11783.22 |
| transcript.whisperx[390].text |
依照法律提供病人服務解決病痛或疾病反而收入減少這個制度是有調整的必要以上這些話是我們賴清德準總統說的 |
| transcript.whisperx[391].start |
11786.769 |
| transcript.whisperx[391].end |
11812.868 |
| transcript.whisperx[391].text |
那健康是1喔財富學歷經歷等等喔我想都是0那沒有1再多的0也沒有用所以我這邊也要先感謝全國的醫事人員還有守護國人的健康也是守護國家的根基那再一次我必須強調一下醫療價值要等於醫療品質也要等於健保點值喔那這句話很重要所以通常會重複三遍但是為了節省大家的時間喔 |
| transcript.whisperx[392].start |
11813.959 |
| transcript.whisperx[392].end |
11843.179 |
| transcript.whisperx[392].text |
各行各業都有專業那我想大家互相尊重而尊重專業的第一步就是這個專業給付因為做功德這件事情偶一為之還可以但是絕對不能套用在專業給付上那如果要長期要求專業給付要打折那就會是一種霸凌啊會是一種踐踏專業我想也沒有人這樣做沒有人願意這樣做那今年以來包含我們的英國包含韓國等國家的醫事人員都走上街頭抗議 |
| transcript.whisperx[393].start |
11844.119 |
| transcript.whisperx[393].end |
11870.239 |
| transcript.whisperx[393].text |
但每個國家醫事人員上街頭的成因不同當然我們也不希望我們的醫護上街頭我想醫護人員也不會想上街頭那迫使醫護人員上街頭不僅是國家悲哀最重要的是也會損及我們全民的健康權益所以試問大家能夠想像當你的家人在急診的時候很焦急等待要診治但是卻沒有足夠的醫護大家會不會心急如焚 |
| transcript.whisperx[394].start |
11872.397 |
| transcript.whisperx[394].end |
11889.043 |
| transcript.whisperx[394].text |
問題這就是這個狀況是誰造成的那我們要不要面對問題要不要來充分的討論來趕快來解決問題所以其實剛剛我也有聽到很多委員說或很多上來發表的專家學者說其實今天在場最重要的應該是賴清德總總統跟我們的部長那 |
| transcript.whisperx[395].start |
11891.021 |
| transcript.whisperx[395].end |
11905.38 |
| transcript.whisperx[395].text |
但是身為民意代表我們也必須做一個表態和推進這件事情這也是剛剛蘇清泉委員說為什麼要趕快把這個醫師法推出委員會趕快讓大家迫使大家再來討論不然這件事情過了幾十年還是一樣 |
| transcript.whisperx[396].start |
11906.584 |
| transcript.whisperx[396].end |
11928.878 |
| transcript.whisperx[396].text |
那健保需不需要改當然需要那過去有沒有在進行改革其實也是有啦但是為何這個時間點要進行修法就是因為過去我想政府會認為這個健保的問題頂多是慢性病慢慢治慢慢改殊不知健保走了快30年支付制度支給付制度也必須與時俱進的改 |
| transcript.whisperx[397].start |
11930.279 |
| transcript.whisperx[397].end |
11945.115 |
| transcript.whisperx[397].text |
更要符合當下的GDP的水準在醫療現場的專業人員也一直在流失願意投入醫療的人也越來越少從這幾年新聞不斷報導這個急診室也大排長龍甚至排在醫院大廳原因為何 |
| transcript.whisperx[398].start |
11946.175 |
| transcript.whisperx[398].end |
11968.876 |
| transcript.whisperx[398].text |
那我想難道大家要繼續把這個當成不當一回事嗎這也是我們現在要強調現在的健保改革也需要一個強心針需要AED來搶救也是要先把狀況先穩定把命保住然後再來慢慢治療最後我也要呼籲全民健康的權益不容打折那改善血汗醫護要儘速啟動健保修法好謝謝 |
| transcript.whisperx[399].start |
11971.567 |
| transcript.whisperx[399].end |
11982.194 |
| transcript.whisperx[399].text |
好 謝謝廖偉祥委員發言接下來請邱振軍委員 邱振軍 邱振軍委員不在接下來請中華民國護理師護士工會理事長暨理事長發言 |
| transcript.whisperx[400].start |
11992.042 |
| transcript.whisperx[400].end |
12019.595 |
| transcript.whisperx[400].text |
主席還有各位長官各位學者專家各位大家早午安啦好我想這個健保制度的改革我想就是在護理界來講我們是一定支持怎麼樣做改革那我們知道這個從全民健保的總額支付制度開始醫療生態跟醫療制度面臨的轉型還有一些變遷那會議專業的領域也受到相當大的打擊 |
| transcript.whisperx[401].start |
12020.771 |
| transcript.whisperx[401].end |
12042.684 |
| transcript.whisperx[401].text |
首當其衝的就是護理人力遭到縮減臨床的護理人員在持續面對沉重的病人照顧的負荷下工作滿意度日益的低下護理照顧品質受到更嚴重的影響那以醫務人員的血汗換來的第一身為護理人員的我們如何感到驕傲 |
| transcript.whisperx[402].start |
12044.435 |
| transcript.whisperx[402].end |
12059.802 |
| transcript.whisperx[402].text |
衛福部的次長曾經講過健保永續人才臂力及精進的基礎建設才能夠穩坐世界龍頭但是當護理人員一直在消失中缺少護理人員的健保還能永續發展嗎 |
| transcript.whisperx[403].start |
12061.796 |
| transcript.whisperx[403].end |
12080.313 |
| transcript.whisperx[403].text |
我想會議人員在消失裡面我這個要換一下會議人員在消失然後我們看到我們的離職率我們從過去的10.3%的離職率到現在已經到11.74我們的空缺率從4.7到6.53 |
| transcript.whisperx[404].start |
12084.136 |
| transcript.whisperx[404].end |
12097.426 |
| transcript.whisperx[404].text |
可以看到各醫院的人力缺短缺非常嚴重而陸續面臨關闖的窘境影響到民眾就醫的權益所以剛才有特別提到急診庸室人力不夠護理人力不夠要關闖醫師不夠還不用關闖護理師不夠要關闖 |
| transcript.whisperx[405].start |
12101.949 |
| transcript.whisperx[405].end |
12123.686 |
| transcript.whisperx[405].text |
所以沒有護理師就沒有未來那我想從健保的給付範圍裡面剛剛很多學者專家特別提到的有很多的給付都是給醫院沒有錯醫院要足夠的錢給醫事人員但是我們回過頭來看到底健保給付也給護理相關的到底有哪些部分我們來看一下在西醫裡面有護理費 |
| transcript.whisperx[406].start |
12126.028 |
| transcript.whisperx[406].end |
12143.275 |
| transcript.whisperx[406].text |
牙醫不斷要求要護理人員沒有護理會中醫要有七科九學分沒有護理會我們目前拿最多是居家護理的部分從104年調整到現在再也沒有調整過我們的第九部護理人員的投入為止也是等一下看一下那個費用 |
| transcript.whisperx[407].start |
12144.435 |
| transcript.whisperx[407].end |
12163.522 |
| transcript.whisperx[407].text |
還有論病記酬 住院診斷 品質支付 完全沒有副理會你說護理師怎麼可以跟醫院說我要更高的薪資 怎麼樣尊重專業給我更多的好但是我相信只要在幾戶上面能夠把它加進去改革我們所有的支付標準跟支付制度 我相信這個對我們的護理員來講會有更多的 |
| transcript.whisperx[408].start |
12166.443 |
| transcript.whisperx[408].end |
12166.583 |
| transcript.whisperx[408].text |
委員會主席 |
| transcript.whisperx[409].start |
12182.242 |
| transcript.whisperx[409].end |
12206.974 |
| transcript.whisperx[409].text |
但是我們很努力的爭取到首日從111年首日的護理費調升百分之三十所以我們才會有第一天的費用大於百分之三十這樣的一個基礎我覺得這都是護理機一直在努力幫護理人員爭取的相關的費用我們也是要讓醫院的管理者看到其實護理是很努力的在付出然後也希望讓我們有一些具體的數字來呈現我們真正要能夠表現出來我們的費用 |
| transcript.whisperx[410].start |
12211.636 |
| transcript.whisperx[410].end |
12219.962 |
| transcript.whisperx[410].text |
所以你會看到我們的居家護理這個是最早健保幾戶居家護理的費用從第一類到第四類你看到我們的出去訪視才1050點那這樣的一個費用我要去照顧病人情況之下 |
| transcript.whisperx[411].start |
12226.787 |
| transcript.whisperx[411].end |
12227.308 |
| transcript.whisperx[411].text |
第9項 所有支付標準 |
| transcript.whisperx[412].start |
12251.969 |
| transcript.whisperx[412].end |
12259.333 |
| transcript.whisperx[412].text |
我們的打點滴3天75塊現在一包一杯的紅茶都要75點不得了75塊所以我要看這一張我們健保長年低廉的幾戶護理專業然後包括這些還包括所有的耗材然後健保幾戶25點每日能夠買什麼 |
| transcript.whisperx[413].start |
12273.081 |
| transcript.whisperx[413].end |
12273.101 |
| transcript.whisperx[413].text |
公聽會議 |
| transcript.whisperx[414].start |
12299.899 |
| transcript.whisperx[414].end |
12315.611 |
| transcript.whisperx[414].text |
這對專業來講 你在外面 你看我們算了成本 真的是 這個都沒有調整的所以所有的幾戶的標準 我覺得應該要重新去看 怎麼樣來看這個幾戶的部分或者你會看到我們的整個總額制度的浮動點子裡面 我們護理勞務貢獻大打折扣 |
| transcript.whisperx[415].start |
12319.034 |
| transcript.whisperx[415].end |
12322.355 |
| transcript.whisperx[415].text |
2003年開始健保的費用不斷的在提升成長了2.2倍但是以醫學中心來講我們的護理點只是成長1.28倍那從這樣的24小時裡面不間斷的專業照護的勞務服務付出的護理費加上打折點數平均比那個青年旅館還要便宜 |
| transcript.whisperx[416].start |
12340.539 |
| transcript.whisperx[416].end |
12344.782 |
| transcript.whisperx[416].text |
真的是很不值得所以護理師的消失有可能就是因為點子或是剛剛講過的我覺得剛剛講的很好健保、醫院的管理者、消費者代表當然還有這個天災 |
| transcript.whisperx[417].start |
12355.569 |
| transcript.whisperx[417].end |
12371.899 |
| transcript.whisperx[417].text |
那所有天災出來我們大概都是走在第一線所以我覺得所有制度要改革怎麼讓醫事人員能夠在友善的環境更能夠去願意在這邊工作那你看我們曾經算過合理的護理費這是2018年還可以再精算那是2018年的我們算過如果用護病比的話關護理醫學中心來講我們需要到276這是圓喔不是點子喔 |
| transcript.whisperx[418].start |
12382.705 |
| transcript.whisperx[418].end |
12389.19 |
| transcript.whisperx[418].text |
如果你是用點子的話那就要被打折扣了我們現在給多少錢給948點還要被打折所以你看看假設我們用這些數據來看看護理人員價值我們是落差多少所以我在想說這樣的一個折扣一個這樣的改革必須要讓我們的醫護人員得到健康的身心如果我們不願意留在職場護理師不斷的消失我們這邊談了那麼多的改革 |
| transcript.whisperx[419].start |
12410.785 |
| transcript.whisperx[419].end |
12417.31 |
| transcript.whisperx[419].text |
老實說真的只是會讓雪上加霜那大家要齊心同力的來改善我們醫事人員的薪資剛剛看到我們那個洪子仁這個醫務管理這個學位說第一個優先改善醫事人員的薪資我也認同剛剛這個委員說的 |
| transcript.whisperx[420].start |
12427.858 |
| transcript.whisperx[420].end |
12427.878 |
| transcript.whisperx[420].text |
公聽會議 |
| transcript.whisperx[421].start |
12448.391 |
| transcript.whisperx[421].end |
12456.213 |
| transcript.whisperx[421].text |
所以我想這個健保給付改善醫療院所都優先改善醫事人員薪資這我們絕對支持那也期待新政府上任能夠兌現承諾讓我們這個點值能夠保障點值然後剛剛特別提到的讓我們的人員能夠得到相對的報酬最重要是讓我們能夠安适的能夠得到休息這樣病人健康才得以保障所以我想護理界我只能代表我們所有19萬的護理師職業的護理師在這邊要肯定的呼籲所有的 |
| transcript.whisperx[422].start |
12478.78 |
| transcript.whisperx[422].end |
12495.087 |
| transcript.whisperx[422].text |
團體所有的政府機關所有的民間代表都能夠支持這件事情謝謝好謝謝紀理師長學者專家及委員的發言全部發言完畢那現在請行政機關做整體回應先請石署長 |
| transcript.whisperx[423].start |
12507.705 |
| transcript.whisperx[423].end |
12535.158 |
| transcript.whisperx[423].text |
趙偉還有王委員現場的還有蘇委員以及我們現場所有的與會的專家學者貴賓那這個很謝謝趙偉安排今天的公聽會就近期大家所關心的健保點值的低下問題來做一個很全面性的討論那麼我們也聽到了很多寶貴的建議那麼容我用幾分鐘的時間很快的跟大家做一些說明 |
| transcript.whisperx[424].start |
12535.758 |
| transcript.whisperx[424].end |
12541.425 |
| transcript.whisperx[424].text |
看下一張第一個往下 |
| transcript.whisperx[425].start |
12546.486 |
| transcript.whisperx[425].end |
12565.058 |
| transcript.whisperx[425].text |
這是剛剛大概我們幾位的健保設計初期的這些學者專家們大概有提到健保初期的時候是以論量為主沒有總額但是造成當時有很大的財務的衝擊後來陸陸續續在1998年開始陸續從牙科總額預算開始逐漸導入 |
| transcript.whisperx[426].start |
12576.947 |
| transcript.whisperx[426].end |
12590.904 |
| transcript.whisperx[426].text |
總額 看下一張那麼在這個整個的過程裡頭那麼其實總額只是一個開端更重要的是後面各位也都剛剛很多提到那麼在很多的評比上面我們的醫療品質 |
| transcript.whisperx[427].start |
12592.566 |
| transcript.whisperx[427].end |
12592.886 |
| transcript.whisperx[427].text |
委員會主席 |
| transcript.whisperx[428].start |
12608.72 |
| transcript.whisperx[428].end |
12608.76 |
| transcript.whisperx[428].text |
主席 |
| transcript.whisperx[429].start |
12630.745 |
| transcript.whisperx[429].end |
12631.045 |
| transcript.whisperx[429].text |
下一張 |
| transcript.whisperx[430].start |
12647.558 |
| transcript.whisperx[430].end |
12662.42 |
| transcript.whisperx[430].text |
今天其實委員的提案裡面應該是有兩個部分一個是希望總額能夠從現有的支出上限制改變到支出目標制另外一個就是保障點值 |
| transcript.whisperx[431].start |
12662.881 |
| transcript.whisperx[431].end |
12690.057 |
| transcript.whisperx[431].text |
那其實這兩個是兩回事因為在支出目標制的做法上它仍然是有一個上限那麼大概也很少去提到保障點值這是兩件事情的討論那這邊只是提供這個有關於目前那麼學界所認知的支出上限制跟支出目標制它的差別我想剛剛幾位學者也已經提到我就不再贅述看下一張 |
| transcript.whisperx[432].start |
12691.36 |
| transcript.whisperx[432].end |
12710.223 |
| transcript.whisperx[432].text |
那麼至於各國的實施行情我們這邊也把他稍微做了一些整理那麼包含德國剛剛這個盧瑞芬老師也特別提到那麼雖是採那麼目標上限目標制那麼但是呢他是對個別醫師跟醫院 |
| transcript.whisperx[433].start |
12710.503 |
| transcript.whisperx[433].end |
12710.703 |
| transcript.whisperx[433].text |
下一張 |
| transcript.whisperx[434].start |
12735.59 |
| transcript.whisperx[434].end |
12741.135 |
| transcript.whisperx[434].text |
至於說為什麼我們今日的點值會下降呢? |
| transcript.whisperx[435].start |
12741.135 |
| transcript.whisperx[435].end |
12758.789 |
| transcript.whisperx[435].text |
趙委也特別要我們做一點分析這裡先提出的兩個總額的分析一個是醫院總額的分析從醫院總額我們跟疫情前相比為什麼點值會下降當然來自於服務量的上升從整個服務量的上升來看 |
| transcript.whisperx[436].start |
12760.13 |
| transcript.whisperx[436].end |
12760.37 |
| transcript.whisperx[436].text |
看下一張 |
| transcript.whisperx[437].start |
12783.575 |
| transcript.whisperx[437].end |
12783.595 |
| transcript.whisperx[437].text |
公聽會議 |
| transcript.whisperx[438].start |
12808.479 |
| transcript.whisperx[438].end |
12819.505 |
| transcript.whisperx[438].text |
主要是在就醫的點數每次就醫的點數的貢獻是最大那麼其次才是每人的就醫次數的成長 |
| transcript.whisperx[439].start |
12820.885 |
| transcript.whisperx[439].end |
12846.823 |
| transcript.whisperx[439].text |
在最後是病人數那病人數這邊的影響最大的應該是在北區因為他整個投保的人口那麼成長率就高達3.3那麼這個是各區的奉獻所以從北區以外來講那麼最主要的門診的申報的增加最主要就是每人就醫次數跟每次就醫點數的成長看下一張 |
| transcript.whisperx[440].start |
12847.932 |
| transcript.whisperx[440].end |
12863.462 |
| transcript.whisperx[440].text |
那至於每次的就醫點 這個申報數會成長 那麼成長在哪個地方呢 那麼再把它深入的分析之後 那麼主要是來自於三個因素 一個是診察費的調整 |
| transcript.whisperx[441].start |
12865.203 |
| transcript.whisperx[441].end |
12874.91 |
| transcript.whisperx[441].text |
主要就是檢查檢驗的費用合計起來這三個因素就是高達了九成三看下一張那麼至於檢查費的調整在過去在這個從108年以後到112年之間那麼分別有這些的支付標準的調整請大家參考下一張 |
| transcript.whisperx[442].start |
12894.744 |
| transcript.whisperx[442].end |
12921.198 |
| transcript.whisperx[442].text |
那麼至於這個這個疾病別的影響呢是影響藥費跟檢查檢驗那麼最大的因素所以我們再把它分析之後就發現呢那麼慢性病的影響跟癌症的影響其實是最大特別是糖尿病跟腫瘤這兩個疾病那麼貢獻度是最大占了整個占比增加的32.6%看下一張 |
| transcript.whisperx[443].start |
12924.199 |
| transcript.whisperx[443].end |
12947.62 |
| transcript.whisperx[443].text |
我們在看它的成長趨勢跟佔比趨勢這個圓球的大小就是它所佔的比例所以最高的其實在醫院的部分是糖尿病在左邊這邊可是就成長趨勢來講那麼就是在右上角的肺癌還有乳癌 |
| transcript.whisperx[444].start |
12949.802 |
| transcript.whisperx[444].end |
12969.335 |
| transcript.whisperx[444].text |
這是最大的這個成長這是成長率來看的話是這樣那麼以個別疾病當然是以糖尿病高血壓疾病在左邊的這邊是影響最大看下一張所以總結來講整個點值的下降在醫院總額部門主要是因為門診建樹跟單價的費用成長 |
| transcript.whisperx[445].start |
12973.137 |
| transcript.whisperx[445].end |
12998.135 |
| transcript.whisperx[445].text |
而門診費用的成長裡面又受到每人就醫次數跟每次的點數的影響最大點數的增加則來自於藥費檢查檢驗費跟診察費那麼來自於癌症跟慢性病的就醫再往下至於在基層的部分同樣的邏輯分析可以看到它的成長呢 |
| transcript.whisperx[446].start |
12999.056 |
| transcript.whisperx[446].end |
12999.076 |
| transcript.whisperx[446].text |
公聽會議 |
| transcript.whisperx[447].start |
13020.635 |
| transcript.whisperx[447].end |
13032.199 |
| transcript.whisperx[447].text |
那麼所以他的每次的就醫的點數會增加那麼主要是來自於三個一個是診察費這裡佔了30%的貢獻度藥費31.6%的貢獻度檢查檢驗的診療費是佔了29.7%這裡合計也是超過了九成是來自於這三個費用看下一張 |
| transcript.whisperx[448].start |
13043.963 |
| transcript.whisperx[448].end |
13072.122 |
| transcript.whisperx[448].text |
至於這三個費用分別是整查費是因為在這個標準上支付標準上有的調整看下一張那麼至於這個藥費的增加主要是來自於慢性病患者的移動左邊這個可以看得到這幾年下來西醫的慢性病的佔率那麼從37%增加到了39.4%所以它有逐年的在成長 |
| transcript.whisperx[449].start |
13074.243 |
| transcript.whisperx[449].end |
13098.431 |
| transcript.whisperx[449].text |
從漫遷的開利率也可以看得到過去在基層的漫遷的開利率大概只有4成那麼多數是採用日記藥費但是到現在已經成長到46.6%那麼這也會是造成它的這個費用藥費的成長的一個重要的影響看下一張 |
| transcript.whisperx[450].start |
13099.531 |
| transcript.whisperx[450].end |
13122.711 |
| transcript.whisperx[450].text |
那麼至於它的檢查檢驗費也是造成它單價上升的最主要的因素從這個球裡面可以看得到它是最大在於檢查檢驗的成長那另外一個就是復健治療這邊佔了很大的一個左邊這邊就是復健治療為主所以這個是在基層的分析總結來講看下一張 |
| transcript.whisperx[451].start |
13123.652 |
| transcript.whisperx[451].end |
13123.672 |
| transcript.whisperx[451].text |
公聽會議 |
| transcript.whisperx[452].start |
13141.849 |
| transcript.whisperx[452].end |
13163.602 |
| transcript.whisperx[452].text |
因而導致相關的藥費跟檢查費用的增加看下一張所以我們的建議是對於短期而言長期而言那麼我們對總額制度需要有一些檢討跟改善那麼朝向目標制也好或者是在上限制這個底下來做出彈性的做法 |
| transcript.whisperx[453].start |
13164.002 |
| transcript.whisperx[453].end |
13164.322 |
| transcript.whisperx[453].text |
法定人數不足 |
| transcript.whisperx[454].start |
13183.991 |
| transcript.whisperx[454].end |
13209.956 |
| transcript.whisperx[454].text |
依據這個非預期風險或非預期政策改變的影響來補典值到0.9之外那麼對於來年就是接下來我們的114年開始要做總的協商的時候我們也會去考量第一個在基層的部分是因為有這個慢性病人的移動那麼造成的費用的成長那麼確實是應該要予以調整 |
| transcript.whisperx[455].start |
13210.356 |
| transcript.whisperx[455].end |
13210.376 |
| transcript.whisperx[455].text |
公聽會議 |
| transcript.whisperx[456].start |
13228.223 |
| transcript.whisperx[456].end |
13246.988 |
| transcript.whisperx[456].text |
這個疫情之前有推動的大型醫院門診減量的措施那麼應該要開始思考要重啟這樣的合理門診量的措施但是另一部分為了要維護到集中症的照護量能應該考慮逐步的擴大 |
| transcript.whisperx[457].start |
13247.828 |
| transcript.whisperx[457].end |
13248.208 |
| transcript.whisperx[457].text |
全面性對這個 |
| transcript.whisperx[458].start |
13274.417 |
| transcript.whisperx[458].end |
13274.437 |
| transcript.whisperx[458].text |
公聽會議 |
| transcript.whisperx[459].start |
13295.597 |
| transcript.whisperx[459].end |
13315.941 |
| transcript.whisperx[459].text |
至於衝擊的部分資料上很快給各位看一下看下一張那如果是討論的是保證點值的話那麼需要的費用在這個地方以0.95而言大概今年大概是需要7億那麼705億那麼到1.1塊錢的話就是1154億左右的預算需求看下一張 |
| transcript.whisperx[460].start |
13322.162 |
| transcript.whisperx[460].end |
13351.865 |
| transcript.whisperx[460].text |
那麼如果沒有這個額外的預算因為113年已經是所有預算執行中如果沒有額外的預算支援的話就必須從我們的安全準備金來支應那這樣到年底的話呢就會不足一個月的這個安全準備金的缺口那明年的費率如果要達到平衡費率的話就必須是超過我們現在健保法的法定上限的費率才得以平衡 |
| transcript.whisperx[461].start |
13354.467 |
| transcript.whisperx[461].end |
13370.097 |
| transcript.whisperx[461].text |
這是1.1塊錢的時候的推估也請各位參考當然對於如果說把這個點子保障入法可能的影響包含對資源分配的影響對分級醫療的影響也都給各位做一個參考 |
| transcript.whisperx[462].start |
13376.885 |
| transcript.whisperx[462].end |
13395.677 |
| transcript.whisperx[462].text |
結論是 持續進行健保改革與總額預算制度的調整 確有這個需要我們會積極研議各項配套措施 包括上面提到的初步建議以上謝謝各位專家的指導 |
| transcript.whisperx[463].start |
13402.323 |
| transcript.whisperx[463].end |
13416.432 |
| transcript.whisperx[463].text |
趙吉仁以及各位委員以及各位學者專家那今天非常感謝我們的趙吉仁以及我們的委員會安排今天的會議今天的公聽會讓我們能夠聆聽各方的聲音那各位所給我們的指教那我想我們都非常仔細的聆聽並且來做記錄那剛才實際上 |
| transcript.whisperx[464].start |
13419.394 |
| transcript.whisperx[464].end |
13419.414 |
| transcript.whisperx[464].text |
委員長 |
| transcript.whisperx[465].start |
13447.412 |
| transcript.whisperx[465].end |
13448.513 |
| transcript.whisperx[465].text |
請問行政院主席總署這邊要回應嗎?在這邊做一下結論 |
| transcript.whisperx[466].start |
13475.823 |
| transcript.whisperx[466].end |
13499.852 |
| transcript.whisperx[466].text |
一據立法院職權行使法規定委員會應提出公聽會報告送交本院全體委員及出席者公聽會報告作為審查特定議案之參考那我們會把各位寶貴的意見還有書面的資料匯編成冊分送給本院的全體委員以及與會的政府機關代表學者專家參閱那今天真的非常 |
| transcript.whisperx[467].start |
13501.232 |
| transcript.whisperx[467].end |
13502.012 |
| transcript.whisperx[467].text |
本次公聽會到此結束 |
| transcript.whisperx[468].start |
13528.957 |
| transcript.whisperx[468].end |
13531.4 |
| transcript.whisperx[468].text |
法定人數不足 |
| transcript.whisperx[469].start |
13563.186 |
| transcript.whisperx[469].end |
13564.628 |
| transcript.whisperx[469].text |
委員會主席 |
| transcript.whisperx[470].start |
13578.599 |
| transcript.whisperx[470].end |
13589.676 |
| transcript.whisperx[470].text |
委員會主席 |