| IVOD_ID |
159162 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Clip/1M/159162 |
| 日期 |
2025-03-13 |
| 會議資料.會議代碼 |
委員會-11-3-26-2 |
| 會議資料.會議代碼:str |
第11屆第3會期社會福利及衛生環境委員會第2次全體委員會議 |
| 會議資料.屆 |
11 |
| 會議資料.會期 |
3 |
| 會議資料.會次 |
2 |
| 會議資料.種類 |
委員會 |
| 會議資料.委員會代碼[0] |
26 |
| 會議資料.委員會代碼:str[0] |
社會福利及衛生環境委員會 |
| 會議資料.標題 |
第11屆第3會期社會福利及衛生環境委員會第2次全體委員會議 |
| 影片種類 |
Clip |
| 開始時間 |
2025-03-13T12:07:16+08:00 |
| 結束時間 |
2025-03-13T12:39:24+08:00 |
| 影片長度 |
00:32:08 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/3b972b8f6f00770f88f5dae81e6bc2890aae3c1a04a00b1b86f8ffab8834d98374ad0faf363c552f5ea18f28b6918d91.mp4/playlist.m3u8 |
| 委員名稱 |
林淑芬 |
| 委員發言時間 |
12:07:16 - 12:39:24 |
| 會議時間 |
2025-03-13T09:00:00+08:00 |
| 會議名稱 |
立法院第11屆第3會期社會福利及衛生環境委員會第2次全體委員會議（事由：邀請衛生福利部部長就「有關全國急重症醫療量能」進行專題報告，並備質詢。
【如遇加開院會本次會議取消，不再另行通知】） |
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謝謝主席我們是不是請邱部長委員好部長好今天大家談了很多這個急診詠攝和護理人力的問題但我今天還是要繼續講這個 |
| transcript.whisperx[1].start |
25.726 |
| transcript.whisperx[1].end |
41.434 |
| transcript.whisperx[1].text |
大家都在談說這個病房護病比的限制護理人力的不足導致醫院這個關病房然後急診的住院帶床病人滯留狀況加劇那上次我也就教於你就是說光是減傷第一級的 |
| transcript.whisperx[2].start |
41.954 |
| transcript.whisperx[2].end |
68.095 |
| transcript.whisperx[2].text |
他的平均的流治的時間都超過標準時間8小時的還要到雙倍以上那我現在就請你看一個圖到底我們這個護理人力你對於平均媒體報導這個護理人力平均年齡39歲資深護理師留任這個健校你們自己是這樣講留任健校你是怎麼看待這個資訊的 |
| transcript.whisperx[3].start |
71.67 |
| transcript.whisperx[3].end |
88.445 |
| transcript.whisperx[3].text |
我是請那個市長先回答一下我是叫你看安安就是這樣講你自己發布的新聞你們自己的這個你自己都沒看過嗎就是說啊這個2024因為這個時候我還沒上任所以我要仔細看一下這樣子 |
| transcript.whisperx[4].start |
89.926 |
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107.137 |
| transcript.whisperx[4].text |
不是啊這是前幾天5月去年5月13號的新聞你還沒上任好那你知道這個議題也應該要了解一下吧因為我當然是希望護理師生能夠留任不是啦現在從一路早上大家問你都覺得說 |
| transcript.whisperx[5].start |
109.178 |
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126.031 |
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離職的雖然很多但你們12項政策要求穩定而且已經有見效增加的人力其實都是增加的雖然有離職的但你們剛才司長一直在講說人力普遍上還是增加的從你們的職登統計都看得出來那你們現在看出來數據我告訴你2021年護理師職業的平均年齡是36.95歲2024年是39.25歲 |
| transcript.whisperx[6].start |
137.879 |
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159.435 |
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那我就這樣子問你就好了 就這件事情啦職業的平均年齡越來越增加 你怎麼看待這一件事情平均職業年齡提高啊你怎麼看啊這可能要從兩個角度嘛 |
| transcript.whisperx[7].start |
162.048 |
| transcript.whisperx[7].end |
180.898 |
| transcript.whisperx[7].text |
因為當初去年你們認為這個是肯定把資深的留下來從這個角度來看也許是好事情那是不是說年輕的留不住也是一件事情這個可能要來看評但我們也很好奇為什麼年輕的因為我們開設多元的人才人力的培養 |
| transcript.whisperx[8].start |
181.718 |
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202.436 |
| transcript.whisperx[8].text |
包括學社後的護理系有持續的開設而且包括護理師的考試從一年兩次變成一年三次但我們的平均職業年齡卻節節攀升那你講的你也講了就是說啊這個留不住年輕的專業的護理人力那你知道部長你知道2012年台灣護理人員平均職業年齡是幾歲嗎2012年 |
| transcript.whisperx[9].start |
211.962 |
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220.613 |
| transcript.whisperx[9].text |
2012年啦 你猜猜看 你用猜的啦 你們沒數據啦 你用猜的 你猜猜看好 那多少歲 被你偷看到了2012年29.6歲 2024年39.25歲 |
| transcript.whisperx[10].start |
230.52 |
| transcript.whisperx[10].end |
234.883 |
| transcript.whisperx[10].text |
當時2012年2012年離現在並沒有很久你們專案報告是說平均年齡29歲而且21到30歲族群最多佔了43.6%43.6%都是30歲以下的護理人力而現在30歲以下護理人力可能是 |
| transcript.whisperx[11].start |
254.895 |
| transcript.whisperx[11].end |
271.866 |
| transcript.whisperx[11].text |
低的不像樣那你對這個數字其實你都沒有掌握我剛剛問你 你也搞不清楚到底我們要肯定平均年齡39歲是留任成功還是說我們要擔心如果2012年平均年齡29歲2024年平均39歲如果照這個邏輯到2036年平均職業年齡會不會變成49歲有沒有可能是這樣子 |
| transcript.whisperx[12].start |
283.743 |
| transcript.whisperx[12].end |
293.728 |
| transcript.whisperx[12].text |
39歲留任都還留任成功我們很感謝這些資深的護理師扛起了這個責任可是呢我擔心的當然是年輕的子卿沒有進來 |
| transcript.whisperx[13].start |
295.1 |
| transcript.whisperx[13].end |
317.152 |
| transcript.whisperx[13].text |
年輕的族群沒進來可是我們的養成班開很多啊我們現在要問的是說剛剛已經有委員講了到澳洲年薪170萬到美國300萬起跳但都還要扣掉生活費那如果在這裡的待遇和工時能夠改善的話大家都知道說大家如果可以留在自己的家鄉誰願意遠離故鄉呢 |
| transcript.whisperx[14].start |
320.854 |
| transcript.whisperx[14].end |
342.865 |
| transcript.whisperx[14].text |
不是了解而已你們開源人數理論上是增加的取得證照的人數也越來越多可是我們平均職業年齡卻越來越高這是不合理的這種狀況裡面畢業生不來心血留不住資深扛起來然後病房關床急診永設一環扣一環 |
| transcript.whisperx[15].start |
345.159 |
| transcript.whisperx[15].end |
351.601 |
| transcript.whisperx[15].text |
這些畢業生留到外國去難道台灣是要幫變成一個國際護理師的執訓中心嗎台灣護理人才的養成是要幫國際的護理人員變成後備養成中心嗎 |
| transcript.whisperx[16].start |
362.332 |
| transcript.whisperx[16].end |
387.762 |
| transcript.whisperx[16].text |
我們很希望我們培養出來的都能夠留在國內因為國內還是需要這些人才我們想盡辦法把他留在國內所以我們現在是政策規劃是有問題還是政策規劃不利還是執行面有問題所以在這種狀況裡面不要動不動就覺得說你們市長剛剛講說我們人數是增加的人數增加都資深的年輕的優秀的沒有心血進來 |
| transcript.whisperx[17].start |
389.062 |
| transcript.whisperx[17].end |
398.22 |
| transcript.whisperx[17].text |
所以你的KPI應該是護理人員回流多少病床開床率是多少而不是在這裡說你有增加可是結果病床關的越多急診越湧射 |
| transcript.whisperx[18].start |
401.366 |
| transcript.whisperx[18].end |
411.175 |
| transcript.whisperx[18].text |
現在護理人員講啊 如果是醫生或醫院跟你們反映問題 你們都馬上回應有所回應 護理人力跟你們反映問題 護理工會跟你們反映問題你們毫無感覺 只好護理人員用集體離職來跟你們做無聲的抗議 |
| transcript.whisperx[19].start |
422.322 |
| transcript.whisperx[19].end |
450.499 |
| transcript.whisperx[19].text |
現在是人家反映了你們對於護理人員跟對於醫師跟對醫院他們講話的份量不一樣啊份量不一樣只好用離職來告訴你他抗議這是大問題捏不對嗎要怎麼走要怎麼走你的12項政策政策工具現在好像也是留住資深的而已資深的而已 |
| transcript.whisperx[20].start |
451.636 |
| transcript.whisperx[20].end |
473.289 |
| transcript.whisperx[20].text |
我們很希望因為一進來他工作是不是滿意新手啦新手其實是非常重要的所以我們有這個護理新手的臨床導師好啦我希望半年後你來告訴我你十二項政策讓年輕的護理師願意留下來為台灣的病患服務我們前一步 |
| transcript.whisperx[21].start |
475.624 |
| transcript.whisperx[21].end |
489.412 |
| transcript.whisperx[21].text |
半年後我會再問你喔就不要再講半年前我問你的這個醫院有公安危機的你還沒告訴我還沒回答我喔當然我今天還有更重要的要問你就是因為有這個問題以外還有 |
| transcript.whisperx[22].start |
492.074 |
| transcript.whisperx[22].end |
519.803 |
| transcript.whisperx[22].text |
今年實施的醫院個別總額制的問題在第二季要上路了醫院個別總額制的問題啊你們有一個很有效的打擊醫療人球的策略和方案那你有很有效的羅伯安棒子你知道總額健保總額增加了700多億醫院增加了300多億吧至少醫院拿走了一半以上吧 |
| transcript.whisperx[23].start |
521.344 |
| transcript.whisperx[23].end |
522.288 |
| transcript.whisperx[23].text |
那一人 |
| transcript.whisperx[24].start |
523.539 |
| transcript.whisperx[24].end |
550.637 |
| transcript.whisperx[24].text |
拿多了幾百億的錢出來可是醫院就這樣子急診永設然後現在關病床這已經是夠荒謬 夠好笑了我今年要給你三四百億結果關了病床更多結果急診更永設然後你說你有一個醫療人球的這個應對的這個策略這樣子那我現在問你喔 就是說啊你有沒有盤點到 |
| transcript.whisperx[25].start |
554.396 |
| transcript.whisperx[25].end |
556.862 |
| transcript.whisperx[25].text |
這個未來醫院個別總額制醫療現場會面臨哪一些衝擊 |
| transcript.whisperx[26].start |
563.066 |
| transcript.whisperx[26].end |
584.202 |
| transcript.whisperx[26].text |
阿你又有什麼因應的策略我可不可以分兩段來報告一下因為我們所有今年的預算都還沒有set down所以還沒有開始來來能夠去落實各種不管是醫院基層相關包括這個年負病比的獎金現在都還沒有開始來發我想希望能夠 |
| transcript.whisperx[27].start |
585.663 |
| transcript.whisperx[27].end |
593.188 |
| transcript.whisperx[27].text |
預算這個會計都能夠趕快做完你現在是在說什麼 說什麼個別醫院總額次啊對你個別醫院總額我們當然知道個別醫院總額是這樣子在台北區也是第二劑才會開始所以你個別醫院總額也是第二劑才要開始啊台北區現在所發生的醫院用色的問題 |
| transcript.whisperx[28].start |
607.407 |
| transcript.whisperx[28].end |
612.511 |
| transcript.whisperx[28].text |
當然應該是還沒有我沒有在問你這個我現在問你是說那個別醫院總額的話我們當然你這樣子實施這個醫院個別總額制實行下去以後醫療現場會發生什麼樣的變化那看病的民眾會受到什麼衝擊我現在是在問這個啊了解 |
| transcript.whisperx[29].start |
627.222 |
| transcript.whisperx[29].end |
633.608 |
| transcript.whisperx[29].text |
我是站在病人和人民的立場在問這個我想這個也不是說突然要去做不是啦會有什麼衝擊你怎麼講不出來沒關係我沒有管你我沒有突然而且我也不見得說認為這樣子是錯的我不認為這樣子就一定是不行的 |
| transcript.whisperx[30].start |
646.518 |
| transcript.whisperx[30].end |
666.362 |
| transcript.whisperx[30].text |
但我現在問你是說有可能面臨到看病的人會受到的衝擊是什麼你來告訴我因為你告訴我了所以你才有想說你的因應策略是什麼那證明你每一個政策新的政策的施行都是有評估有步驟而且到最後的衝擊你們也有因應的策略的我是要看到這個過程啊所以我現在問你 |
| transcript.whisperx[31].start |
673.599 |
| transcript.whisperx[31].end |
675.882 |
| transcript.whisperx[31].text |
這樣子新的制度上路你有沒有盤點過醫療現場會面臨什麼衝擊 |
| transcript.whisperx[32].start |
680.31 |
| transcript.whisperx[32].end |
701.655 |
| transcript.whisperx[32].text |
第一個是什麼我想醫院在財務的自我管理會更加的一個謹慎那如果說他的管理他對病人就會用最有效益的方式來解決你可不可以講具體一點啊不然我說給你聽你補正耶不然我說給你聽啦我再舉個例子他的大姨的日子 |
| transcript.whisperx[33].start |
704.496 |
| transcript.whisperx[33].end |
713.681 |
| transcript.whisperx[33].text |
聽你講這個我認為你不使人間煙火因為很多醫院都跳出來反應了很多醫院的發言人都出來講話了第一個根據媒體的報導台大 |
| transcript.whisperx[34].start |
719.864 |
| transcript.whisperx[34].end |
747.861 |
| transcript.whisperx[34].text |
民眾最擔心的就是醫學中心掛號費會不會調漲然後呢台大醫院目前掛號費100健保部分負擔420然後呢發言人就表示各種醫療支出要價不斷攀升去年點值不到0.9仍然遠遠的趕不上高漲的電費人事費為了因應可能的財務衝擊他們已經商量很多了然後他們不排除最後一個就是調漲掛號費 |
| transcript.whisperx[35].start |
749.762 |
| transcript.whisperx[35].end |
769.176 |
| transcript.whisperx[35].text |
然後新光醫院的副院長大家都知道醫務管理學會的理事長洪子仁也表示不過他們講的更多他們盤點醫院量能他們能做的調控措施包括調高掛費以外減少週六及夜間門診控制掛號人數延後非緊急手術等等 |
| transcript.whisperx[36].start |
776.254 |
| transcript.whisperx[36].end |
777.537 |
| transcript.whisperx[36].text |
現在這事情有嚴重嗎?我現在講這個可能的衝擊在這裡生病的人會受到的衝擊 |
| transcript.whisperx[37].start |
786.408 |
| transcript.whisperx[37].end |
806.785 |
| transcript.whisperx[37].text |
那錢會開過的還算是最小的 調高掛號費再來開集也不會開過的週末假日還有夜間門診減少了開集要去掛號又掛不到了控制掛號人數你要去看也掛不到了半夜的週末的集中症的 |
| transcript.whisperx[38].start |
808.387 |
| transcript.whisperx[38].end |
820.095 |
| transcript.whisperx[38].text |
延後非緊急手術那意思是說都要碰瓶子那瓶子不上不下集中症當然排除在那個外面啦但是呢還有一種是減傷 |
| transcript.whisperx[39].start |
822.92 |
| transcript.whisperx[39].end |
828.205 |
| transcript.whisperx[39].text |
輕的報重的 這也不可能啊當然這種狀況 調整掛號費還掛不到號 這民怨四起啊對民眾來講 可能衝擊到醫療品質 掛號看診困難自費項目變多 手術被延後然後消基會的董事吳榮達 他擔憂啊 |
| transcript.whisperx[40].start |
843.599 |
| transcript.whisperx[40].end |
848.801 |
| transcript.whisperx[40].text |
這一個新制上路醫療品質會下降醫院如果縮門診量民眾掛號看診更困難影響就醫的可敬性當然我們希望分級醫療所以這個縮門診量是對是錯我們暫姑且不論但是這個蕭紀惠董事會講就檢驗檢查手術時間的遞延也會影響病情的發現導致病情惡化 |
| transcript.whisperx[41].start |
871.75 |
| transcript.whisperx[41].end |
884.834 |
| transcript.whisperx[41].text |
如果醫院若自行限縮醫療服務的申報門診檢查檢驗手術住院減少可能會影響這個事情再來喔醫療人員的收入加劇人力的出走這你們有想過嗎 |
| transcript.whisperx[42].start |
888.72 |
| transcript.whisperx[42].end |
902.766 |
| transcript.whisperx[42].text |
你知不知道不是我們不支持分級醫療有時候到小診所然後醫生檢查不出問題都會叫我們說你為了慎重起見到醫學中心去做檢查有沒有這種狀況 |
| transcript.whisperx[43].start |
904.148 |
| transcript.whisperx[43].end |
911.275 |
| transcript.whisperx[43].text |
有啊很多啊還有一個根據媒體報導56歲的楊女士服用高血壓的藥6年照都在台中榮總心臟內科定期回診拿單然後呢她也不懂什麼是腫瘀然後為了要掛號她覺得掛號費漲她會吞下去但是她曾經因為服用醫院給的藥不要忘了你們還有缺藥的問題喔 |
| transcript.whisperx[44].start |
929.591 |
| transcript.whisperx[44].end |
942.115 |
| transcript.whisperx[44].text |
你們缺藥的問題尤其是一些特殊的藥只有供給給醫院沒有供給給地區醫院也沒有供給給地方診所也沒有供給給地區的藥房結果他說他的經驗是他病情穩定了醫院將他下轉到診所 |
| transcript.whisperx[45].start |
947.196 |
| transcript.whisperx[45].end |
962.761 |
| transcript.whisperx[45].text |
從診所 從原廠藥變學名藥還需要在醫學中心回診 已經每半年都抽血檢驗看這個一下在診所 檢驗又要回到醫學中心就算了但是呢 後來 檢查好以後 他有時候又要到發現變嚴重了 又要到中榮去就診 |
| transcript.whisperx[46].start |
969.81 |
| transcript.whisperx[46].end |
984.728 |
| transcript.whisperx[46].text |
這個我們要講的是說分級是對的但是有很多狀況並不是民眾迷信醫學醫院或教學中心而是事情的原本就是這樣直接治療好控制好你叫我去診所就控制不好我就要回來 |
| transcript.whisperx[47].start |
986.471 |
| transcript.whisperx[47].end |
999.144 |
| transcript.whisperx[47].text |
這個教學中心所以這個很複雜的不一定大家都喜歡逛醫院也不一定大家都認為到醫學中心好可是他的經驗就是如此所以他覺得說這個狀況怎麼處理呢你不可以僅憑政策的調整或是你們從上面講說就是這樣子沒問題可以改變了 |
| transcript.whisperx[48].start |
1007.552 |
| transcript.whisperx[48].end |
1012.415 |
| transcript.whisperx[48].text |
你要去掌握民眾的就醫習慣和決策的行為這是很複雜的你單純調高掛號費也不代表能夠有效的降低民眾因輕症前往醫學中心的就診的狀況這個我也質詢過你調整了部分負擔結果呢結果呢 到醫學中心裡面看病的 看門診的量增加 增加 |
| transcript.whisperx[49].start |
1037.072 |
| transcript.whisperx[49].end |
1044.08 |
| transcript.whisperx[49].text |
現在只有改變什麼從人民的荷包掏出更多錢這一件事情而已你想要做的分級醫療沒有改變你當初漲部分負擔就說是為了要落實分級醫療結果沒有辦法控制啊 |
| transcript.whisperx[50].start |
1052.088 |
| transcript.whisperx[50].end |
1054.289 |
| transcript.whisperx[50].text |
無效啊 無效的政策啊那現在呢醫改會也擔心啦門診減量以後醫院可能會透過健保轉資費減少賣信簽的處方簽的釋出調漲掛號費來增加收入導致病人看病變貴 |
| transcript.whisperx[51].start |
1070.558 |
| transcript.whisperx[51].end |
1087.904 |
| transcript.whisperx[51].text |
那為了讓治療項目得到保障甚至可能會將輕症報為重症那為了避免過度申報而斷頭給付他也可能會發展什麼我報太多被斷頭給付那他要怎麼因應如果你是醫院接應者你要怎麼因應部長 |
| transcript.whisperx[52].start |
1089.822 |
| transcript.whisperx[52].end |
1105.468 |
| transcript.whisperx[52].text |
真的很敬佩委員你覺得他們上有政策下有對策你覺得醫院會怎麼因應啊他是非常複雜的因素但是我必須要跟大家講說今天我們生活在台灣這個國度是非常幸福的 |
| transcript.whisperx[53].start |
1105.828 |
| transcript.whisperx[53].end |
1114.812 |
| transcript.whisperx[53].text |
我現在要跟你說你的政策有問題沒有啦我投資你政策可能的問題在哪裡沒有啦你講不出來我就告訴你啦醫院你一直去看他沒有辦法負責別人我們一定要改革讓他練保養讓永遠得到好的照顧 |
| transcript.whisperx[54].start |
1131.94 |
| transcript.whisperx[54].end |
1160.297 |
| transcript.whisperx[54].text |
我不叫你回答,你一直跟我相親,我要跟你說,北醫要面對這麼多人來看診,他怎麼因應,上有政策下有對策道高於尺,魔高於杖啦北醫要透過門前診所啦將輕症帶出醫院治療啦而門前診所已經很多了,很普遍啦這個就是我們在集合的重點之一集合的重點之一有改變嗎? |
| transcript.whisperx[55].start |
1161.567 |
| transcript.whisperx[55].end |
1190.454 |
| transcript.whisperx[55].text |
有解決嗎我們各區的管理在這個部分沒有啦將輕症帶出醫院假裝不是醫院去看的門前診所然後再去瓜分西醫的基層診所的總額從醫院的總額再來瓜分診所的總額而重症的病人如果沒有人要收通通給他送到公立醫院讓護理人力更慌公立醫院的 |
| transcript.whisperx[56].start |
1191.434 |
| transcript.whisperx[56].end |
1204.025 |
| transcript.whisperx[56].text |
所以如果避免醫院選病人你衝擊的配套在哪裡如果讓人家剛提出來的可能的問題你們是有能力因應的嗎你來告訴我 |
| transcript.whisperx[57].start |
1205.643 |
| transcript.whisperx[57].end |
1222.818 |
| transcript.whisperx[57].text |
透過健保轉資費你要怎麼處理減少慢性遷的事數你要怎麼處理調漲掛號費但是沒有改善醫療分級的問題你怎麼處理門前診所你說你要列為評鑑的項目但是你沒有效你要怎麼處理我們委員所擔心所提出的請你放心 |
| transcript.whisperx[58].start |
1229.319 |
| transcript.whisperx[58].end |
1248.911 |
| transcript.whisperx[58].text |
我們一定一個一個去把它監測還有呢保障人權最佳的政府限縮門診你知道台大你們台大健康政策管理研究所門診的數量真的不用太重我現在不跟你說了我現在不請你講你之前在這裡說的黃正熙教授有要替我看其實大家都看了沒有啦我現在沒有在提你台港主席我要問問題他這樣子一直台港我怎麼問 |
| transcript.whisperx[59].start |
1257.856 |
| transcript.whisperx[59].end |
1270.499 |
| transcript.whisperx[59].text |
我是說台大健康政策管理研究所的副教授郭年珍他最近也撰文指出個別醫院總額上路會遇到的四個問題第一個限縮門診手術是否會影響就醫的限縮門診和手術會不會影響到就醫的可進性 |
| transcript.whisperx[60].start |
1278.041 |
| transcript.whisperx[60].end |
1295.737 |
| transcript.whisperx[60].text |
那第二個就是說啊如何避免醫療醫院選擇輕症病患啊如何避免啊今年醫院的總額比去年增加了370億欸那預期的點值穩定性會提升啊可是關鍵問題在如果避免影響民眾就醫的可進性和醫療品質很低啊但是有可能 |
| transcript.whisperx[61].start |
1303.781 |
| transcript.whisperx[61].end |
1323.394 |
| transcript.whisperx[61].text |
醫院我們健保多給了370億然後你們漲部分負擔也增加了醫院的收入然後呢如果再增加掛號費收入又要增加可是未來掛號掛不到然後檢查檢查不到然後未來看病的可靜性會受影響 |
| transcript.whisperx[62].start |
1324.855 |
| transcript.whisperx[62].end |
1353.422 |
| transcript.whisperx[62].text |
你有沒有可能面臨導致高醫療需求的病患不符但是不符合重症的範圍面臨更大的困難或者是變成全民搶掛號大賽大家都要搶掛號都拜託你不要搶掛號或是促使醫院策略性的選擇輕症病患平轉或上轉醫療資源耗用多的病患給其他公立的醫院進一步的加劇醫療資源分配不均 |
| transcript.whisperx[63].start |
1355.37 |
| transcript.whisperx[63].end |
1380.423 |
| transcript.whisperx[63].text |
然後再來第三點 郭年增教授講的醫院內部資源分配和管理衝突這不是醫病的問題 也不是醫院跟病人的問題而已光是醫院內部各分科的內部資源分配和管理就會產生衝突所以在某些科別好看的 成本低的 然後服務量增加 |
| transcript.whisperx[64].start |
1381.443 |
| transcript.whisperx[64].end |
1394.166 |
| transcript.whisperx[64].text |
然後薪資裡面呢 如果這種像成本高的不賺錢的科別 然後人數下降這邊看這個吃力不討好的 醫生會收入減成本高的 成本低的 然後好看的 人看越多越賺錢的 醫生薪水越來越高 |
| transcript.whisperx[65].start |
1402.228 |
| transcript.whisperx[65].end |
1430.404 |
| transcript.whisperx[65].text |
光是在這種狀況裡面醫師現有的薪酬制度除了兼行政主管或擔任研究醫師以外仍然都是以不拖你服務的量能為基礎鼓勵多做來分配酬勞和所得可是你當總額受到嚴格的控制然後醫院如果沒有有效的調整薪資激勵這個這個激勵的鼓勵的機制的話你如果反向的鼓勵不要充量然後你沒有鼓勵 |
| transcript.whisperx[66].start |
1431.405 |
| transcript.whisperx[66].end |
1432.286 |
| transcript.whisperx[66].text |
你這個管理食物上還有一種問題是論人記仇的狀況那你減少醫療你要讓這個醫生和部門之間真的啦這問題很嚴重的譬如說 |
| transcript.whisperx[67].start |
1450.475 |
| transcript.whisperx[67].end |
1470.796 |
| transcript.whisperx[67].text |
本醫來得住院 住院的我們都知道門診轉住院的病患病情比較穩定住院的天數容易管理比較有機會接受自費治療可是急重症的急診他轉住院的病患病情是相對嚴重的住院的時間也不確定的 |
| transcript.whisperx[68].start |
1472.498 |
| transcript.whisperx[68].end |
1477.764 |
| transcript.whisperx[68].text |
也可能比較容易被排擠有沒有可能在醫院的管理上他們在各部門的住院收留上寧可優先選擇收留門診轉上來的 |
| transcript.whisperx[69].start |
1487.435 |
| transcript.whisperx[69].end |
1499.205 |
| transcript.whisperx[69].text |
而策略性的將急重症的急診部門的要轉病房的讓他留在急診室導致急診有壓力進一步升高因為這部門和部門之間 我也要選定他要選勤課 他也要選籌檔的 |
| transcript.whisperx[70].start |
1507.173 |
| transcript.whisperx[70].end |
1536.029 |
| transcript.whisperx[70].text |
所以在這種狀況裡面這一類的急診和非急診專科的衝突在醫院裡面會不會被進一步的放大畢竟多收一個急診的患者即使能有健保的加成或是排除個別的總額之外相較於門診排成的住院病患哪一個比較符合他們那個部門的利益這個是很現實的因為那個部門也有護理人力缺護理師也考量到我寧可照顧 |
| transcript.whisperx[71].start |
1536.869 |
| transcript.whisperx[71].end |
1540.212 |
| transcript.whisperx[71].text |
門診轉上來誰要照顧那個急症急重症轉上來的所以為了在這種狀況裡面這個問題都是內部管理會衝突的而犧牲的是病人啦在這種狀況裡面還有一種病床控管的方式並不是由科部統一管理有一些醫院的病床的管理是根據個別醫師資歷去分配的 |
| transcript.whisperx[72].start |
1563.717 |
| transcript.whisperx[72].end |
1579.807 |
| transcript.whisperx[72].text |
而個別醫師的資歷的分配中它導致有空床仍然無法有效收治急診的病患所以在這裡我並不是說我們反對你分級醫療並不是說你反對你個別醫院的總額管制而是 |
| transcript.whisperx[73].start |
1581.257 |
| transcript.whisperx[73].end |
1596.305 |
| transcript.whisperx[73].text |
你要做的你要監測的更細緻你的配套機制要更完善而是你要預期到可能的衝擊對病人的衝擊是什麼而你的因應之道是什麼請問我剛剛講那些問題你們的配套是什麼 |
| transcript.whisperx[74].start |
1601.547 |
| transcript.whisperx[74].end |
1615.238 |
| transcript.whisperx[74].text |
病人受到這麼大的衝擊 你的配套是什麼所以在醫界 在學界人家已經跟你講你的政府要細緻的進行相關的監測和配套機制你講話怎麼這樣你們現在有什麼細緻的監測和配套機制你們監測的項目有哪些監測的頻率會如何設定監測後的檢討設定多久時間 |
| transcript.whisperx[75].start |
1627.984 |
| transcript.whisperx[75].end |
1643.915 |
| transcript.whisperx[75].text |
包園,你剛剛提的,不管是郭教授,或者是你提的寶貴的見解其實我們都知道我現在問你,你也在這裡,不是問你知不知道,我問你啊你現在監測的配套機制是什麼,你若不能說,叫你書長來說啦我看你是不會說啦,叫你書長來說你,謝謝記者,讓書長我問一下 |
| transcript.whisperx[76].start |
1654.679 |
| transcript.whisperx[76].end |
1666.489 |
| transcript.whisperx[76].text |
醫療可見性和品質的衝擊跟委員報告這個個別醫院總額除了台北區之外全部都在今年1月1號都實施了台北區當然是最困難的 |
| transcript.whisperx[77].start |
1668.371 |
| transcript.whisperx[77].end |
1673.493 |
| transcript.whisperx[77].text |
南區高屏區東區都已經早已實施多年所以這個不是一個新的制度因為這些問題在過去實施之前也都有這樣的疑慮但是實施下去之後我們各區的你不要這樣子好不好中南部的醫療現場的問題跟我們北區會一樣嗎 |
| transcript.whisperx[78].start |
1692.76 |
| transcript.whisperx[78].end |
1704.732 |
| transcript.whisperx[78].text |
一個大台北地區多少人你知道嗎大台北就好了北北基就好了多少人你告訴我700萬人啊但是大台北地區啊700萬在全台灣三分之一耶北北基而已耶 |
| transcript.whisperx[79].start |
1709.929 |
| transcript.whisperx[79].end |
1737.723 |
| transcript.whisperx[79].text |
你知道2004年就以醫院卓越計畫之名推行過了類似個別總額的制度了啦這個概念在2004年就做過了那因為部分醫院減少開立藥品種類和數量而且限制門診量導致民眾申訴掛不上號醫院減少開藥種類或數量甚至有醫學中心因為頻繁遭投訴而被中區健保業務組終止合約但是因為當時是自願參與的 |
| transcript.whisperx[80].start |
1739.884 |
| transcript.whisperx[80].end |
1766.143 |
| transcript.whisperx[80].text |
而未參加的醫院這個點子會讓他下降然後影響了整體醫療生態最後這一個計畫被監察院糾正欸那我不認為現在的計畫跟當時是一模一樣但是你們面對這個的態度你們認為台北的模式跟中南部會一樣都不會有問題學者專家叫你們監測什麼你們要監測了嗎 |
| transcript.whisperx[81].start |
1769.105 |
| transcript.whisperx[81].end |
1775.87 |
| transcript.whisperx[81].text |
有監測嗎 都會參考啦他們叫你監測什麼 你先回答我你先回答我 他們要求的監測合不合理他們要求監測什麼東西 你回答得出來嗎 |
| transcript.whisperx[82].start |
1786.277 |
| transcript.whisperx[82].end |
1814.966 |
| transcript.whisperx[82].text |
我們有很多的指標在檢測他在說你們都知道知道 你連聽都不想聽人家建議 監測實施前後的實施前後的門診和住院病患的屬性變化監測病人就醫流向是不是出現不合理的平轉或下轉引導醫院建立更合理的薪酬和資源分配機制 |
| transcript.whisperx[83].start |
1816.363 |
| transcript.whisperx[83].end |
1824.93 |
| transcript.whisperx[83].text |
引導醫院建立更合理的星球和資源分配機制你們的對策是什麼你們的手段 蘿蔔和棒子是什麼 |
| transcript.whisperx[84].start |
1829.793 |
| transcript.whisperx[84].end |
1849.01 |
| transcript.whisperx[84].text |
大家都轉到台大和北龍然後像那個人酬的話不收的話是要轉出那邊處分還是還是台大和北龍要負責我真的要語重心長的跟委員報告啦您的資料我們都會我們都了解也會解決但是我不是要來了解我現在問你說人家拋出來的問題 |
| transcript.whisperx[85].start |
1851.932 |
| transcript.whisperx[85].end |
1872.364 |
| transcript.whisperx[85].text |
他們絕對都是...我是幫醫院拋出來的問題拿來問你我不是在問醫院院長我擔心的是衛福部部長你要怎麼解決而你講不出來所以我擔心啦有蘿蔔有棍子但是不是一個學者所講的就代表全部 |
| transcript.whisperx[86].start |
1873.044 |
| transcript.whisperx[86].end |
1878.666 |
| transcript.whisperx[86].text |
我現在最好說一句啦現在我最好說一句啦 因為我說很久了啦你為大家不是靠上身就可以解決問題你不是大家叫你為上身就可以解決問題今天在這裡是說 人家提出問題了你有什麼看法 你有什麼解方你面對病人受到這麼大的衝擊 你的配套是什麼而今天 |
| transcript.whisperx[87].start |
1901.713 |
| transcript.whisperx[87].end |
1923.559 |
| transcript.whisperx[87].text |
而今天整個衛福部包括部長包括署長都對我們提出來的病人受到衝擊回答不出來不願意回答然後轉移焦點答非所問這才是大問題啦我們會解決所有的您擔心的問題大家宣誓性的唯獨一再的宣誓而已謝謝 |