| IVOD_ID |
16023 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Full/1M/16023 |
| 日期 |
2024-06-19 |
| 會議資料.會議代碼 |
黨團協商-2024061866 |
| 會議資料.會議代碼:str |
立法院朝野黨團協商 |
| 會議資料.屆 |
11 |
| 會議資料.會期 |
1 |
| 會議資料.種類 |
黨團協商 |
| 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 |
立法院朝野黨團協商 |
| 影片種類 |
Full |
| 開始時間 |
2024-06-19T09:00:00+08:00 |
| 結束時間 |
2024-06-19T12:20:00+08:00 |
| 影片長度 |
03:20:00 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://h264media01.ly.gov.tw:443/vod_1/_definst_/mp4:1M/bfaf9b39ac01a6855292db7196bde669262f4dea22c8b7da19186e52af124432e10024d1ab923fd75ea18f28b6918d91.mp4/playlist.m3u8 |
| 會議時間 |
2024-06-19T09:30:00+08:00 |
| 會議名稱 |
立法院朝野黨團協商（事由：一、社會福利及衛生環境、司法及法制兩委員會報告併案審查「兒童及少年性剝削防制條例部分條文修正草案」等36案。二、逕付二讀：委員張嘉郡等23人、委員李彥秀等16人、委員羅廷瑋等16人、委員翁曉玲等22人、委員洪孟楷等19人、台灣民眾黨黨團、委員蔡易餘等17人、委員伍麗華SaidhaiTahovecahe等17人、委員羅智強等16人(2案)、委員張宏陸等19人、委員吳沛憶等21人、委員吳思瑤等18人、委員黃秀芳等17人、委員林淑芬等17人、委員賴瑞隆等17人、委員陳秀寳等26人、委員蔡其昌等17人、委員林楚茵等20人分別擬具「兒童及少年性剝削防制條例部分條文修正草案」等19案。(第一、二案預計9：30---10：30)三、社會福利及衛生環境委員會報告併案審查委員王育敏等19人、委員蘇清泉等28人及國民黨黨團分別擬具「全民健康保險法第六十二條條文修正草案」案。四、逕付二讀：委員謝衣鳯等21人、委員楊瓊瓔等26人分別擬具「全民健康保險法第六十二條條文修正草案」等2案。(第三、四案預計10：30---11：30)） |
| 委員名稱 |
完整會議 |
| 委員發言時間 |
09:00:00 - 12:20:00 |
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| transcript.whisperx[0].start |
1835.435 |
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好,那我們今天要併案協商是《兒童及少年性剝削防制條例部分條文修正草案》暨55案。一、已經併案審查完略36案。二、逕付二讀19案。 |
| transcript.whisperx[1].start |
1851.752 |
| transcript.whisperx[1].end |
1856.094 |
| transcript.whisperx[1].text |
本會期第一次本會與司法法制委員會聯席會議審查即6月5日第一次黨團協商後共計保留條文6條、第二條、第三條、第三十八條 |
| transcript.whisperx[2].start |
1878.342 |
| transcript.whisperx[2].end |
1890.467 |
| transcript.whisperx[2].text |
第45條之二、第51條及第55條。那我們現在就開始協商上次還沒有確認的條文。來,第二條。 |
| transcript.whisperx[3].start |
1892.034 |
| transcript.whisperx[3].end |
1919.094 |
| transcript.whisperx[3].text |
是不是請衛福部這邊說明一下是謝謝主席那第二條我們建議參考這個衛生福利部所建議的修正條文在這個第一項的第三款圖畫的部分相關委員建議要做一個定義那我們建議這個定義已經放在修正的說明裡頭那建議維持現在我們建議的文字以上 |
| transcript.whisperx[4].start |
1920.66 |
| transcript.whisperx[4].end |
1941.337 |
| transcript.whisperx[4].text |
好 針對第二條的部分衛福部在作出修正動議那請問各位委員對於衛福部今天提出來的版本有沒有意見好 來陳昭智委員好 謝謝主席在第二條已經是在這個大本的第二頁的地方 |
| transcript.whisperx[5].start |
1943.331 |
| transcript.whisperx[5].end |
1945.535 |
| transcript.whisperx[5].text |
本黨團是希望對於所謂的虛擬創作的部分能夠也把它 |
| transcript.whisperx[6].start |
1955.168 |
| transcript.whisperx[6].end |
1978.726 |
| transcript.whisperx[6].text |
就是在虛擬方面要排除所以我們的字眼會有這個地方女性向客觀上所引起刺激或滿足性而無藝術性、醫學性或教育性價值而令一般人感覺不堪承信於眾或不能忍受而排除之土化這個目的是這樣子但是剛剛當然有一些溝通他們是 衛福部是把它寫在這個條文說明裡面 |
| transcript.whisperx[7].start |
1981.468 |
| transcript.whisperx[7].end |
2000.153 |
| transcript.whisperx[7].text |
那本黨是認為說這個就是所排除的那個虛擬創作放在本條文裡面就是比較明確那放在說明的地方其實是可以是可以在再來討論那我們希望我們希望是可以放在這個本條文當中好謝謝主席好還有沒有其他委員有其他意見 |
| transcript.whisperx[8].start |
2007.591 |
| transcript.whisperx[8].end |
2033.494 |
| transcript.whisperx[8].text |
那是不是衛福部再說明一下為什麼要放在說明欄因為《兒童及少年性剝削防制條例》其實是這個刑法的特別法那在刑法的2、3、5條裡頭有針對民眾黨黨團提的這些文字在這個2、3、5條裡頭它也是截圖圖畫文字那因此我們在跟這個ACG團體溝通的時候他們也同意說我們放在這個說明欄 |
| transcript.whisperx[9].start |
2034.955 |
| transcript.whisperx[9].end |
2045.541 |
| transcript.whisperx[9].text |
然後避免他在這個特別法的文字跟普通法文字這個會有一些漢格同時放在說明欄他保持一個彈性以上建議 |
| transcript.whisperx[10].start |
2049.502 |
| transcript.whisperx[10].end |
2073.699 |
| transcript.whisperx[10].text |
那張職民眾黨是不是可以接受?也有跟團體溝通過。我們是覺得明確性是比較不足啦。那就算說法官法庭在判決的時候,我們不知道他會不會去注意到這個所謂的說明欄的這個資訊。那我們請那個是不是司法單位法務部跟司法院說一下,如果這樣的修法你們會不會注意到? |
| transcript.whisperx[11].start |
2077.221 |
| transcript.whisperx[11].end |
2102.893 |
| transcript.whisperx[11].text |
有關這個定義就是文字它的定義它的概念我們的意見是是不是因為像這樣的概念它通常會隨著社會觀念的發展會有不同的內涵那我們是比較建議維持衛福部的版本留在說明欄然後讓這個主管機關解釋主管法規的彈性空間可以及時來因應社會情勢的變遷這樣是不是會比較好 |
| transcript.whisperx[12].start |
2103.956 |
| transcript.whisperx[12].end |
2122.711 |
| transcript.whisperx[12].text |
那放在說明欄會不會有就是檢察官他們在起訴過程當中未注意?通常如果這樣的有疑義的話我們是會在那個說明欄都是我們參考的一個你每會兵都會參考嗎?都會參考是不會只是看不法的條文嗎?對不對?好來檢察官 |
| transcript.whisperx[13].start |
2126.007 |
| transcript.whisperx[13].end |
2141.674 |
| transcript.whisperx[13].text |
我們這邊補充一下因為那個衛福部其實他在五月份的時候已經有發一個函式了就是針對就是把我們現在立法裡有說明的內容以發函的方式函式給我們幾個單位然後包含我們法務部也有那我們法務部收到函文的時候已經現在已經發 |
| transcript.whisperx[14].start |
2142.774 |
| transcript.whisperx[14].end |
2171.492 |
| transcript.whisperx[14].text |
整個韓文到各地檢署去所以現在目前檢察署這一邊都已經有拿到這個函釋那說穿了就是說即使行政機關的函釋基本上是不拘束我們司法機關但是其實我們檢察官在辦案的時候其實都會參考參考這個意見所以基本上雖然這個寫在立法裡有但是我們現在函釋函釋下去了其實他們都大家都看得到了解好謝謝那司法院要補充說明嗎 |
| transcript.whisperx[15].start |
2177.237 |
| transcript.whisperx[15].end |
2187.582 |
| transcript.whisperx[15].text |
就是各位委員早安那我說明一下就是就像剛剛張司長說的這個兒少性剝削防制條例他是屬於特別的刑罰 |
| transcript.whisperx[16].start |
2188.615 |
| transcript.whisperx[16].end |
2212.196 |
| transcript.whisperx[16].text |
那所以他一定必須要站在普通刑法他這個既有的基礎上去做一個法的解釋那的確尤其是像這樣的一個數位的網路時代那其實快速的變遷那除以個案的不管是檢察官或者法官甚至第一線的司法警察人員他都必須要合於這樣一個法語時轉去必須要去妥適去解釋這樣的一個立法的目的的達成 |
| transcript.whisperx[17].start |
2213.157 |
| transcript.whisperx[17].end |
2237.383 |
| transcript.whisperx[17].text |
那所以個案裡面的解釋論裡面大概就會透過目的性限縮、目的性擴張去符合我們的這樣一個兒少性剝削要防制兒少被剝削的這樣一個時代的一個任務所以我會建議就是我們還是由這個主管機關在做一個這樣法的價值的一個控管那至於個案呢大概就要回到法的本質去做個案的判斷以上謝謝 |
| transcript.whisperx[18].start |
2239.201 |
| transcript.whisperx[18].end |
2247.288 |
| transcript.whisperx[18].text |
好謝謝那是不是我們就是按照這個衛福部的版本通過可以嗎那個陳昭智委員好那我們就按照衛福部的修正動議的條文通過來接下來第三條 |
| transcript.whisperx[19].start |
2260.682 |
| transcript.whisperx[19].end |
2269.886 |
| transcript.whisperx[19].text |
第三條前次協商的時候爭議點會是在第二項的第五款警政主管機關的這個執掌那因為這個執掌目前呢他會涉牽涉到後面的51條51條如果過那回頭這個第三條的這個 |
| transcript.whisperx[20].start |
2281.892 |
| transcript.whisperx[20].end |
2292.203 |
| transcript.whisperx[20].text |
第二項的第五款警論主管機關的選擇這個部分就可以確定那是不是可以建議主席這一條暫時保留好第三條保留來第38條 |
| transcript.whisperx[21].start |
2296.175 |
| transcript.whisperx[21].end |
2321.352 |
| transcript.whisperx[21].text |
第38條在前次的協商我們建議維持現行條文理由是這個林月琴委員以及范雲委員建議對於這個犯本條例之罪違反個人資料保護要加重其刑二分之一這一段那因為當時考量到司法院跟法務部也建議在各支法已經有載明已經有相關的罰則在這個地方再重複 |
| transcript.whisperx[22].start |
2326.175 |
| transcript.whisperx[22].end |
2350.725 |
| transcript.whisperx[22].text |
會有跌床駕屋的疑慮所以因此建議維持現行條文不以修正以上好 第三十八條維持現行條文委員們意見好 林委員好 我先就較於那個那個司法院那邊如果說今天各自因為本來范雲委員提的是要加重二分之一行政 |
| transcript.whisperx[23].start |
2352.165 |
| transcript.whisperx[23].end |
2354.386 |
| transcript.whisperx[23].text |
各執法41條及38條,1至7年,各執法5年以下 |
| transcript.whisperx[24].start |
2368.362 |
| transcript.whisperx[24].end |
2390.664 |
| transcript.whisperx[24].text |
姓剝削一年然後各執法我可能事實上是一年那一加一等於二可是沒有的話變成說我這邊判一年所以為什麼要在這邊講說那是不是可以加重二分之一比方一年然後我再加重二分之一可能是一年半所以先請教一下說會分別這樣子還是事實上是就單一的我今天用姓剝削因為 |
| transcript.whisperx[25].start |
2392.552 |
| transcript.whisperx[25].end |
2418.862 |
| transcript.whisperx[25].text |
創意十方幾乎都是跟著各自在賣。多年後這些人還是不斷的被跟騷,對他們成年後生活影響非常非常的大。那我想如果各位有看到那個報導者在講到這些受害人的狀況的話,那我雖想就教育那個沙雅燕這邊可不可以給一個解釋說,到底會是怎樣。否則的話,先講說有各自法,可是不是一加一等於二的話根本沒有辦法解決問題。 |
| transcript.whisperx[26].start |
2419.802 |
| transcript.whisperx[26].end |
2431.851 |
| transcript.whisperx[26].text |
最後還是一樣啊每個大家都是有個資跟著賣的每個資跟著賣的都是一年啊所以我們為什麼那時候范縣委員跟我們這邊會特別期待是說要甲種二分之一所以先就教謝謝好那是不是請我們廳長 |
| transcript.whisperx[27].start |
2438.908 |
| transcript.whisperx[27].end |
2462.589 |
| transcript.whisperx[27].text |
我可以先補充一下然後等一下也可以請那個法務部的參事來做一個刑法的一個理論的一個就是我們評價上面的一個一般實務上會處理的做法那比如說現在的38條我們之前也有表達過一件事因為一個行為人他所做的一件這個就是一個行為那他如果符合兒童性剝削38條這樣一個形態的話 |
| transcript.whisperx[28].start |
2465.211 |
| transcript.whisperx[28].end |
2484.997 |
| transcript.whisperx[28].text |
他當然就是會看說他是不是也同時去違反了譬如說各執法的這樣一個違反各執法的這樣一個犯罪的一個態樣那如果這兩個其實是同一行為那我們大概就會去用競合理論的方式去處理這個行為也就是說其實他如果他是有另外一個訴罪併罰情就會像剛剛劉委員講的是兩個加起來 |
| transcript.whisperx[29].start |
2488.158 |
| transcript.whisperx[29].end |
2517.438 |
| transcript.whisperx[29].text |
但如果這個行為本來就是本質上就是一個行為那我們會用刑法的競合理論去解決這個法的適用的問題所以不會有一個就是漏了評價這個行為那至於剛剛魏請委員提到的那個刑法的對被害人的一個造成傷害請應該回到良心比如他這個行為對被害人造成的一個損害是多少那那個影響的深遠是多少他就可以做一個刑法的評價在這個七年以下一年以上部分去做一個法的評價 |
| transcript.whisperx[30].start |
2518.598 |
| transcript.whisperx[30].end |
2522.96 |
| transcript.whisperx[30].text |
李彥秀等19人、委員羅廷瑋等19人、委員洪孟楷等19人、委員洪孟楷等19人、委員洪孟楷等19人、委員洪孟楷等19人、委員 |
| transcript.whisperx[31].start |
2543.15 |
| transcript.whisperx[31].end |
2558.544 |
| transcript.whisperx[31].text |
參與了詐欺集團的這個犯罪還會去加重因為他對少年去利用他來做車手這個另外的這個行為會再去做一個加重起刑二分之一他那個就是刑法分責的加重所以這個部分的一個立法我們還是會建議就是說這個就是 |
| transcript.whisperx[32].start |
2560.834 |
| transcript.whisperx[32].end |
2588.268 |
| transcript.whisperx[32].text |
用主管機關他的這樣一個文字那不需要再去做一個家中騎行二分之一的這樣一個立法的一個模式所以委員擔心的部分我們將來會在我們的一個在職的教育訓練裡面去讓大家了解報導者還有就現在大家應該充分都非常了解說這個造成對兒少的一個深刻的一個影響那其他部分是不是可以請那個就是法務部看是主檢或者是參事來做一個補充謝謝 |
| transcript.whisperx[33].start |
2596.403 |
| transcript.whisperx[33].end |
2611.458 |
| transcript.whisperx[33].text |
法務部在這裡就這條是不是要定加重其刑的這個條文做一個補充因為這個條文草案條文如果有加重其刑的話那到底我們這條定下去我們是依兒少性剝削 |
| transcript.whisperx[34].start |
2612.759 |
| transcript.whisperx[34].end |
2638.024 |
| transcript.whisperx[34].text |
防制條例38條各項加重其刑還是要依個資法規定加重其刑其實這個部分這樣子規定並不是太明確為什麼呢我想從一個法理的部分也來跟大家說明一下因為如果說我們依照這個兒少性剝削第38條各項加重其刑的話那因為這個洩漏被害人的個資這個是一個獨立的犯行那跟兒少性剝削38條的行為 |
| transcript.whisperx[35].start |
2646.368 |
| transcript.whisperx[35].end |
2660.197 |
| transcript.whisperx[35].text |
三十八條第一項跟第二項它本身的樣態是不一樣形度也不一樣但是我們現在要處罰的這個洩露個資的行為它的本質是一樣的因為不管它是三十八條第一項或者是第二項 |
| transcript.whisperx[36].start |
2661.772 |
| transcript.whisperx[36].end |
2662.893 |
| transcript.whisperx[36].text |
等19人等19人等19人等19人等19人等19人等19人等 |
| transcript.whisperx[37].start |
2679.165 |
| transcript.whisperx[37].end |
2694.258 |
| transcript.whisperx[37].text |
有不太合的齁是不太合但是如果我們依個資法的規定來加重其刑的話因為這個個資法本身它就是有刑事處罰的規定而且它是適用所有的個案那如果違反個資法犯刑的被害人是兒少的話 |
| transcript.whisperx[38].start |
2694.958 |
| transcript.whisperx[38].end |
2711.721 |
| transcript.whisperx[38].text |
那行為人他是必須要適用《兒孝權法》的第112條第一項規定來加重期刑到二分之一其實這樣子規定下來他的刑度是會重的比如說一年到七年的那他就是七年再加上兒孝性剝削的 |
| transcript.whisperx[39].start |
2712.222 |
| transcript.whisperx[39].end |
2732.37 |
| transcript.whisperx[39].text |
二分之一,那就各自的五年最重可以再加變成七年半,其實而且他如果訴罪定罰這是七年再加上七年半,其實這樣的刑律應該是重的吼,那我們是認為應該是沒有跌床駕屋的必要再去增訂一個加重期刑的38條第五項的狀況,那以上補充,謝謝。 |
| transcript.whisperx[40].start |
2734.211 |
| transcript.whisperx[40].end |
2734.512 |
| transcript.whisperx[40].text |
主席 |
| transcript.whisperx[41].start |
2749.951 |
| transcript.whisperx[41].end |
2778.667 |
| transcript.whisperx[41].text |
那這麼多年以來有因為創意私房也不是第一天存在它已經存在10年了那在111年破獲的時候有因為它販賣個資有這個刑度不一樣嗎那想先問這個如果有當然我們現在坐在這邊很放心剛剛講的那個法律有一些競合關係的話那我覺得OK啊如果過去在判刑本來本來就會去考慮到這個或考慮到我們的兒少全法 |
| transcript.whisperx[42].start |
2779.948 |
| transcript.whisperx[42].end |
2806.843 |
| transcript.whisperx[42].text |
那如果沒有的話,我覺得今天怎麼會在,可以在這邊說服我們,因為我們會,為什麼我想范委員會特別提出來,因為他背後的一些,所以我可不可以在這邊可以就叫說,過去真的的確有因為擱置法而有加重,因為而且是一加一等於二。因為這,我說今天不是我們突然要去立這個法,那過往已經有了,那過往有沒有這樣子判嗎?可不可以回答我這一個問題,謝謝。 |
| transcript.whisperx[43].start |
2815.58 |
| transcript.whisperx[43].end |
2827.623 |
| transcript.whisperx[43].text |
有沒有這樣的判例過去有沒有你們因為真的他就已經有販賣擱置你們真的是讓他一加一等於二這樣 |
| transcript.whisperx[44].start |
2832.162 |
| transcript.whisperx[44].end |
2857.034 |
| transcript.whisperx[44].text |
報告委員因為其實因為我們現在目前手上沒有資料那說販賣個資這個部分可能要回去查詢才有辦法確定但是在我們之前在查獲這個創意私房的時候檢察官的起訴事實其實比較著重因為那是當時的修正因為我們看過一下那個起訴事實那當時的修正跟起訴的內容比較著重於那個收集性影像跟散佈性影像的這一塊 |
| transcript.whisperx[45].start |
2857.834 |
| transcript.whisperx[45].end |
2871.304 |
| transcript.whisperx[45].text |
所以他那時候起訴的犯罪事實他是著重在散佈就是在買賣這個兒童性剝削的影響所以當時這個起訴的犯罪事實並沒有去收集到就是沒有去起訴到這個販賣 |
| transcript.whisperx[46].start |
2873.766 |
| transcript.whisperx[46].end |
2882.634 |
| transcript.whisperx[46].text |
主委就是委員所提到的販賣個資這一塊但是販賣個資確實它是屬於如果說以這個情節來講的話如果說以委員舉例的這個情節來說其實它如果是有另外有販賣個資其實是真的是按照個資法它會有另外一條罪主席好可是今天幾乎創意市場它都是合併個資賣連觸感空間都是欸 |
| transcript.whisperx[47].start |
2900.083 |
| transcript.whisperx[47].end |
2921.432 |
| transcript.whisperx[47].text |
那我的意思是說而且今天血淋淋的這些受害人他即便臉書換了一些名稱都還是被跟騷那你說他後半輩子要怎麼去過生活甚至他以後面對到交友、結婚這些都是問題的時候所以我們為什麼特別認為你合併各自賣的話跟一般 |
| transcript.whisperx[48].start |
2921.992 |
| transcript.whisperx[48].end |
2936.168 |
| transcript.whisperx[48].text |
只是去販賣一個影像我覺得那還是不一樣所以我才會問你說如果說今天不要去加重二分之一過去一定都是一加一等於二的話那當然對我們來講我們覺得很放心那不用特別在這邊去加重二分之一行政 |
| transcript.whisperx[49].start |
2937.885 |
| transcript.whisperx[49].end |
2959.855 |
| transcript.whisperx[49].text |
呃那現在我我說實在跟委員說一下齁我沒有辦法說呃一定是怎麼樣那過去過去我現在目前得到的資訊就是這樣那也許就是說檢察官在檢警以前在辦案的過程當中比較focus在就是那個性影像的散佈而已齁那這邊委員有提到的話那我們就是說我們接下來因為每年我們每年附又有三訊啊 |
| transcript.whisperx[50].start |
2961.896 |
| transcript.whisperx[50].end |
2968.222 |
| transcript.whisperx[50].text |
我可以在附幼訓的過程當中去宣導讓檢察官去提升有關於三不各自的意識 |
| transcript.whisperx[51].start |
2972.561 |
| transcript.whisperx[51].end |
3001.16 |
| transcript.whisperx[51].text |
對,我們在那個這次兒少性剝削條例裡面也有規定是說我們要做專業訓練嘛那其實我們婦幼其實我很經常就是利用我們婦幼研訓的時候就是把一些宣導因為其實檢察官辦案說實在話因為案件量很多然後形態非常的多所以大家可能就是著那個重點就是看到是性影像就針對性影像那當然就是說因為其實我們現在這個相次啊增訂了這個文字其實我們研究剛剛就像我們參事所講的 |
| transcript.whisperx[52].start |
3002.421 |
| transcript.whisperx[52].end |
3004.242 |
| transcript.whisperx[52].text |
立法院朝野黨團協商：一、社會福利及法制兩委員會報告併案審查 |
| transcript.whisperx[53].start |
3020.808 |
| transcript.whisperx[53].end |
3032.105 |
| transcript.whisperx[53].text |
如果說我散布的個資其實是背叛就是兒童的話其實它就是違反個資法加兒權法那這已經有二分之一了那如果是依照38條的一項二項加重的話 |
| transcript.whisperx[54].start |
3034.895 |
| transcript.whisperx[54].end |
3058.532 |
| transcript.whisperx[54].text |
就像我剛剛參事講的今天他散佈除非說他是同一個行為這樣不然的話你有經驗有散佈性影像然後後面再販賣格子那這樣子的話其實我們不太知道說為什麼後面販賣格子要跟隨著他賣的性影像的那個對對對就是其實我們不太知道說那個就是法理上所以這個部分 |
| transcript.whisperx[55].start |
3060.153 |
| transcript.whisperx[55].end |
3064.058 |
| transcript.whisperx[55].text |
我只能說我這邊可以承諾就是說因為這一次因為委員有特別提醒我們這件事那以後我們就是在教育訓練的時候或者是在相關的業務座談我們就會提醒檢察官說 |
| transcript.whisperx[56].start |
3080.555 |
| transcript.whisperx[56].end |
3092.744 |
| transcript.whisperx[56].text |
除了修正這個散佈性影像的部分還要去修正那個散佈那個個資的部分就是去查扣這一塊因為有時候辦案其實真的沒辦法一下想到那麼的多這樣那我們可能提醒他們這樣好來林委員好來先讓廳長講一下 |
| transcript.whisperx[57].start |
3098.688 |
| transcript.whisperx[57].end |
3112.453 |
| transcript.whisperx[57].text |
委員我跟您報告一下就是我剛剛跟那個就是張市長有交換過一點意見就是現行法的第三項本來就有一個剛剛委員提到的不管他是意圖營利 |
| transcript.whisperx[58].start |
3113.753 |
| transcript.whisperx[58].end |
3117.474 |
| transcript.whisperx[58].text |
蔡英文、蔡英文、蔡英文、蔡英文、蔡英文、蔡英文 |
| transcript.whisperx[59].start |
3142 |
| transcript.whisperx[59].end |
3164.116 |
| transcript.whisperx[59].text |
的這樣一個性影像他其實就是代表個資那我剛剛第一次我提出來的看法就是說這個的販賣性影像或者是意圖盈利去做這些散布他本來就會同時去觸犯這個就是個資法所以個資他的法定刑度五年以下是比較低的但是為了保護兒少這邊刑度是比較高的 |
| transcript.whisperx[60].start |
3168.539 |
| transcript.whisperx[60].end |
3179.268 |
| transcript.whisperx[60].text |
的確在實務上,就像朱副檢剛剛說的,可能在偵查中他著重的是那個散佈的這個行為,但是如果說他偵查中有查到他其實是像 |
| transcript.whisperx[61].start |
3180.549 |
| transcript.whisperx[61].end |
3181.67 |
| transcript.whisperx[61].text |
蔡易餘等17人、委員蔡易餘等17人、委員 |
| transcript.whisperx[62].start |
3200.589 |
| transcript.whisperx[62].end |
3218.071 |
| transcript.whisperx[62].text |
那所以如果再加上一個又要再因為各自把又再加重其性二分之一其實就會變成說他其實是同一個行為然後他其實並沒有另外一個新的一個太陽對所以我們才去做這樣一個就是法理上的一個就是意見的一個提供給大院參考以上謝謝 |
| transcript.whisperx[63].start |
3220.04 |
| transcript.whisperx[63].end |
3242.176 |
| transcript.whisperx[63].text |
從剛剛各位說明,看起來以前也沒有特別注意各自這件事情,所以在判決的時候也沒有特別去考慮嗎?剛剛這樣說明,這是第一點,我的質疑。第二個,因為我覺得各自不是影像,因為它事實上是隨從就讀的學校,然後名稱什麼,名字通通一起去販賣的。 |
| transcript.whisperx[64].start |
3244.887 |
| transcript.whisperx[64].end |
3263.159 |
| transcript.whisperx[64].text |
對當事人如果是單純只是影像要去辨別這個人有可能認識他看得到和我合併名字然後就讀學校然後他的一些相關的資訊一起販賣我覺得跟這影片一起販賣還是不太一樣的這是我第二點 |
| transcript.whisperx[65].start |
3263.759 |
| transcript.whisperx[65].end |
3278.228 |
| transcript.whisperx[65].text |
第三點是 剛才講說我個人承諾我覺得今天如果是你個人承諾在這邊我有點擔心說那這個個人承諾下一次換另外一個人的時候就沒有辦法再去承諾所以如果 |
| transcript.whisperx[66].start |
3280.629 |
| transcript.whisperx[66].end |
3294.738 |
| transcript.whisperx[66].text |
針對這一點假設有一些你們考慮到的問題那可不可以考量用附帶我同意附帶決議我覺得不能可能事實上是完全不說明因為過去我剛聽各位這樣說明的時候就有點感覺到過去原來都不考量的 |
| transcript.whisperx[67].start |
3295.558 |
| transcript.whisperx[67].end |
3295.698 |
| transcript.whisperx[67].text |
因有個資跟沒個資還是不一樣。 |
| transcript.whisperx[68].start |
3321.308 |
| transcript.whisperx[68].end |
3323.269 |
| transcript.whisperx[68].text |
主席主席 |
| transcript.whisperx[69].start |
3340.856 |
| transcript.whisperx[69].end |
3350.823 |
| transcript.whisperx[69].text |
非常謝謝委員對這個部分給我們的一個提醒跟建議那如果是用附帶決議讓我們在教育訓練再加強的話我想這應該這是沒有問題的好那如果這樣子的話38條就維持原條文但是加一個附帶決議那就請法務部待會把這個附帶決議提出來好 |
| transcript.whisperx[70].start |
3368.109 |
| transcript.whisperx[70].end |
3390.289 |
| transcript.whisperx[70].text |
三十八條維持現行條例。來,第四十五條之二。四十五條之二。在這個一百零四年,這個少性剝削防制條例一百零四年以前,其實對於這個本條例的加害人是有判刑確定後要有公佈姓名這一件事。但是在一百零四年修這一部法的時候呢,在這個 |
| transcript.whisperx[71].start |
3392.593 |
| transcript.whisperx[71].end |
3406.877 |
| transcript.whisperx[71].text |
執政黨跟當時的執政黨跟這個這個在野黨也就是國民黨跟民進黨都有委員提案要刪除該條文的內容就是不要這個公佈姓名那同時也經過23讀大院23讀通過那所以現在要回復 |
| transcript.whisperx[72].start |
3412.759 |
| transcript.whisperx[72].end |
3439.297 |
| transcript.whisperx[72].text |
是不是要請委員再斟酌這是第一個第二個說明就是在兒童及少年福利權益保障法裡頭對於對兒少為不當對待包括性剝削其實在97條就兒權法的97條有得公佈其姓名這件事那我想兩個說明就是過去有但是刪掉了 |
| transcript.whisperx[73].start |
3439.977 |
| transcript.whisperx[73].end |
3440.137 |
| transcript.whisperx[73].text |
第五十一條 |
| transcript.whisperx[74].start |
3468.163 |
| transcript.whisperx[74].end |
3473.668 |
| transcript.whisperx[74].text |
11條委員對加害人要做聲音治療、輔導或教育以及後續要做登記報告查訪我們現在增訂在第一項這個部分請委員參考對第二項有委員建議要把輔導教育的時數提升從4小時到5小時 |
| transcript.whisperx[75].start |
3488.844 |
| transcript.whisperx[75].end |
3499.969 |
| transcript.whisperx[75].text |
提升從8小時到5小時那衛福部接受第二項的這個建議所以我們修正8小時到50小時以上好第51條的部分輔導教育增加為8小時到50小時那請問各位委員針對第51條還有沒有意見 |
| transcript.whisperx[76].start |
3520.953 |
| transcript.whisperx[76].end |
3523.508 |
| transcript.whisperx[76].text |
好 如果沒有意見 那就按衛福部修正通過來 第55條 |
| transcript.whisperx[77].start |
3527.654 |
| transcript.whisperx[77].end |
3551.961 |
| transcript.whisperx[77].text |
55條這邊有一個修正動議在這一次的第三項最後的第三條除第三條、第八條、第八條之一以及第47條後面漏了四個文字施行日期由行政院定之外自公佈日施行增加在47條後面增加施行日期以上 |
| transcript.whisperx[78].start |
3555.66 |
| transcript.whisperx[78].end |
3584.657 |
| transcript.whisperx[78].text |
好 針對第55條衛福部所新修正的文字 大家有沒有意見好 沒有意見的話 那就按照衛福部修正版本通過那剛剛有保留第三條第三條剛剛是說它涉及到哪一條的修正51條51條有關所以如果51條那剛剛51條已經通過了是 那現在警政署對於這個文字應該就可以接受 |
| transcript.whisperx[79].start |
3585.965 |
| transcript.whisperx[79].end |
3586.986 |
| transcript.whisperx[79].text |
警政署表示下意見 |
| transcript.whisperx[80].start |
3603.587 |
| transcript.whisperx[80].end |
3629.42 |
| transcript.whisperx[80].text |
第三條的部分就是還有一個就是中央主管機關得自行或委由民間那議事處的意見是應該是用委託而不是用委由是不是應該是說委由也可以委由跟委託其實是都可以的所以我們在當初提案的時候是建議寫委由是 |
| transcript.whisperx[81].start |
3630.43 |
| transcript.whisperx[81].end |
3636.42 |
| transcript.whisperx[81].text |
你們建議違有?是是但是那個要不要說明一下來你說明一下這個行政程序行政程序有第16條關於這個 |
| transcript.whisperx[82].start |
3647.32 |
| transcript.whisperx[82].end |
3665.673 |
| transcript.whisperx[82].text |
民間團體跟個人的部分都是用委託這是統一法律的用詞而且我們在這個再生醫療雙法裡面本來要提違由後來都改成委託所以我們希望說還是用標準的法律用詞謝謝那法務部的意見呢 |
| transcript.whisperx[83].start |
3670.139 |
| transcript.whisperx[83].end |
3696.349 |
| transcript.whisperx[83].text |
因為委托跟委由的確委托委任這定義的確是不一樣像剛剛議事這個主管說的那我們也如果說在整個條文裡面沒有重複性的話那我們是建議說是不是用委托的詞會比較好因為這個問題我之前我們在部會在跨部會的討論的時候我有提過但是好像是因為跟後面的詞句好像有點重疊我想再檢查一下是不是有重疊的問題 |
| transcript.whisperx[84].start |
3699.383 |
| transcript.whisperx[84].end |
3726.755 |
| transcript.whisperx[84].text |
如果沒有重疊如果說整個問題可以處理的話那當然是用委託會比較好那如果是這樣的話是不是改成委託比較好好不好因為再生醫療法才剛修正通過如果那邊本來是唯有改委託那就這邊我們也是改成委託好 |
| transcript.whisperx[85].start |
3731.264 |
| transcript.whisperx[85].end |
3756.624 |
| transcript.whisperx[85].text |
主席又有兩個附帶決議在針對第三條先處理完條文再處理附帶決議那如果第三條大家沒有意見的話就按照衛福部還有剛剛修正的文字通過那我們保留的條文六條都已經處理完畢現在處理附帶決議總共有三案 |
| transcript.whisperx[86].start |
3760.034 |
| transcript.whisperx[86].end |
3779.605 |
| transcript.whisperx[86].text |
附帶決議,請警察機關應於本條例公布實施後半年內完成指定或設立專責單位建立資料庫之事宜,並利用該資料庫協助犯罪偵查,以及透過數位鑑識比對潛在被害人。提案人委員林月琴、王振旭 |
| transcript.whisperx[87].start |
3780.385 |
| transcript.whisperx[87].end |
3797.056 |
| transcript.whisperx[87].text |
第二案,為確保散佈兒少性影像之違法境外平台網站得以有效封網,數位發展部應全力協調教育部、通傳會、整合限制接取封網單位,包含網際網路接取服務提供者、學術網路、財團法人台灣網路資訊中心、電信業者、DNS業者、 |
| transcript.whisperx[88].start |
3802.58 |
| transcript.whisperx[88].end |
3825.796 |
| transcript.whisperx[88].text |
要求限制接取封網單位,落實執行《兒童及少年性剝削防制條例限制接取規定》,避免我國民眾於封網後仍能看到違法境外平台之兒少性影像。另請數位發展部與兒童及少年性剝削防制條例修正公布施行後半年內,將限制接取執行機構落實情形,以書面報告 |
| transcript.whisperx[89].start |
3826.877 |
| transcript.whisperx[89].end |
3847.592 |
| transcript.whisperx[89].text |
以書面報告含報立法院社會福利及衛生環境委員會提案人委員林月琴、王振旭第三案為立衛生福利部落實執行兒少性剝削防制條例第三條、第八條有關主動巡查兒少性影像及中央主管機關辦理兒少性影像移除下架業務行政院人事行政總署 |
| transcript.whisperx[90].start |
3848.573 |
| transcript.whisperx[90].end |
3866.549 |
| transcript.whisperx[90].text |
主計總處應全力協助衛福部增列預算及人力源額以因應上述新增法定業務提案人委員林月琴、王振旭宣讀完畢好我們現在處理附帶決議先討論第一案請問第一案這個警政署有沒有意見好來請 |
| transcript.whisperx[91].start |
3869.862 |
| transcript.whisperx[91].end |
3888.1 |
| transcript.whisperx[91].text |
主席、還有各委員、警政署、刑事局這邊報告因為有兩個附帶決議基本上有部分是相同我這邊也先一併做說明在第一項的附帶決議裡面已經我們在第二條第一項三款要建立這次撤戶 |
| transcript.whisperx[92].start |
3890.793 |
| transcript.whisperx[92].end |
3912.563 |
| transcript.whisperx[92].text |
決議裏面要去監視比對潛在被害人的部分在上次的黨團協商的時候我們已經報告就是說目前我們針對這些可能還殘存在網路的這些的可能兒少的這些性影像的部分我們光從影像是沒辦法去的去辨識出他的身份 |
| transcript.whisperx[93].start |
3913.403 |
| transcript.whisperx[93].end |
3926.152 |
| transcript.whisperx[93].text |
我們目前在建立這個資料庫是針對已知被害人的部分去以雜湊詞去做相關可能仍存在這個網路世界的影像但是對於 |
| transcript.whisperx[94].start |
3928.217 |
| transcript.whisperx[94].end |
3955.031 |
| transcript.whisperx[94].text |
除了已知被害人以外目前可能後來後續被發現的這些可能是偶像的這些被害人的影像我們並沒有辦法單純從影像就去知道這個人這如同就是說我們現在警察機關我們很多入口監測器我們在偵辦嫌犯的時候我們會調閱那我們可能會拍攝到嫌犯的影像但我們並沒有辦法從這影像就知道這個嫌犯的身份是什麼我們必須透過各種偵查的技術 |
| transcript.whisperx[95].start |
3956.112 |
| transcript.whisperx[95].end |
3959.58 |
| transcript.whisperx[95].text |
才能去發見這個嫌犯是什麼人。所以我們 |
| transcript.whisperx[96].start |
3961.98 |
| transcript.whisperx[96].end |
3988.05 |
| transcript.whisperx[96].text |
不五錢的這個技術上並不可行而且如果你真的要建立這個影像的話你可能還要龐大的一個資料庫包含可能全民的一個影像資料庫才能去做這個比對所以建立在附帶決議的部分的潛在這兩字我們把它改成已知或是說這兩個文字拿掉這才是我們目前上真正可行的部分以上報告 |
| transcript.whisperx[97].start |
3990.054 |
| transcript.whisperx[97].end |
4015.982 |
| transcript.whisperx[97].text |
你說要修正,阿淺再兩個字拿掉,比對被害人是,那報告主席我可以另外針對另外一個附帶決議也是林業群委員所提出來在這個資料另外一份有相近的可以一併報告嗎?好,可以來另外一份附帶決議就是有鑑於食物經驗常見被害人不願報案的這個提案今天的第一案已經抽回了 |
| transcript.whisperx[98].start |
4019.073 |
| transcript.whisperx[98].end |
4024.469 |
| transcript.whisperx[98].text |
你剛剛只報告三案。所以這一案已經抽回了?是。 |
| transcript.whisperx[99].start |
4030.743 |
| transcript.whisperx[99].end |
4047.414 |
| transcript.whisperx[99].text |
本條例公布實施後半年內完成指定。本條例實施之後,依我們現在新修訂的修正條文,必須要訂定管理使用辦法。相關辦法的訂定,法制程序基本上都要花費一定時間。 |
| transcript.whisperx[100].start |
4049.395 |
| transcript.whisperx[100].end |
4071.678 |
| transcript.whisperx[100].text |
原則上像過去我們在修正原名槍支的使用辦法就使用了大概兩年的時間那所有法制作業有一定包含他要訂定還要公告所以建議在整個文字上我們應該是要管理使用辦法有訂定出來之後才可以有後續的一個操作使用的問題所以建議在 |
| transcript.whisperx[101].start |
4072.762 |
| transcript.whisperx[101].end |
4090.257 |
| transcript.whisperx[101].text |
文字的第四行本條例公佈實施定定管理增加幾個字增加八個字定定管理使用辦法後因為一定要先有辦法才有辦法去做後續的一個操作那因為整個還牽涉到整個 |
| transcript.whisperx[102].start |
4091.491 |
| transcript.whisperx[102].end |
4111.21 |
| transcript.whisperx[102].text |
監事資料庫的一個建立他還有相關的一個經費所以建立我們半年把它改成一年這是我們行政機關在目前積極下可能行的一個範圍最後一段文字的潛在被害人也建立把潛在這兩個字把它拿掉以上好謝謝說明那委員他們意見好來林委員 |
| transcript.whisperx[103].start |
4118.928 |
| transcript.whisperx[103].end |
4145.777 |
| transcript.whisperx[103].text |
想先釐清一下這個本條例公布時是半年內要去希望你可以把這些開始利用這些資料剛剛講是說辦法還要一年那這個我比較不同不是這麼同意這是第一個第二個本來為什麼寫潛在被害人因為有時候這個影像這一次沒有辦法拿到可是我有這個影像查不出來 |
| transcript.whisperx[104].start |
4146.497 |
| transcript.whisperx[104].end |
4164.622 |
| transcript.whisperx[104].text |
那他是不是下一次的潛在被害人是嗎那你如果後續假設又有拿到影像的時候去比對的時候我們的那個賀許職去比對說他就是不能是說那已經被害人都知道了那還要留這個做什麼用所以我才會寫潛在被害人所以這個我比較不同意以上 |
| transcript.whisperx[105].start |
4165.502 |
| transcript.whisperx[105].end |
4183.392 |
| transcript.whisperx[105].text |
那個跟委員報告我了解我的意思就是說或許過去我們偵辦中有某些的這些影像當時還未知他的悲哀人是什麼人那我後續可能偵辦之後有相關的悲哀人之後那我要去比對過去取得的這些 |
| transcript.whisperx[106].start |
4184.312 |
| transcript.whisperx[106].end |
4210.271 |
| transcript.whisperx[106].text |
當時無法辨識的被害人我要把他再找出來那這部分基本上我們可行但是就文字上的認知的時候我們潛在這兩個字可能會是未來新的陌生的部分這目前當然跟委員報告就是說我目前的相關技術跟後續的部分並技術上不可行所以委員所提的部分其實我們警察機關本來就會譬如說我現在偵辦一個新的案件然後 |
| transcript.whisperx[107].start |
4211.872 |
| transcript.whisperx[107].end |
4231.193 |
| transcript.whisperx[107].text |
有同樣的已經找到被害人那要再去跟過去的這些資料庫當時還沒找到被害人不會用雜誌去比對這部分我們一定都會去做這沒有問題但是他潛在這個用詞可能會太過廣泛變成是未來的這些陌生的這部分所以說 |
| transcript.whisperx[108].start |
4232.574 |
| transcript.whisperx[108].end |
4247.142 |
| transcript.whisperx[108].text |
這這個用詞我們建議自我說可以不要用這樣來使用但委員所要求的部分我們未來是會去做因為我們在做犯罪偵查的時候我們會用雜作組跟我們資料庫去做比對而這部分是沒有問題的另外一個剛剛 |
| transcript.whisperx[109].start |
4248.752 |
| transcript.whisperx[109].end |
4274.885 |
| transcript.whisperx[109].text |
半年一年的這件事情可不可以解釋一下那個跟委員說明說我們因為新修法的部分要我們去訂定管理使用辦法這管理使用辦法的法制作業就要相當耗費時間因為我要這是從無到有再來就是說它的相關法制作業光比如說像我們列正部的法制單位公告經過它除了條文修正之後它公告就必須要兩個月 |
| transcript.whisperx[110].start |
4276.238 |
| transcript.whisperx[110].end |
4297.324 |
| transcript.whisperx[110].text |
所以這個有一定的時程最後這個辦法要必須到行政院再做公告所以說這整個要我們直接條例實施後半年內基本上你沒有辦法是很難去達成你後續要去使用所以我們會建議說增加8個文字的訂定管理使用辦法後 |
| transcript.whisperx[111].start |
4298.288 |
| transcript.whisperx[111].end |
4325.965 |
| transcript.whisperx[111].text |
因為一定要先完成前端的法制作業才可以去做後面的行政的執行跟操作,包含資料庫的一個建立。因為資料庫的建立也需要相關機會我們要編列,所以同時我們建立是說是否可以這個半年,除了增加文資以外,半年改為一年,我們這樣當然我們會盡快去做,什麼時候做得到我們就會什麼時候去把它完成。 |
| transcript.whisperx[112].start |
4326.727 |
| transcript.whisperx[112].end |
4343.84 |
| transcript.whisperx[112].text |
所以你是講條例實施後的一年內嗎?不是,條例實施、定定管理使用辦法後,因為…辦法後還要再一年的時間,我覺得真的太長了,因為我不知道你辦法又定個半年,然後如果這個又一年的話,那不是一年半? |
| transcript.whisperx[113].start |
4345.34 |
| transcript.whisperx[113].end |
4368.369 |
| transcript.whisperx[113].text |
這是因為行政程序上有一定他要操作的我會盡快去完成只是一年我覺得每次用個人承諾這些東西盡快那我也不知道你盡快可是你現在如果定了給你一年時間你搞不好就是走到結果就花了一年半的時間如果我們的政府體系這麼緩慢的話有時候緩不及急真的也沒有辦法救助更多的受害人這是第一個 |
| transcript.whisperx[114].start |
4368.939 |
| transcript.whisperx[114].end |
4397.897 |
| transcript.whisperx[114].text |
第二我還是不同意那個把錢再拿掉還有另外一個就是說如果這個條例公佈後一年內我同意不要半年我就OK可是如果你又說要辦法然後又要再一年那真的搞不好拖個搞不好是兩年不是一年半那包委員是不是因為一定要有辦法辦法一定沒有通過是沒辦法去做後續的操作了啦預估辦法大概要多久嘛否則那就辦法之後的半年內我同意 |
| transcript.whisperx[115].start |
4403.291 |
| transcript.whisperx[115].end |
4406.496 |
| transcript.whisperx[115].text |
建議增加文字定定管理使用辦法後半年內。 |
| transcript.whisperx[116].start |
4414.788 |
| transcript.whisperx[116].end |
4434.546 |
| transcript.whisperx[116].text |
對過去影像的潛在的話是 如果你本來是說比對被害人那就已經是被害人所以 呃 剛 鄭旭委員有建議說那用可能 因為我認為不要告訴我說你們一定會去做我覺得這種承諾我實在是不太能在這邊去現場知道說欸 我們一定會去做那到底什麼 |
| transcript.whisperx[117].start |
4435.347 |
| transcript.whisperx[117].end |
4456.268 |
| transcript.whisperx[117].text |
佛徹過去為什麼不去做所以我說為什麼我加這個字眼是因為賀許子留下來事實上是可能未來有發生這種因為這次查我還是要再三強調這次查不到的時候下次賀許子去對的時候那個不會是現在存在的被害人那可能我們會去找到從這個影像去找到過去對 |
| transcript.whisperx[118].start |
4457.851 |
| transcript.whisperx[118].end |
4483.432 |
| transcript.whisperx[118].text |
是 所以我才會希望說你用潛在可是否則你要用什麼字眼來說服我可是如果單純指向被害人的話我是不同意的或許可以用可能被害人因為潛在我們會講未來的那改成可能我們應該是可以做得到的在文字上可能會比較可以兩點 第一個是不是在辦法後的半年內或者是就是這個條例實施後的一年內這是一件事情第二個就是改成 |
| transcript.whisperx[119].start |
4483.952 |
| transcript.whisperx[119].end |
4486.154 |
| transcript.whisperx[119].text |
等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人 |
| transcript.whisperx[120].start |
4512.815 |
| transcript.whisperx[120].end |
4513.476 |
| transcript.whisperx[120].text |
若沒有意見,復待決議通過。 |
| transcript.whisperx[121].start |
4519.642 |
| transcript.whisperx[121].end |
4542.117 |
| transcript.whisperx[121].text |
有異見,是不是?第二案,好,來,請說明報告主席跟各位委員那世衛發展部針對附帶決議第二案有兩點建議第一點的建議是文字的調整也就是說這個附帶決議內容裡面出現蜂網的這個文字建議用限制階級來替代 |
| transcript.whisperx[122].start |
4543.138 |
| transcript.whisperx[122].end |
4562.097 |
| transcript.whisperx[122].text |
第一行的最後兩個字第二行的最後兩個字第四行也是一樣最後兩個字還有第六行的第四個字第四個字跟第五個字這是第一個文字修正建議那第二點的建議是數位發展部依照我們已經通過了草案八條之一 |
| transcript.whisperx[123].start |
4563.098 |
| transcript.whisperx[123].end |
4590.818 |
| transcript.whisperx[123].text |
那對於所謂限制階級協助限制階級主管機關來執行這件事情的除了數位發展部以外還有教育部、通常會還有法務主管機關跟警政的主管機關所以要求就是說我們只是一個協助機關之一所以由我們來做一個書面報告的一個函報執行結果適不適當建議可以再考量一下以上 |
| transcript.whisperx[124].start |
4596.397 |
| transcript.whisperx[124].end |
4621.28 |
| transcript.whisperx[124].text |
你後面的那個意見聽起來有點模糊那要不然要怎麼修改就是所有的單位都列出來報告主席因為基本上我們是協助這些單位是在協助主管機關來執行所以到底是應該是把主管機關由主管機關來做書面報告或者是由協助機關來做書面報告可以再考量一下以上 |
| transcript.whisperx[125].start |
4624.529 |
| transcript.whisperx[125].end |
4648.55 |
| transcript.whisperx[125].text |
主席好來 林委員第一個我同意用那個限制擷取第二個這邊為什麼會這樣子寫是因為我這邊我覺得單純我們要看到的只是限制擷取那現在因為已經是在你們的工作所以我們沒有特別要去要求因為對於受害人最大的影響是在趕快事實上是封網嘛用比較單純之言 |
| transcript.whisperx[126].start |
4651.414 |
| transcript.whisperx[126].end |
4653.384 |
| transcript.whisperx[126].text |
如果那樣的話那是不是就是 |
| transcript.whisperx[127].start |
4654.386 |
| transcript.whisperx[127].end |
4682.151 |
| transcript.whisperx[127].text |
有你們因為限制擷取的這個工作是你們在做嗎我沒有要求其他的我只要看的是這個東西因為那個影響自身啊所以我只要看這個東西的話報告林委其實是我們督導Link就是網資中心來做一個處理但是分網這件事情除了網際網路接取服務提供者還有協助網路還有一些其他的電信業者還有DNS等等所以其實相關的業者很多為什麼協助機關會列這麼多 |
| transcript.whisperx[128].start |
4696.274 |
| transcript.whisperx[128].end |
4705.136 |
| transcript.whisperx[128].text |
陳儒主席講你們有沒有什麼字眼上是要把全部的部分列上去嗎你們希望可以怎麼修正呢就講你的意見 |
| transcript.whisperx[129].start |
4711.205 |
| transcript.whisperx[129].end |
4735.497 |
| transcript.whisperx[129].text |
我自己的看法是說就是說因為基本上這是主管機關有下達一個限制接取的一個命令那命令了以後相關的不管是所謂的電信業者或者是一些網路的接取服務提供者協助網路等等他們大家就一起來做一些就是說白名單黑名單的一個更新頭部來完成這件事情那這只是一個執行面的事情 |
| transcript.whisperx[130].start |
4736.477 |
| transcript.whisperx[130].end |
4738.838 |
| transcript.whisperx[130].text |
蔡英文、蔡英文、蔡英文、蔡英文、蔡英文、 |
| transcript.whisperx[131].start |
4764.366 |
| transcript.whisperx[131].end |
4781.054 |
| transcript.whisperx[131].text |
因為就像剛才講的事實上是委外用那個台灣NIC來做那可是我們講說你還是他事實上財團法人這個也是你們附屬的所以本來還是希望說可不可以這個限制擷取的執行的狀況是什麼 |
| transcript.whisperx[132].start |
4783.479 |
| transcript.whisperx[132].end |
4808.119 |
| transcript.whisperx[132].text |
因為我剛剛提過這個很自為關鍵到底有沒有馬上進行去封網因為會影響比較深所以我們想說而且只有這個半年內先讓我們了解一下落實狀況又不是未來持續要這樣子做所以我就不懂是說我想我們的衛環因為訂了這個法很關心的是因為過去數位發展部沒有放進來 |
| transcript.whisperx[133].start |
4809.58 |
| transcript.whisperx[133].end |
4829.749 |
| transcript.whisperx[133].text |
那其他的部會已經有運作過了那後來也是大家針對於限制擷取這件事情很看重那我們也只有要求一次這樣子半年內把他送進來看那個資訊才讓我們未還的委員可以更知道下一次針對諮詢的時候也可以更明確的知道說有沒有有些東西還要push政府可以做得更好 |
| transcript.whisperx[134].start |
4830.629 |
| transcript.whisperx[134].end |
4847.331 |
| transcript.whisperx[134].text |
所以才會把它列進去我不是每半年要每一個半年都要這個執行的落實的情形到底讓我們知道否則上次也是衛福部請問給你們之後事實上你們可以做到沒有馬上馬上有效封網啊等到要拿到文 |
| transcript.whisperx[135].start |
4847.751 |
| transcript.whisperx[135].end |
4862.015 |
| transcript.whisperx[135].text |
那我們這樣子同時也可以看到如果你有沒有封網因為要等衛福部的那個公文啊現在你如果可以做你們是不是趕快做就讓傷害可以下降到最低啊那我們先看那個半年內的狀況是什麼來我們請市長 |
| transcript.whisperx[136].start |
4865 |
| transcript.whisperx[136].end |
4889.76 |
| transcript.whisperx[136].text |
那這個附帶決議建議就是第一項重點放在整合是沒有問題那第二項我也理解數位發展部的長官他在意的部分是不是可以在那個另請數位發展部後面加配合衛生福利部與兒少性剝削防制後面這樣的一個文字就配合衛生福利部這樣是不是比較可行 |
| transcript.whisperx[137].start |
4894.557 |
| transcript.whisperx[137].end |
4909.967 |
| transcript.whisperx[137].text |
跟主席跟林委員報告剛剛同仁有提醒我我們能夠提供的就只有NINK的相關資料所以其他的資料我們就是說執行的情形我們可能沒有大概是這樣的情況不是我們不願意做是事實上我們的資料是有限的 |
| transcript.whisperx[138].start |
4913.848 |
| transcript.whisperx[138].end |
4925.574 |
| transcript.whisperx[138].text |
如果剛剛保護司司長講的就是配合衛福部因為我們想知道那半年執行狀況才有辦法供衛環委員去檢討要不要進一步再做些什麼事按照衛福部這樣修正文字這樣子是不是在執行上就是你們是配合的角色嗎 |
| transcript.whisperx[139].start |
4939.565 |
| transcript.whisperx[139].end |
4953.174 |
| transcript.whisperx[139].text |
立法院朝野黨團協商：一、社會福利及法制兩委員會報告併案審查:「兒童及少年性剝削防制條例部分條文修正草案：一、社會福利及法制兩委員立法院朝野黨團協商：一、社會福利及法制兩委員立法院朝野黨團協商：一、社會福利及法制兩委員立法院朝野黨團協商：一、社會福利及法制兩委員立法院朝野黨團協商：一、社會福利及法制兩委員立法院朝野黨團協商：一、 |
| transcript.whisperx[140].start |
4961.892 |
| transcript.whisperx[140].end |
4978.159 |
| transcript.whisperx[140].text |
報告主席,主計總署針對附帶決議第三案建議修正文字按照我們現行通過的修正草案第三條有明定中央主管機關應獨立編列預算、辦理兒童及少年性剝削防制業務 |
| transcript.whisperx[141].start |
4979.179 |
| transcript.whisperx[141].end |
4999.478 |
| transcript.whisperx[141].text |
那另外按照我們預算籌編的精神及規定呢不會面對新增的業務還是優先在行政院核定的概算額度內來編列那麼如果有不足的話可以循程序提高額度外的需求因此這裡有的文字呢建議後段 |
| transcript.whisperx[142].start |
5000.259 |
| transcript.whisperx[142].end |
5010.609 |
| transcript.whisperx[142].text |
主計總署應全力協助衛福部增列預算這個部分可以修正為主計總署應協助衛福部編列預算以上沒有增列是編列 |
| transcript.whisperx[143].start |
5024.298 |
| transcript.whisperx[143].end |
5034.238 |
| transcript.whisperx[143].text |
按照我們現在通過的第三條條文其實WIFI部本來就應該按照新通過的條文去配置該有的預算 |
| transcript.whisperx[144].start |
5036.38 |
| transcript.whisperx[144].end |
5062.278 |
| transcript.whisperx[144].text |
那些增列有什麼問題嗎?應該也沒有問題啊因為它如果配合現行的條文它就是會增列預算啊你們就是送上去你們不要砍就好了跟主席報告主要就是說的確按照我們預算籌編的精神呢不會它它該增列就要增列那就是說它送上來的時候我們當然在額度那邊我們都 |
| transcript.whisperx[145].start |
5063.258 |
| transcript.whisperx[145].end |
5091.363 |
| transcript.whisperx[145].text |
原則上不會去砍部會的預算那只是說這樣的文字看起來會是似乎這樣的條例通過以後主計總署就要額度外來增列相關的預算所以可能我們文字上避免誤解我們是建議就是我們來協助衛福部編列預算那這個協助當然就包括衛福部在額度內編列的部分我們會來優先支持以上 |
| transcript.whisperx[146].start |
5093.025 |
| transcript.whisperx[146].end |
5114.434 |
| transcript.whisperx[146].text |
那個衛福部表示一下意見尊重竹種的建議所以那個文字修正你們同意是不是可以好沒有意見好衛福部沒有意見委員沒有意見好那就按照剛剛修正的文字通過好來第四案附帶決議第四案對不起 |
| transcript.whisperx[147].start |
5123.834 |
| transcript.whisperx[147].end |
5145.188 |
| transcript.whisperx[147].text |
第三十八條附帶決議,鑒於創意私房觸感空間等非法論壇,除販賣兒少性剝削影像外,常有販賣兒少被害人各自之情形,對於兒少身心危害甚具,原請法務部對檢察官強化相關教育訓練,以提升對兒少權益的保護。提案人委員林月琴宣讀完畢。 |
| transcript.whisperx[148].start |
5147.926 |
| transcript.whisperx[148].end |
5169.193 |
| transcript.whisperx[148].text |
請法務部針對這個提案表現非常感謝委員剛剛我們也有就這個附帶決議有先前的一個討論但是看到那個決議的文字我想是不是這樣因為強化社會這個保護兒少的權益的意識還有對各自的重視這個應該是要有全民的共識才會有全面性的成效 |
| transcript.whisperx[149].start |
5169.813 |
| transcript.whisperx[149].end |
5198.084 |
| transcript.whisperx[149].text |
那如果單單是法務部或者是檢察官我想這個是不夠這個沒有辦法盡全功的所以這個決議我們是不是建議應該是要擴大相關權責機關的教育訓練促請大家一起努力來提升兒少權益的保護因為如果只是單單就檢察官可能我想這個效果會有限那建議是不是在這個文字上面可以有相關的單位比如說法官的部分那個 |
| transcript.whisperx[150].start |
5199.786 |
| transcript.whisperx[150].end |
5228.419 |
| transcript.whisperx[150].text |
調查的警察機關警政單位是不是應該也是一併放在這個教育訓練強化的一個部分以上好那個建議的文字是原請就是第三行原請司法院頓號法務部頓號警政看是警政單位還是警政署來強化相關教育訓練這樣是不是可行就是相關的人員也都應該要訓練就是 |
| transcript.whisperx[151].start |
5235.869 |
| transcript.whisperx[151].end |
5248.242 |
| transcript.whisperx[151].text |
警政署、還是警政機關?警政署沒意見。如果是司法機關、檢察機關、警政機關。教育訓練。 |
| transcript.whisperx[152].start |
5266.373 |
| transcript.whisperx[152].end |
5283.67 |
| transcript.whisperx[152].text |
剛剛一開始我們說司法院不曉得司法院有沒有意見喔司法院法務部警政署用我會建議就是說先從行政機關因為案發在第一線嘛對其實行政機關其實應該是司法警察機關 |
| transcript.whisperx[153].start |
5285.091 |
| transcript.whisperx[153].end |
5300.742 |
| transcript.whisperx[153].text |
法務部、司法院。因為司法院法院是在最後端。舉例來講,剛剛魏警員最擔心的評價不足的問題,必須要靠第一線警察的修正,才有辦法查明他到底有沒有販賣。 |
| transcript.whisperx[154].start |
5301.783 |
| transcript.whisperx[154].end |
5304.684 |
| transcript.whisperx[154].text |
等19人、委員蔡易餘等19人、委員洪孟楷等19人、委員洪孟楷等19人、委員洪孟楷等19人、委員 |
| transcript.whisperx[155].start |
5329.614 |
| transcript.whisperx[155].end |
5354.263 |
| transcript.whisperx[155].text |
那大概都要包括那比如說我覺得其他的行政機關其實包含其他的比如說像NCC這些相關協助衛福部的也大概都有對於這個兒少性剝削的一個基本的素養其實才是夠的那應該是一個我們的政府機關大概都應該要有這樣的一個基本的素養以上那法務部來 |
| transcript.whisperx[156].start |
5355.682 |
| transcript.whisperx[156].end |
5384.119 |
| transcript.whisperx[156].text |
跟委員報告我們這個第五條已經通過的第五條的最後一項其實我們是這個決議是不是剛好可以配合這個最後這一項的文字它的最後一項文字是中央警政主管機關、中央法務主管機關及司法院應適時辦理兒童及少年性剝削防制教育訓練以充實調查、偵查或審理兒童及少年性剝削案件之司法警察、司法警察官、檢察事務官、檢察官或法官之辦案專業素養 |
| transcript.whisperx[157].start |
5385.16 |
| transcript.whisperx[157].end |
5407.598 |
| transcript.whisperx[157].text |
那這樣我們決議剛好可以配合這個第五條的最後一項的文字那也比較全面性那以上提供給委員們參考好那我想是不是就按照剛剛王三世所建議的這個文字修正通過好不好還有意見嗎來請我確認一下只是後邊有些改變因為我們我這邊最重要的就是個資的這個狀況要讓 |
| transcript.whisperx[158].start |
5410.82 |
| transcript.whisperx[158].end |
5425.188 |
| transcript.whisperx[158].text |
判的時候要能夠很確定所以前面文字保留只是後邊增加了其他行政機關一直到我們的司法院的這邊對於相關人員的訓練是這樣嗎想說再確認一下 |
| transcript.whisperx[159].start |
5431.058 |
| transcript.whisperx[159].end |
5456.057 |
| transcript.whisperx[159].text |
主席我建議就是原請司法相關機關落實本條例第五條相關規定以提升對兒少權益的保護這樣把那個原來寫說原請法務部這樣太針對性的部分把它換成用落實第五條的相關規定 |
| transcript.whisperx[160].start |
5458.803 |
| transcript.whisperx[160].end |
5480.518 |
| transcript.whisperx[160].text |
那第五條上面就寫第五條最後一項相關規定應該就可以可以接的起來第四項嗎 |
| transcript.whisperx[161].start |
5486.86 |
| transcript.whisperx[161].end |
5515.14 |
| transcript.whisperx[161].text |
那法務部針對剛剛司長這樣的建議這樣的文字有沒有意見就第五條第四項約情委員的意思是要強調那個個資的部分那是不是這個文字文字因為前面這個決議的文字有上有販賣兒少被害人個資之情形這個部分委員是不是覺得夠了還是我們要再多一句什麼跟個資有關的文字嗎 |
| transcript.whisperx[162].start |
5521.081 |
| transcript.whisperx[162].end |
5538.716 |
| transcript.whisperx[162].text |
對對我的意思就是除了這樣的文字我們還要再加強嗎?如果是這樣就夠的話我們是建議就是照剛剛張司長的意見我們就把那個落實第五條第四項的強化相關教育訓練的規定把它放進來我想這樣應該是很清楚 |
| transcript.whisperx[163].start |
5539.741 |
| transcript.whisperx[163].end |
5549.73 |
| transcript.whisperx[163].text |
好,那另外還有沒有意見?沒有意見,同意。好,沒有意見,那我們就按照剛剛張司長建議的修正文字通過。好,第四案通過。好,那我們現在協商的條文跟附帶決議都已經處理完畢。 |
| transcript.whisperx[164].start |
5563.137 |
| transcript.whisperx[164].end |
5586.68 |
| transcript.whisperx[164].text |
條次及援引條次、授權議事人員調整。立法說明如有需要補充或調整部分,授權行政機關處理。其餘均照審查會審查結果通過。本案協商會議到此結束。稍後我們休息五分鐘,繼續協商全民健康保險法。謝謝大家。 |
| transcript.whisperx[165].start |
5588.117 |
| transcript.whisperx[165].end |
5592.995 |
| transcript.whisperx[165].text |
那跟全民健康保險法無關的相關人員就可以先行離席。謝謝。 |
| transcript.whisperx[166].start |
6076.581 |
| transcript.whisperx[166].end |
6103.99 |
| transcript.whisperx[166].text |
好,我們接下來召開關於全民健康保險法修正草案第二次的黨團協商那今天要併案協商的全民健康保險法第62條修正草案共計五案第一個已經併案審查完略的總共有三案第二逕付二讀的有兩案那我們現在就開始協商好,那這個因為 |
| transcript.whisperx[167].start |
6106.909 |
| transcript.whisperx[167].end |
6131.924 |
| transcript.whisperx[167].text |
部長之前我們在討論的時候其實是去國外開會參加WHA大會所以我們等你回來之後我們今天再召開一次協商是不是部長要先跟大家講一下到目前為止衛福部對於第62條修正草案的看法你們是不是已經同意了 |
| transcript.whisperx[168].start |
6132.737 |
| transcript.whisperx[168].end |
6159.808 |
| transcript.whisperx[168].text |
這個健保點值1.1元這樣子來我們先請部長說明一下好不好可以可以你這個案子你還沒有完整說明過讓你報告一下謝謝主席朝野給我這個機會跟大家報告也抱歉上次協商到WHA跟我們陳欣慧委員、王正熙委員都在一起在那邊 |
| transcript.whisperx[169].start |
6161.799 |
| transcript.whisperx[169].end |
6189.154 |
| transcript.whisperx[169].text |
把我們台灣的醫療成就展示國際也感謝大家關心健保的一個永續有關於健保法第62條修法保障點子一案因為其中涉及健保合理支付、保障醫護收入、穩定點子等這都是本部非常重視的議題我想也是大家所重視的議題 |
| transcript.whisperx[170].start |
6191.023 |
| transcript.whisperx[170].end |
6206.011 |
| transcript.whisperx[170].text |
因此合理的點子本部跟各委員、各目標都是一致的啦那前面健保實行已經28年健保總額支付制度實行也22年當時總額支付制度規劃及推動的背景 |
| transcript.whisperx[171].start |
6207.804 |
| transcript.whisperx[171].end |
6230.803 |
| transcript.whisperx[171].text |
希望透過前瞻性協商與分配來引導醫療服務的提供並與醫界共同分擔財務風險,合理控制醫療費用,然後現今面對新醫療科技發展及人口老化等挑戰,現行的總額支出制度在收入面、支出面都必須要再精進改革, |
| transcript.whisperx[172].start |
6231.463 |
| transcript.whisperx[172].end |
6250.259 |
| transcript.whisperx[172].text |
才能促進醫療體系健全的發展,若使健保永續經營。那有關於修正健保法第262條將現行健保總額支付制度由支出上限制改為支出目標制然後前面保障點值為每點0.9元或每點1元 |
| transcript.whisperx[173].start |
6255.514 |
| transcript.whisperx[173].end |
6262.961 |
| transcript.whisperx[173].text |
來推估113年須增加預算約705億元及1,155億元,應涉及整體政府預算財務規劃與預算,時需審慎研議與策策,如以公務預算之應,將大幅增加政府財務負擔,尚需行政院 |
| transcript.whisperx[174].start |
6281.024 |
| transcript.whisperx[174].end |
6298.636 |
| transcript.whisperx[174].text |
主計總署依預算法及財務收支劃分法規劃、確認、時有經費。如有健保收入來支應,安全準備114年一次用盡,113年底急需調整費率,增加民眾的負擔。 |
| transcript.whisperx[175].start |
6299.693 |
| transcript.whisperx[175].end |
6315.864 |
| transcript.whisperx[175].text |
那為其實行政部門、新政府也不停的在努力所以在過去幾個月到包括還沒上任開始就已經為了達到健康台灣健保永續的經營也辦了全國性的六場健康台灣論壇 |
| transcript.whisperx[176].start |
6317.565 |
| transcript.whisperx[176].end |
6331.178 |
| transcript.whisperx[176].text |
這是在賴總統的指示之下具體的兩千多位醫界的精英領據了優化醫療環境確保全民健康十大策略這十大策略其實都是相當具體 |
| transcript.whisperx[177].start |
6332.921 |
| transcript.whisperx[177].end |
6352.307 |
| transcript.whisperx[177].text |
當然不敢講說百分之百周前,但是都是重要的主題。第一,當然要擴大健保財務來源,兼顧社會公平。第二,提升健保效力,抑制不必要支出。第三,改革總和制度,穩定醫療服務點值。第四,整合藝網保健的資源, |
| transcript.whisperx[178].start |
6354.825 |
| transcript.whisperx[178].end |
6380.275 |
| transcript.whisperx[178].text |
銜接長照體系。第五,改善醫療職業環境,穩定人力供給。第六,檢討健保藥品政策,扶持國內製藥產業。第七,檢討商業保險制度,強化民眾醫療保障。第八,加強醫療資訊升級,智慧醫療服務轉型。第九,優化醫事人員育才及留才的工作條件。 |
| transcript.whisperx[179].start |
6381.835 |
| transcript.whisperx[179].end |
6408.761 |
| transcript.whisperx[179].text |
第十優化評鑑的工作。我想這幾個月所有行政部門包括衛福部還有行政部門其實都針對這相關的議題不但有的組織而且進行一種規劃,我想這個應該跟各位委員先進報告。那另外為了考慮修法來保障點子這個財源提稅,對保障點子 |
| transcript.whisperx[180].start |
6410.097 |
| transcript.whisperx[180].end |
6433.693 |
| transcript.whisperx[180].text |
另外考量修法要來保障點子的裁員,尤其不確定性。本部委就收支議題、通盤檢討、積極研擬各項改革措施,藉以逐步達到穩定點子的目標。第一,在收入面方面,我們積極規劃多元化的財務方案,包括擴大保險會計,讓我們的基期能夠擴大。 |
| transcript.whisperx[181].start |
6437.911 |
| transcript.whisperx[181].end |
6445.938 |
| transcript.whisperx[181].text |
這個說實在才是醫療單位能夠比較重要的啦那我們另外排除非健保法規定的福利項目將會 |
| transcript.whisperx[182].start |
6448.052 |
| transcript.whisperx[182].end |
6476.117 |
| transcript.whisperx[182].text |
不要與政府負擔36%以外不要塞在這個這個大概可以那個節省的應該有超過100億那爭取公務預算預助健保這當然就是說有些計畫其實它是公務費啦相關的那本來應該另外在公務預算來編譯過去有一些的把它弄在健保裡面這個部分 |
| transcript.whisperx[183].start |
6476.97 |
| transcript.whisperx[183].end |
6500.661 |
| transcript.whisperx[183].text |
也會處理。當然我們應該爭取公務預算來益助健保當然我們要檢討保險費率的上限並嚴厲修正相關的法規有相關的法規我們才會進行以上的事情這個都要請未來大家支持如簽名健康保險基金收租保管 |
| transcript.whisperx[184].start |
6501.437 |
| transcript.whisperx[184].end |
6510.765 |
| transcript.whisperx[184].text |
及應用辦法,有些未來在中程長程的時候可能需要修法。在支出的面我們當然會設定,這也是賴總統的政見,設立癌藥基金並爭取以公務預算撥補,這個已經確定沒有問題,應該很快就可以來實施。 |
| transcript.whisperx[185].start |
6523.752 |
| transcript.whisperx[185].end |
6548.861 |
| transcript.whisperx[185].text |
也研議將公共衛生性質的改善,改以公務預算支出。那在健保的改革,絕對要配合醫療政策獲得體系的改革。所以我們要落實推動分級醫療加疫制度,推動適當的DRD制度,優先保障住院及集中症照護。我想集中症是重中之重。 |
| transcript.whisperx[186].start |
6550.135 |
| transcript.whisperx[186].end |
6563.736 |
| transcript.whisperx[186].text |
這個一定要保護好,確保山地離島資源不足地區之所入之點子,因為這也是我們台灣全民金錢是謀換的一個必須要做到的事情,當然我們要落實意志, |
| transcript.whisperx[187].start |
6564.958 |
| transcript.whisperx[187].end |
6585.76 |
| transcript.whisperx[187].text |
支援不當耗用及重複用藥檢查、檢驗、管理等措施以提升支援配置的效益、長期策略並將包含支付制度的改革、藥效差方面的處理。感謝大院各委員對健保政策與醫療環境之關心並提出 |
| transcript.whisperx[188].start |
6586.76 |
| transcript.whisperx[188].end |
6600.547 |
| transcript.whisperx[188].text |
諸多指點及監督本部及健保署將與各委員共同努力朝穩定健保電池、保障醫護人員合理待遇、總而適度地成長醫療體系漸層發展及健保永續經營的目標前進,並請各位委員繼續予以支出。 |
| transcript.whisperx[189].start |
6609.039 |
| transcript.whisperx[189].end |
6616.272 |
| transcript.whisperx[189].text |
好 謝謝部長的說明那接下來我們就請委員發言那我們是不是先請陳金輝委員 |
| transcript.whisperx[190].start |
6627.213 |
| transcript.whisperx[190].end |
6651.471 |
| transcript.whisperx[190].text |
各位委員、同事還有各位部長、官員、主席大家早安我是用我僅存的聲音為醫護人員發聲今天其實我做了一些手板所以也希望大家可以看一下剛剛部長有提到說我們的確是應該要增加公共投資所以我現在是要跟部長表達我們距離現實有多遙遠 |
| transcript.whisperx[191].start |
6653.032 |
| transcript.whisperx[191].end |
6681.574 |
| transcript.whisperx[191].text |
今年我們跟王振旭委員、江副院長一起去洛桑管理學院洛桑管理學院把他近20年來的報告都拿出來給我們看其實我們是感到蠻驕傲的因為台灣在世界競爭力一直在6到8名之間可是呢他也問我們說哇你們的這個醫療基礎建設的投資啊公部門的投資居然都是24到26名敬佩莫作 |
| transcript.whisperx[192].start |
6682.395 |
| transcript.whisperx[192].end |
6709.126 |
| transcript.whisperx[192].text |
非常地慘所以我是聽了很傷心是因為台灣的醫護人員、醫事人員是用全球24到26名的資源可是我們做到第一名的醫療水平以至於我們去WHA的時候有這麼多醫生問我們認不認識這個名醫那個名醫想要下次找他們來演講講一下他們的手術 |
| transcript.whisperx[193].start |
6710.166 |
| transcript.whisperx[193].end |
6732.614 |
| transcript.whisperx[193].text |
所以剛剛部長講得非常好其實我們有重複的用藥重複的檢查這個我昨天總諮詢都有諮詢過所以又加上比如說利用AI的這樣導入我用AI也可以諮詢所以基本上很多醫務人員最簡單的慢性病衛教也可以轉往許多科技上的輔助還有 |
| transcript.whisperx[194].start |
6733.294 |
| transcript.whisperx[194].end |
6758.605 |
| transcript.whisperx[194].text |
如果部長可以把這些健檢的資料統一的話其實你也不會做出不夠精準的慢性病的這些研究以至於你未來的資源配置又不平均嘛好所以呢今天為什麼我們希望可以一點醫源是因為大家也要救病人以外還要救醫護醫護現在動脈已經被砍斷了動脈已經被砍斷了所以一直在流血 |
| transcript.whisperx[195].start |
6763.327 |
| transcript.whisperx[195].end |
6780.585 |
| transcript.whisperx[195].text |
這個流血除了1.1元馬上注入就像我們現在缺的生理鹹水一樣除了馬上滴進去為什麼一個病人來急診休克的時候我們要馬上打生理鹹水因為你要趕快補進來我們現在是在止損我們是在救醫護 |
| transcript.whisperx[196].start |
6782.626 |
| transcript.whisperx[196].end |
6809.375 |
| transcript.whisperx[196].text |
這個是昨天急診長庚的護理師我很喜歡看一個版叫做靠杯護理師他裡面充滿了各種他們把他們人生最痛苦的事寫成笑話所以你是一邊哭一邊看現在急診長庚的帶床數已經241帶加護病房帶加護病房就是已經即將在生命危急喔是5這個是醫學中心喔 |
| transcript.whisperx[197].start |
6811.018 |
| transcript.whisperx[197].end |
6817.264 |
| transcript.whisperx[197].text |
大家可以想像區域醫院跟地區醫院嗎?上禮拜,亞東醫院的急診科醫師 |
| transcript.whisperx[198].start |
6818.973 |
| transcript.whisperx[198].end |
6841.323 |
| transcript.whisperx[198].text |
他PO出了一張照片他說他們護理長久以來沒辦法排班所以那天小夜只有兩個人他一個醫生結果來了兩個O卡O卡就是到院前就死亡的年輕人除了這兩個O卡以外還有無數個心肌梗塞的糖尿病的緊急要處理要插管的 |
| transcript.whisperx[199].start |
6842.637 |
| transcript.whisperx[199].end |
6866.188 |
| transcript.whisperx[199].text |
他們的leader馬上到別的單位去找一個另外一個單位的護理師還有實習生來但是這個是好命啊這兩個OCA的人是上帝在眷顧他們啊如果其他單位也很忙呢他們那天完全沒有辦法應付可是他們達成了臨死亡率這不是要我們讓他拍拍手他其實是很感嘆 |
| transcript.whisperx[200].start |
6867.148 |
| transcript.whisperx[200].end |
6892.965 |
| transcript.whisperx[200].text |
很感嘆很感嘆他的意思是說他為什麼今天會拍這張照片是因為他不知道五年後他跟他現在一起奮鬥的人還在不在這樣子的現場因為他們遠遠知道說他們是用美國醫療十分之一的人力三分之一到四分之一的薪水可能Perform的比美國人還要好 |
| transcript.whisperx[201].start |
6894.246 |
| transcript.whisperx[201].end |
6923.386 |
| transcript.whisperx[201].text |
這個是長期20年以來的狀況那你知道靠北護理師在這個群組說什麼嗎靠北護理師在這個群組說哈 這樣也要PO這是我們每天的常態這已經是北部天龍國的醫學中心會講的事情是他們的常態他們的班表現在已經亂七八糟生理時鐘完全被打斷所以呢他如果遇到育兒育嬰的需求 |
| transcript.whisperx[202].start |
6924.006 |
| transcript.whisperx[202].end |
6924.987 |
| transcript.whisperx[202].text |
等19人、委員蔡易餘等19人、委員 |
| transcript.whisperx[203].start |
6939.341 |
| transcript.whisperx[203].end |
6962.331 |
| transcript.whisperx[203].text |
沒有人悔,所有的護理師、第一首選、空服員、業務等等的他們已經沒有辦法忍受這樣子的生活所以我們今天一點一點不是我們在這邊要排擠到別人的預算而是這個是長期以來大家都應得的只是要還給我們而已現在到底還有 |
| transcript.whisperx[204].start |
6963.631 |
| transcript.whisperx[204].end |
6967.395 |
| transcript.whisperx[204].text |
20年前大家想珍奶一杯多少錢?25到50,10年前大概50,現在有時候60、80,雞排也是啊,80到100,可是醫護人員的點值過去20年、30年 |
| transcript.whisperx[205].start |
6979.365 |
| transcript.whisperx[205].end |
6993.115 |
| transcript.whisperx[205].text |
隨著通膨完全沒有改變完全沒有改變之下還在近幾年一一被打折所以我們是跟這個現實物價的世界是越脫離越遙遠我相信沒有一個 |
| transcript.whisperx[206].start |
6994.696 |
| transcript.whisperx[206].end |
7022.367 |
| transcript.whisperx[206].text |
這個醫院或者是基層診所的經營者不想留財啊所以上次大家也都承諾了只要點職一住進來的話第一步馬上幫醫護人員加薪現在呢大家去看有賺錢的醫院仔細看誰誰賺錢有開停車場的有開美食街的還有自己做投資的就這三種你覺得每一家都有辦法做到嗎基層診所是一間一間的關啊 |
| transcript.whisperx[207].start |
7023.968 |
| transcript.whisperx[207].end |
7036.239 |
| transcript.whisperx[207].text |
所以我希望衛福部部長就跟我們一起站在一起跟家人一樣我們要爭取自己應得的這個已經是長秋以來我們沒有被平等的對待 |
| transcript.whisperx[208].start |
7038.03 |
| transcript.whisperx[208].end |
7062.642 |
| transcript.whisperx[208].text |
不要說破壞國家的財政你看洛桑管理學院這張圖你就知道我們現在面臨小子化、高齡化你本就一定要投資的公部門的基金、預算我們遠遠不如其他世界上最先進的這些國家所以這個本來就是我們一直都要檢討的才對 |
| transcript.whisperx[209].start |
7064.543 |
| transcript.whisperx[209].end |
7089.599 |
| transcript.whisperx[209].text |
所以本席在這邊也非常希望委員們、官員們可以多多鼓勵我們的醫護人員繼續留在他們的崗位因為我其實與其說健保的財務會不會倒我現在最擔心的是醫護先垮是不是醫護先垮會遠遠的提早發生在健保財政先垮的前面因為 |
| transcript.whisperx[210].start |
7090.8 |
| transcript.whisperx[210].end |
7115.408 |
| transcript.whisperx[210].text |
新疆按摩比腳底按摩便宜通血管比通水管還便宜所以目前這樣子我只是希望說大家可以馬上幫他們打生理鹹水至少讓他們撐住不要休克然後其他的改革我們可以繼續一起慢慢來研擬就如同昨天總質詢跟部長一起分享的心得一樣謝謝大家 |
| transcript.whisperx[211].start |
7117.367 |
| transcript.whisperx[211].end |
7127.004 |
| transcript.whisperx[211].text |
好謝謝金輝委員那那個剛剛是趙志偉先舉手再來蘇星權委再王振旭委員來請都可以都可以 |
| transcript.whisperx[212].start |
7130.389 |
| transcript.whisperx[212].end |
7154.819 |
| transcript.whisperx[212].text |
謝謝主席邱部長其實這個健保的問題已經累積了數十年了那您剛好上任了其實是我個人認為其實是你要概括承受啦概括承受就是說辛苦啦我個人認為健保現在已經因為種種的包括投資不足已經有點變成那個巨大怪獸那但是我們也不能都不處理 |
| transcript.whisperx[213].start |
7155.879 |
| transcript.whisperx[213].end |
7157.04 |
| transcript.whisperx[213].text |
等19人等19人、委員蔡易餘等19人、委員 |
| transcript.whisperx[214].start |
7174.149 |
| transcript.whisperx[214].end |
7202.251 |
| transcript.whisperx[214].text |
論服務量來拒籌那這個當然是一個要檢討的部分那但是現在我們在我們本黨民眾黨沒有提出任何點值的方案但是因為很多總統候選人就是包括賴總統都沒有提出當時說希望能夠提高這個點值所以這個我們覺得要有一些配套措施但是我今天當然沒有看到很具體的衛福部有一些這個配套措施那個配套措施我也同意 |
| transcript.whisperx[215].start |
7202.651 |
| transcript.whisperx[215].end |
7203.832 |
| transcript.whisperx[215].text |
等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等 |
| transcript.whisperx[216].start |
7231.013 |
| transcript.whisperx[216].end |
7254.446 |
| transcript.whisperx[216].text |
建保典值的部分當然不同的層級的醫院它有不同的任務我理解它的典值它這個幾乎也會不一樣但是其中一點當然今天可能不會是要處理的但是我在質詢之前質詢也是提到您剛剛提到分級醫療您是出身家醫科醫師您應該最重視的就是一個分級醫療但是台灣整個醫院是往道的方向去走 |
| transcript.whisperx[217].start |
7255.967 |
| transcript.whisperx[217].end |
7266.775 |
| transcript.whisperx[217].text |
已經過度了你還要繼續增加但我所謂的你就是這個醫院評鑑又增加的這個醫學中心所以台北分區我如果去看整個點數的分佈台北分區其實是最嚴重的 |
| transcript.whisperx[218].start |
7271.078 |
| transcript.whisperx[218].end |
7298.821 |
| transcript.whisperx[218].text |
但是這個嚴重是誰倒成的?醫院一直蓋大樓然後這個醫院評鑑也一直同意他們成為醫學中心嘛所以其實大概我看這個點數的分佈其實在各區會是不一樣的那這是第一點那要不要怎麼有優先次序來處理有沒有其他方式要來校正這件事情這個可以討論那第二個就是說部長您在當立委的時候您也覺得說有時候我們看那個平均點值其實是有一點被扭曲啦 |
| transcript.whisperx[219].start |
7299.581 |
| transcript.whisperx[219].end |
7307.905 |
| transcript.whisperx[219].text |
我們其實比較重視的是那個浮動點子,浮動點子是比較,浮動點子要圓真相,而不是說攤扣之後,或是斷頭之後,你呈現的東西,因為我們要看的是真相,那這個部分因為在官網上看到的,就不是這個部分,所以這個 |
| transcript.whisperx[220].start |
7320.33 |
| transcript.whisperx[220].end |
7346.736 |
| transcript.whisperx[220].text |
像東區看到有超過1了嘛那高頻也是靠近0.9但是最嚴重的就是那就是醫院平間造成啦臺北分區累積了那麼多醫學中心大家都在搶資源啦所以這個部分就是說那就是這個部分要一起處理另外部長因為上次您不在的時候好像我初步是聽石署長來說明提到到0.95要增加700億 |
| transcript.whisperx[221].start |
7350.257 |
| transcript.whisperx[221].end |
7368.564 |
| transcript.whisperx[221].text |
提高到一要增加千億這個計算基礎我覺得還是要有一個說明就是不是喊一個數字但是剛剛陳金輝委員他就一直提到部長您這個數字不要記不記得下來您知道我們現在的健保佔GDP的百分之多少嗎 |
| transcript.whisperx[222].start |
7370.379 |
| transcript.whisperx[222].end |
7397.049 |
| transcript.whisperx[222].text |
您就是有沒有這個概念當然有所謂的national health expenditure醫療通知會一般性的這個部分我們在OECD國家是淨賠莫作假設這個我們是總共是一般性醫療支出是大概6.1但是那個OECD國家的中位數跟平均都是9我們是淨賠我記得是倒數第二個還第三個就是源頭錢不夠 |
| transcript.whisperx[223].start |
7399.549 |
| transcript.whisperx[223].end |
7416.988 |
| transcript.whisperx[223].text |
對那這個東西可是如果我們今天談健保因為我們在處理健保還只佔50%到55%所以是3點多那3點多你要照顧你3點多要照顧百分之百的病人就是民眾百分之百的民眾那這當然是奇蹟因為沒有人有辦法做到用3.5來照顧所有的病人所有的人 |
| transcript.whisperx[224].start |
7419.611 |
| transcript.whisperx[224].end |
7434.241 |
| transcript.whisperx[224].text |
而且您現在是就是全保嘛小病大病什麼都全保在這個裡面嘛那這個當然等一下我還是提到那個法規的部分你說只是要給給付等等所以今天我覺得會碰觸到很多很敏感但是過去政府不去面對的問題老實說 |
| transcript.whisperx[225].start |
7436.183 |
| transcript.whisperx[225].end |
7438.986 |
| transcript.whisperx[225].text |
那包括這個要價差的部分,要價差部分老實說因為我質詢過薛部長兩次,他一個月內就差一百億他最少說四百億,後來說五百億,其實都不計 |
| transcript.whisperx[226].start |
7451.483 |
| transcript.whisperx[226].end |
7452.044 |
| transcript.whisperx[226].text |
葛珮帆、葛珮帆、葛珮帆、 |
| transcript.whisperx[227].start |
7473.607 |
| transcript.whisperx[227].end |
7475.087 |
| transcript.whisperx[227].text |
用乙藥養醫的方式。 |
| transcript.whisperx[228].start |
7494.674 |
| transcript.whisperx[228].end |
7520.596 |
| transcript.whisperx[228].text |
這個東西就是說等一下我想等一下在討論的過程中我還是有幾點我個人是同意因為本黨沒有提出點子的部分我提出了一些附帶的那個決議部分部長我可以理解說沒有辦法一步到位當你突然把點子提高的時候但是我也希望你們有根據的有數字的提出一些你們覺得可以優先來做的 |
| transcript.whisperx[229].start |
7521.116 |
| transcript.whisperx[229].end |
7535.122 |
| transcript.whisperx[229].text |
剛剛你也有提到急重病啦也許過去還有什麼燈塔行業等等有一些這個優先次序然後但是但是也要有一些時程啦就要有時程譬如說你規劃怎麼來規劃什麼時候來解決這個問題那最後我們就是投資不夠所以部長不只是您的責任啦我覺得院長跟總統都要正視這個問題啦 |
| transcript.whisperx[230].start |
7545.907 |
| transcript.whisperx[230].end |
7569.506 |
| transcript.whisperx[230].text |
賴總統不能只講健康台灣,但是他不去看數字,就輸人了。張誠醫師是很客氣在談說,我們醫療是一流,很抱歉喔,部長,我們醫療不是一流的,不是因為人不好,不是人不好,是我們整個健康投資是不行的,我隨便講幾個數字都知道,我們落後的很厲害,平均餘命是落後的,癌症存活率是落後的,新生兒死亡率也是落後的, |
| transcript.whisperx[231].start |
7570.386 |
| transcript.whisperx[231].end |
7589.513 |
| transcript.whisperx[231].text |
那個藤尿病的合併的都是落後都是後段班但是這個東西不是因為人不好是整個投資包括我最熟悉的新藥的部分你引進的速度因為沒有錢所以老實說我不會去直接責怪石署長因為部長、院長、總統我覺得你們要從源頭從源頭把這個問題解決那等一下我想還有其他的看怎麼來做我再繼續表達我的意見謝謝部長 |
| transcript.whisperx[232].start |
7600.097 |
| transcript.whisperx[232].end |
7623.852 |
| transcript.whisperx[232].text |
好 謝謝 接下來我們請蘇星泉委員謝謝主席 那上次協商的時候因為我們部長 |
| transcript.whisperx[233].start |
7625.407 |
| transcript.whisperx[233].end |
7625.728 |
| transcript.whisperx[233].text |
我這邊要講三點,第一個 |
| transcript.whisperx[234].start |
7645.768 |
| transcript.whisperx[234].end |
7671.778 |
| transcript.whisperx[234].text |
我們都是臨床醫師部長你是嘉義科、臺大門診中心這位主任林次長他是福山科那十雙兩是急診科急診的第一線所以剛剛陳慶威在講的那些在急診OCCA的啦甚至信託館啦PTCA啦等等這些以前都在那邊錄的 |
| transcript.whisperx[235].start |
7673.559 |
| transcript.whisperx[235].end |
7683.369 |
| transcript.whisperx[235].text |
那我們現在我們以前當醫生的時代就是任老任厭我在馬街外科心臟外科的時候是隔天值班 |
| transcript.whisperx[236].start |
7684.813 |
| transcript.whisperx[236].end |
7704.831 |
| transcript.whisperx[236].text |
然後我當總醫師的時候,我第四年、第五年、第六年,我的前面沒有總醫師,我的後面沒有總醫師。我一個人,戇口三年,我也是假期間加了、拼了,也是加過,但是那一種燒勁的精神,現在已經沒有了。 |
| transcript.whisperx[237].start |
7706.229 |
| transcript.whisperx[237].end |
7730.814 |
| transcript.whisperx[237].text |
現在的年輕人,不可能,也多一個新冠病毒,不跟台灣那樣了,整個是超乎我的想像,年輕人根本他們的想法是完全南轅北轍,所以現在的醫生不要用現在裡面以前的想法來要求他們,這是不可能的事情,那所以醫護人員, |
| transcript.whisperx[238].start |
7734.158 |
| transcript.whisperx[238].end |
7736.291 |
| transcript.whisperx[238].text |
連那個放射師都跑了你知道嗎 |
| transcript.whisperx[239].start |
7737.406 |
| transcript.whisperx[239].end |
7762.397 |
| transcript.whisperx[239].text |
跑到新加坡去新加坡去人家放射師一個月的薪水可以拿到16萬、17萬台幣在這邊4萬到6萬現在還有一個就是那個晶片業者在搶了那個薛睿遠他有跟我討論過現在晶片業者他們也要因為要用X-ray scan所以呢他們現在開都開八萬、九萬 |
| transcript.whisperx[240].start |
7764.676 |
| transcript.whisperx[240].end |
7767.36 |
| transcript.whisperx[240].text |
我跟你們說,各位臉皮放射技術的照料料 |
| transcript.whisperx[241].start |
7768.399 |
| transcript.whisperx[241].end |
7792.844 |
| transcript.whisperx[241].text |
所以這個是很嚴重的問題所以到現在已經不得不面對了我們怎麼說都不對啦我們沒有一個公共政策說用總額預算給你框著就丟著這樣搞了十幾二十年太厲害了政府就搞一個預算然後丟給議界整個風險控管、整個經濟的控管都拚命給他改反正我就總額 |
| transcript.whisperx[242].start |
7796.525 |
| transcript.whisperx[242].end |
7818.096 |
| transcript.whisperx[242].text |
知務制、高年代的夫婦的孫嫂、0.7、0.6都知道的事情。就這樣,就這樣幹,到現在還這樣幹。然後呢,整個風險都拚拚讓他自己去搭。你自己的朋友,你台大醫院也是挨挨救。所以,我要跟大家說的是,你沒有到這個時候已經沒處理不行了。 |
| transcript.whisperx[243].start |
7822.028 |
| transcript.whisperx[243].end |
7825.94 |
| transcript.whisperx[243].text |
真正的大招了了所以我們這個法提出來 |
| transcript.whisperx[244].start |
7827.453 |
| transcript.whisperx[244].end |
7837.658 |
| transcript.whisperx[244].text |
三個總統候選人都自己這樣說﹖包括柯文哲﹖包括侯友宜﹖包括賴清德﹖同樣都說一點一口﹖自己說的喔。阿0.9﹖0.9是在假象嘛﹖時中量太厲害了嘛﹖他叫醫院先斷頭﹖斷頭後再延審﹖延審後他再攤扣﹖這攤扣有沒有違法﹖時長﹖攤扣是違法的嗎﹖ |
| transcript.whisperx[245].start |
7854.417 |
| transcript.whisperx[245].end |
7878.928 |
| transcript.whisperx[245].text |
每一家醫院,你又害逃,我告訴你,攤扣完就維持0.9的假象,那個已經前面都站大堆了,所以這個都是假象,這個把它提出來,讓它通過,對你們也是一個助力,怎麼說,第二個,讓你們有所依託,因為事實就是要這樣, |
| transcript.whisperx[246].start |
7880.965 |
| transcript.whisperx[246].end |
7890.984 |
| transcript.whisperx[246].text |
不然台電、台電來...郭...郭...郭...經濟部長...郭部長...台電怎麼不可以給綜合?我一年在外地,一年在台大我贏,可以嗎? |
| transcript.whisperx[247].start |
7893.319 |
| transcript.whisperx[247].end |
7907.424 |
| transcript.whisperx[247].text |
不可憐嘛所以我們的公共政策只有醫療醫療是用綜合其他的沒有那你說如果沒有用綜合他會衝量什麼的這個成長十幾趴這都是想像啦啊輸出來了又不可憐 |
| transcript.whisperx[248].start |
7917.148 |
| transcript.whisperx[248].end |
7931.39 |
| transcript.whisperx[248].text |
那所以我們提出來這個折衷,就是說綜合我們來用目標制,就是說你綜合裡面只要補充一點點一口,那你如果真的做到敲出去,敲出去你就審查,審查之後,你自己補的時候,你把它拍下來, |
| transcript.whisperx[249].start |
7934.039 |
| transcript.whisperx[249].end |
7950.084 |
| transcript.whisperx[249].text |
就總共在做目標是,這樣不太好,這樣是最新意外,每一年差的就是差那塊,差那塊四、五百億,四、五百億,那塊你給10年來就四、五千億,20年來就快要一兆, |
| transcript.whisperx[250].start |
7951.124 |
| transcript.whisperx[250].end |
7976.099 |
| transcript.whisperx[250].text |
全部拚給醫界醫界就是短收就是摳東摳西的然後醫界就沒有韌性不要講一天到晚叫沒有韌性沒錢要有韌性啦大家都在巧立名目大家親家庭啦、美容啦、藥啦然後新的藥材、科技就一直往病人身上加現在去開個骨科換個頸椎的一個一個cushion25萬 |
| transcript.whisperx[251].start |
7980.862 |
| transcript.whisperx[251].end |
7988.996 |
| transcript.whisperx[251].text |
二十八萬?有我也看不下去。那是怎樣?因為便宜沒那麼多嘛,所以主委的東西這麼多,這署長你也知道嘛。 |
| transcript.whisperx[252].start |
7990.851 |
| transcript.whisperx[252].end |
8019.105 |
| transcript.whisperx[252].text |
然後你現在健保還有一個很荒唐的事情,比如說今年總額給你成長200億、300億,那你隔天就開始啦,新的東西就一直往裡面加,一直往裡面加,啊你就,反正你就請人家去,他給你買單嘛,啊所以你就去什麼家,新的業務、新的科技,什麼都教教你,啊你寫上今年就只剩下兩百元、三百元而已,結果你去把整個社會答應的,剩下四、五百元。 |
| transcript.whisperx[253].start |
8020.726 |
| transcript.whisperx[253].end |
8039.122 |
| transcript.whisperx[253].text |
你那些請假的錢剛才沒有交付那些陳昭蘇委員你講的薪要進不進來?進不進來,不如請你當時也進不進來我希望你不要進,想到10年都不要進去,你還要再考但這不可能的事情啦王振旭總理學科的醫生他每天也要求想新的藥要進來他就沒辦法進來,是怎樣?所以這個就是,都是問題所以我跟大家報告 |
| transcript.whisperx[254].start |
8047.905 |
| transcript.whisperx[254].end |
8070.771 |
| transcript.whisperx[254].text |
這一個議題,藍綠的立委大家也沒什麼加標識意見啦!那你的總統、候選人都這樣承諾啊!所以,這如果通過,你說要收集、開辦實施、晚個半年、晚個一年再慢慢到位,現在就開始努力啦!現在事實上我有看到石崇良署長還有我們邱部長, |
| transcript.whisperx[255].start |
8071.391 |
| transcript.whisperx[255].end |
8076.715 |
| transcript.whisperx[255].text |
都去列入籍,說是公務預算的,什麼有的有的,這樣還沒做就死了,這是我們死的,對吧?所以他們列入,我也有看到,看到他們有努力,這個看得好過,比較難實施的,這樣就折衷啊,這樣就真的到位啊,這樣在健康台灣啦,什麼台灣都一樣啦,沒錢都好笑的啦,所以我在這邊再一次的跟大家報告, |
| transcript.whisperx[256].start |
8098.827 |
| transcript.whisperx[256].end |
8108.291 |
| transcript.whisperx[256].text |
這個法還是要讓他過過了之後可以把期程壓一下我們都是內行人大家講內行話以上 謝謝好 謝謝蘇星泉委員接下來請王振旭委員好 謝謝主席那我就在位子上跟大家報告 |
| transcript.whisperx[257].start |
8122.475 |
| transcript.whisperx[257].end |
8143.545 |
| transcript.whisperx[257].text |
我來自醫界嘛 跟大家都很一樣所以其實對於如何能夠把醫療資源有效的提升來回饋給相關做醫療服務的同仁這個一定要全力來支持這個是一定要做的事情因為健保改革也一定要透過大家努力一起來完成 |
| transcript.whisperx[258].start |
8144.065 |
| transcript.whisperx[258].end |
8166.145 |
| transcript.whisperx[258].text |
那剛剛經會委員提到我們這次也一起去參加WHA相關的活動那也去拜訪了IMD就是洛桑管理學院那除了剛剛經會委員所提的數據以外那我也順便把兩個數據給大家做參考就是今年我們是稍微微幅下降了兩名 |
| transcript.whisperx[259].start |
8166.986 |
| transcript.whisperx[259].end |
8194.201 |
| transcript.whisperx[259].text |
变成第八名不过我们在2000万的人口我们还是维持最具竞争力的一个国家那不过相关于比较有优势的地方在医疗的部分他有一个item基础建设就是医疗保健基础设施符合社会需要那这一部分我们成绩非常的好是占第三名就是说我们基础设施其实是非常够表示我们的硬体 |
| transcript.whisperx[260].start |
8195.734 |
| transcript.whisperx[260].end |
8211.585 |
| transcript.whisperx[260].text |
各方面相關的處理是符合社會期待所以我們的就醫的可敬性其實是讓我們的醫療服務得到非常高的滿意度可是另外一個部分弱勢的項目就在於 |
| transcript.whisperx[261].start |
8212.886 |
| transcript.whisperx[261].end |
8238.968 |
| transcript.whisperx[261].text |
醫療保健支出佔GDP的比例他這邊列的數據是2021年的比例他佔了7.3他是在評比裡面佔第41位意思就是說的確我們的醫療在相關的保健的支出是真的很需要透過不管是主管機關或是如何來增加這個醫療保健支出真的是非常非常的重要 |
| transcript.whisperx[262].start |
8239.828 |
| transcript.whisperx[262].end |
8264.124 |
| transcript.whisperx[262].text |
當然這個百分比或者是如何能夠讓它更有效的精進這個其實是關乎我們今天想要討論的重點剛剛部長也有提到我們的收入面透過現在的方式是有機會去增加相當一定數額的這個支出希望將來也針對這個醫療保健戰機TP的比例可以有效的提升 |
| transcript.whisperx[263].start |
8264.884 |
| transcript.whisperx[263].end |
8292.018 |
| transcript.whisperx[263].text |
那收入面除了剛剛部長所提到的以外其實醫界一直很想像中的一個可能性就是基金有沒有可能透過公務預算來撥補之類的那我們最近也看到了勞工勞動部那邊針對勞工基金的補助是透過勞保基金來協助讓這個運作可以可長可久不至於受到太大的影響 |
| transcript.whisperx[264].start |
8293.158 |
| transcript.whisperx[264].end |
8310.609 |
| transcript.whisperx[264].text |
所以其實那健保基金有沒有機會有類似的可能性這個其實醫界會相當的期待那也許部長也可以讓我們多了解一下這個差異性是在哪裡那這個有沒有機會針對收入面來做相對的這些處理 |
| transcript.whisperx[265].start |
8311.61 |
| transcript.whisperx[265].end |
8333.808 |
| transcript.whisperx[265].text |
那其實我想讓醫界最有感的或者是剛剛我們所看到的各方面的護理是人力不足、藥品供應不足、醫院降低病房數因為就是相關的資源不夠包括急診、醫療、量能這些滿載等等的困境我們幾乎每天隨時都會從媒體看到這些困境 |
| transcript.whisperx[266].start |
8335.569 |
| transcript.whisperx[266].end |
8352.155 |
| transcript.whisperx[266].text |
包括在現場的所有的同仁,不管是不是從事醫療都會覺得非常的辛苦。也很感心,因為這是醫療一種我們希望針對於讓全民的健康在疾病控制上得到最大的協助的情形下所面臨的困境。 |
| transcript.whisperx[267].start |
8352.995 |
| transcript.whisperx[267].end |
8374.347 |
| transcript.whisperx[267].text |
那這個支出面如何能夠讓我們的醫療同仁有感我記得上一次也有請這個部長或者是相關的我們的這個主管機關能夠盡快的提出相關的措施來讓不管除了在服務民眾的過程裡面也讓所有的 |
| transcript.whisperx[268].start |
8375.407 |
| transcript.whisperx[268].end |
8397.647 |
| transcript.whisperx[268].text |
相關的醫事人員多有感的一些政策那我們這邊是有看到今天部長所提出的非常多元的支出面的這些協助那當然如果醫療資源越多我們這個支出面可以更為廣泛的來處理的話對所有的這些可能改善的情形都會有很有幫助可是因為這個只有很簡短的書面說明 |
| transcript.whisperx[269].start |
8398.388 |
| transcript.whisperx[269].end |
8427.62 |
| transcript.whisperx[269].text |
其實我們期待的是更完整的專案報告如果我們還有機會能夠把這個部分做更多的了解的話那相信提出來政策也有一定的期程有一定的目標那我們最近雖然有看到各方面的一些針對於如何去改善整個健保的制度的運作的部分有包括健康台灣的論壇還有今天也看到總統府有提出健康台灣委員會等等的工作 |
| transcript.whisperx[270].start |
8428.46 |
| transcript.whisperx[270].end |
8429.881 |
| transcript.whisperx[270].text |
委員翁曉玲等19人、委員翁曉玲等19人、委員 |
| transcript.whisperx[271].start |
8449.011 |
| transcript.whisperx[271].end |
8471.172 |
| transcript.whisperx[271].text |
除了民眾了解以外也能夠讓整體的這個醫療同業人員都能夠確認知道我們這個整體主管機關努力的方向也希望有機會來得到更多讓我們所有針對於要打造健康台灣包括醫療服務的過程裡面能夠大家非常 |
| transcript.whisperx[272].start |
8472.193 |
| transcript.whisperx[272].end |
8478.845 |
| transcript.whisperx[272].text |
安心的繼續來努力的部分希望也能夠再從部長那邊得到更多的一個訊息以上 |
| transcript.whisperx[273].start |
8481.759 |
| transcript.whisperx[273].end |
8487.162 |
| transcript.whisperx[273].text |
黃秀芳、林月琴主席健保脈絡近三十年健保的部分應該要去做一個總體的一個討論跟檢視醫護應該要有合理的報酬這個我相信所有在場的委員都非常的認同 |
| transcript.whisperx[274].start |
8507.995 |
| transcript.whisperx[274].end |
8508.275 |
| transcript.whisperx[274].text |
我希望透過我們這次 |
| transcript.whisperx[275].start |
8523.292 |
| transcript.whisperx[275].end |
8543.749 |
| transcript.whisperx[275].text |
有關這個健保這個健保的部分不論是這個健保的這個第62條或者是說整個全民健保是不是要重新做一個審視那如果說不去做一個重新的審視其實我覺得這個醫療資源不可能說無限因為 |
| transcript.whisperx[276].start |
8544.409 |
| transcript.whisperx[276].end |
8545.39 |
| transcript.whisperx[276].text |
蔡易餘等19人、委員洪孟楷等19人、委員 |
| transcript.whisperx[277].start |
8568.849 |
| transcript.whisperx[277].end |
8589.9 |
| transcript.whisperx[277].text |
配套到底配套是什麼其實我剛剛也聽不到部長就整個這個未來的配套是什麼如果說照這樣子今天如果這個健保法這個62條如果今天協商那未來如果這樣通過之後就之前講的可能會增加這個財務的負擔那我覺得說我們應該要讓醫護有一個合理的報酬 |
| transcript.whisperx[278].start |
8595.363 |
| transcript.whisperx[278].end |
8616.143 |
| transcript.whisperx[278].text |
這個是我一定要重申的我相信所有的委員都非常的認同那這些醫護要合理報酬在這樣子有限的資源之下我們要怎麼去分配那另外就是說這個剛剛部長也有特別提到整個這個醫療體系要永續發展那分級醫療或者是醫藥分業配合著 |
| transcript.whisperx[279].start |
8616.643 |
| transcript.whisperx[279].end |
8617.284 |
| transcript.whisperx[279].text |
蔡英文、蔡英文、蔡英文、蔡英文 |
| transcript.whisperx[280].start |
8643.638 |
| transcript.whisperx[280].end |
8667.037 |
| transcript.whisperx[280].text |
不增加這個保費的這個情況之下我覺得都有一些困難所以我希望說等一下也可以聽到部長未來你們針對這一部分你們要怎麼做那我希望說在下一次我擔任召委的時候我希望我未來排一個就是有關衛福部你們要針對這個健保的合理支付那保障醫護人員的收入還有設置百億 |
| transcript.whisperx[281].start |
8668.058 |
| transcript.whisperx[281].end |
8682.871 |
| transcript.whisperx[281].text |
癌症基金還有健康投資這些我希望說在我擔任召委的這個時候我會來排那希望說這邊能夠做一個專案報告那我等一下是不是先可以聽部長針對這一部分你們未來要怎麼做 |
| transcript.whisperx[282].start |
8684.961 |
| transcript.whisperx[282].end |
8697.975 |
| transcript.whisperx[282].text |
好 謝謝接下來請林月琴委員然後劉建國委員如果健保有足夠的資金去應付這龐大的醫療支出健保的點子如果每一點保證 |
| transcript.whisperx[283].start |
8698.888 |
| transcript.whisperx[283].end |
8699.948 |
| transcript.whisperx[283].text |
董事長、董事長、董事長、董事長、 |
| transcript.whisperx[284].start |
8726.537 |
| transcript.whisperx[284].end |
8729.361 |
| transcript.whisperx[284].text |
從106年到110年,帳面上連續5年的虧損,那110年到去年政府預算經費的挹注,帳面上才會轉虧為盈,由虧轉盈,那實際上還是虧損 |
| transcript.whisperx[285].start |
8742.378 |
| transcript.whisperx[285].end |
8761.491 |
| transcript.whisperx[285].text |
那這個虧損狀況呢大家就是用醫院所醫療院所的健保點值的打折少看一點病啊少做一些檢查再少跟健保領一點錢之後審下來結果可是如果不再節省的話大家換句話說就是要把政府可以主導的打折的空間限制 |
| transcript.whisperx[286].start |
8762.692 |
| transcript.whisperx[286].end |
8764.094 |
| transcript.whisperx[286].text |
等19人等19人等19人等19人等19人等19人等19人等19人等 |
| transcript.whisperx[287].start |
8778.189 |
| transcript.whisperx[287].end |
8803.499 |
| transcript.whisperx[287].text |
再來就是醫療的資源可能的問題事實上是浪費的問題大家沒有辦法被控制那對民眾有直接利益的醫療政策就沒有錢去做推動或是因為錢不夠只能慢慢的去推所以最重要的問題有兩個就是醫院因為對於健保的依賴我們的收費市場漲不出來導致健保總額瘦身的概念又還沒有開始就要遇到困難了 |
| transcript.whisperx[288].start |
8804.099 |
| transcript.whisperx[288].end |
8831.676 |
| transcript.whisperx[288].text |
那第二個是今天的法案如果通過後那我不知道國民黨是不是會接著要去提案修法是調高費率6%的上限然後開始漲保費這個是我想民眾也會有些壓力擔憂因為整個尤其是年輕人他們的費用上調高的話對他們收入不多那又要再去繳這個所以這樣子的話我要怎麼告訴民眾社會保險沒有問題大家可以安心生活 |
| transcript.whisperx[289].start |
8832.777 |
| transcript.whisperx[289].end |
8850.139 |
| transcript.whisperx[289].text |
民眾會知道這不是哪一個黨比較會執政的問題而是立法院修法的結果所以健保問題沒有關係到政黨是一個屬於每一個世代要去共同面對到的問題所以本席認為現階段不應該用法律把健保的點子 |
| transcript.whisperx[290].start |
8850.68 |
| transcript.whisperx[290].end |
8852.262 |
| transcript.whisperx[290].text |
等19人等19人、委員蔡易餘等19人、委員 |
| transcript.whisperx[291].start |
8870.64 |
| transcript.whisperx[291].end |
8889.762 |
| transcript.whisperx[291].text |
可以提出一個合理的暫時性方案我們也期待衛福部是不是可以有我們有一個時間性然後讓衛福部能夠去有這樣子的一個中整的挑戰不是在這邊去訂出這樣的直接就在這邊今天要去做這樣的一個決定以上謝謝接下來我們請劉建國委員 |
| transcript.whisperx[292].start |
8892.694 |
| transcript.whisperx[292].end |
8907.185 |
| transcript.whisperx[292].text |
好,謝謝主席。我現在呼應蘇清泉委員剛才講的,大家都來行人。但是來行人,我現在講話尾聲,我當然不要外行外行。 |
| transcript.whisperx[293].start |
8908.667 |
| transcript.whisperx[293].end |
8912.712 |
| transcript.whisperx[293].text |
因為他們的養成過程裏面,抱著要救人救世的心情,所以那個精神都專注在這個地方。 |
| transcript.whisperx[294].start |
8924.386 |
| transcript.whisperx[294].end |
8936.971 |
| transcript.whisperx[294].text |
有些人對剩餉、剩點子不是要注意,也太無盈了,所以如果醫生提到國稅局都怕要死就對了,不是要討人厭,是那些人剩餉不是要準。 |
| transcript.whisperx[295].start |
8943.733 |
| transcript.whisperx[295].end |
8953.12 |
| transcript.whisperx[295].text |
我今天看你的報告坦白講,我也覺得就如蘇青雄委員所講的,你們來行人,來行人寫這份報告出來,也不夠該來行。 |
| transcript.whisperx[296].start |
8958.328 |
| transcript.whisperx[296].end |
8985.156 |
| transcript.whisperx[296].text |
今天要協商啊,這個協商也已經因為你,又延後、又延後了,教委也這樣擺出來。我是覺得這樣啦,大家都說很多,我們要讓醫護得到合理的報酬,這個目標是不會有爭執的啦。但是典值要去把它入法,可能會延伸到了後續問題,來行的醫界的人,你們都比大家還要清楚。所以醫界原本也就有不一樣的聲音。 |
| transcript.whisperx[297].start |
8986.867 |
| transcript.whisperx[297].end |
9003.962 |
| transcript.whisperx[297].text |
當你去把點子法制化之後造成的所有的衝擊我不曉得這個是我們目標能不能就在短時間達成而且可以永續若不行的情況之下我們就要回到真的內行的做法 |
| transcript.whisperx[298].start |
9005.403 |
| transcript.whisperx[298].end |
9033.061 |
| transcript.whisperx[298].text |
什麼叫內行的做法是說先不要去跟他們討論有什麼問題這個問題是不是有一個破例畢竟你也是來自醫界那大家的因應其判就是希望確保醫護有合理的報酬你在健保署我們在各區北中南南區一直可以維持到這個0.93那其他地方為什麼不行 |
| transcript.whisperx[299].start |
9034.462 |
| transcript.whisperx[299].end |
9059.569 |
| transcript.whisperx[299].text |
那我只是覺得說在北中還是其他地方你如果可以朝這個方向去走而且在短時間之內好比說一個月、兩個月、三個月我新部長我就能努力的讓這個點子可以朝向這個樣子你給我時間委會、各位委員你給我空間我絕對努力給你看我覺得這個才是真正在處理事情啦 |
| transcript.whisperx[300].start |
9061.145 |
| transcript.whisperx[300].end |
9076.537 |
| transcript.whisperx[300].text |
啊你如果今天南美的協商你連這個違例都說不出來我會覺得我們就僵在這個地方啦這樣坦白講也讓大家在期待我們可以往前一步的這樣的一個期待會落空啦 |
| transcript.whisperx[301].start |
9080.04 |
| transcript.whisperx[301].end |
9108.232 |
| transcript.whisperx[301].text |
所以我覺得補充是不是你要縮寬應該是這樣因為我前幾天接到很多訊息我以為今天來我們是有一個很大的進步有一個很大的進展而不是僵在這個地方然後一直要處理我想有人要確保點值就是一點等一元嘛 對不對當然我有看到國民黨其他委員他現在要確保是一點等0.95嘛0.95元這個就是還有大家有討論的空間嘛 |
| transcript.whisperx[302].start |
9109.833 |
| transcript.whisperx[302].end |
9121.931 |
| transcript.whisperx[302].text |
所以如果你宜蘭區的這樣的一個基準,我們可以努力達到這個地方,還是我們第一步,你在一個月內、兩個月內、三個月內,你可以達到這個全國各區,就是這個1.2 009元以上。 |
| transcript.whisperx[303].start |
9127.129 |
| transcript.whisperx[303].end |
9152.48 |
| transcript.whisperx[303].text |
我是覺得請長兄也來行的陳委員也是來行的就對了你們都是在來自醫界應該大家這樣會比較對我們的醫護也好交代對社會面也好交代也不用去動到健保的匯率等等等是不是可以朝這個方向來努力請部長還有次長還有署長你都是來行的 |
| transcript.whisperx[304].start |
9153.925 |
| transcript.whisperx[304].end |
9163.259 |
| transcript.whisperx[304].text |
你們是來做議題嗎?是不是你可以休息?休息五分鐘讓他們去吵架嗎?他們在內行的、吵吵的,這裡真的很內行。好,謝謝。好,因為還有兩位委員要發言。我們先請邱政軍委員,再來廖偉祥委員。 |
| transcript.whisperx[305].start |
9173.952 |
| transcript.whisperx[305].end |
9201.883 |
| transcript.whisperx[305].text |
主席還有各位委員還有我們部長大家午安大家好我剛剛聽了很多那我想在座很多都是來自醫界我們建國委員也講了大家都來行的我們還是這樣講就是說因為我們來自於地方我們看到情形其實是我們醫護人員確實嚴重不足我們最常面對的問題就是常常我們的鄉親要到醫院 |
| transcript.whisperx[306].start |
9202.923 |
| transcript.whisperx[306].end |
9228.774 |
| transcript.whisperx[306].text |
都沒有病床這是我們面臨最大的問題那為什麼會有這些問題當然就是我們醫護人員的嚴重不足那醫護人員為什麼不足就是薪水不夠我要這樣講就是說我們培養一個醫護人員其實是非常也是要一段時間也是要一段時間才會有一個優秀的一個醫護人員那如果因為我們今天的政策不一樣導致我們的醫護人員 |
| transcript.whisperx[307].start |
9230.615 |
| transcript.whisperx[307].end |
9232.236 |
| transcript.whisperx[307].text |
剝削防制條例部分條例部分條例部分 |
| transcript.whisperx[308].start |
9250.026 |
| transcript.whisperx[308].end |
9251.306 |
| transcript.whisperx[308].text |
等19人等19人等19人等19人等19人等19人 |
| transcript.whisperx[309].start |
9272.532 |
| transcript.whisperx[309].end |
9297.191 |
| transcript.whisperx[309].text |
不要講說健保破產我們全民健保這個政策將沒有辦法再執行我想這面臨的問題是越來越嚴重就像我打個比方就是我們前陣子這個永豐化學它是做這個生理實驗水的它現在跟醫護人員沒有關係但我打個這個比方就是說我們從因為健保一直砍價砍一直砍從一包點滴從20年前的56.7砍到剩下25.6比礦泉水還低啊 |
| transcript.whisperx[310].start |
9302.755 |
| transcript.whisperx[310].end |
9324.586 |
| transcript.whisperx[310].text |
那造成這個問題之後然後我們國內的廠商沒辦法活下去我們會要花更多的錢兩三倍的價格去外面採購我想醫護人員同樣是會面臨到這個問題假如不夠的時候是不是我們要將會面臨更多的成本去來做這個事情我想部長這邊待會我也希望大家能夠 |
| transcript.whisperx[311].start |
9325.326 |
| transcript.whisperx[311].end |
9338.792 |
| transcript.whisperx[311].text |
認真的來考量這個問題我們是來解決問題不是製造問題因為碰到問題的我們發現問題的就是把它提出來希望大家一起來解決以上報告 謝謝好 謝謝接下來我們請廖偉強委員好 |
| transcript.whisperx[312].start |
9341.996 |
| transcript.whisperx[312].end |
9355.113 |
| transcript.whisperx[312].text |
在場所有委員、同仁、主席還有我們的部長以及所有相關部會的同仁簡單來講我想大家應該也聽得蠻多健保已經到了不得不改的時候可是其實已經拖了很久所以要改也拖了很久 |
| transcript.whisperx[313].start |
9355.774 |
| transcript.whisperx[313].end |
9368.845 |
| transcript.whisperx[313].text |
那當然今天說要保障一點議員我想這個是姿勢體大的確不是修一條法或是硬要做這件事情就一定就是就沒有要考量其他的部分可是我想這段時間以來這個醫療體系發生的問題還有這個所有醫護、血汗醫護等等的問題大家都知道 |
| transcript.whisperx[314].start |
9376.411 |
| transcript.whisperx[314].end |
9400.494 |
| transcript.whisperx[314].text |
所以我們其實今天討論這裡就是希望有一個具體的方案那像我們在像我本期在今年會期剛出的時候其實是有提一個健全醫療法人特別條例這個部分呢其實那個時候是希望保障0.95可是用的是這個特別的預算就是也就是另外用特別預算來打這個強行針為期三年的部分 |
| transcript.whisperx[315].start |
9401.095 |
| transcript.whisperx[315].end |
9430.197 |
| transcript.whisperx[315].text |
好那當時提出來的確你們行政單位也有各種的問題甚至攻擊可是我想要講的事情就是在野黨提出一些解方希望你們可以去看有沒有辦法我們的行政院也提出衛福部也提出個相應可以解決現在問題的方案可是看起來是並沒有的所以今天才會開到這個會來所以基本上我們想要講的事情是這些醫護醫療體系先倒最終其實倒楣的是人民所以在這裡希望我們衛福部可以盡速 |
| transcript.whisperx[316].start |
9431.318 |
| transcript.whisperx[316].end |
9437.742 |
| transcript.whisperx[316].text |
到時候來協商提出一個大家可以滿意怎麼樣在這個時間裡面解救我們醫療體系面對的問題的一個方案那謝謝以上好那剛剛委員有特別提到其實很希望說今天衛福部其實可以提一個比較具體的 |
| transcript.whisperx[317].start |
9449.485 |
| transcript.whisperx[317].end |
9478.001 |
| transcript.whisperx[317].text |
你們怎麼來說服大家的你們改善的做法那因為剛剛部長報告都是方向性的就是沒有你的短中長期你會改善到什麼程度是方案還沒有準備好還是還沒有拿出來因為我記得上次這個石署長的時候已經有講到一些比較具體的東西結果今天那具體的東西又不見了那所以這個不曉得是你們內部到底有沒有持續討論 |
| transcript.whisperx[318].start |
9479.372 |
| transcript.whisperx[318].end |
9500.466 |
| transcript.whisperx[318].text |
現在到什麼階段?是不是部長可以回應一下?因為剛剛有多位委員都一直很想知道說你們真正比較具體的想法要怎麼做?謝謝主席,謝謝各位委員先進真的我是非常的感動大家為人民的健康的努力各位都知道幾個月前 |
| transcript.whisperx[319].start |
9501.894 |
| transcript.whisperx[319].end |
9525.052 |
| transcript.whisperx[319].text |
我的位置是跟你們一樣的那我蘇星騰理事起理事長當過前聯會的理事長他的英俊的肖像還掛在那個牆壁上我是他後面的啦我因為表現不好所以我到現在都還沒掛表示說我們都是一起為人民在 |
| transcript.whisperx[320].start |
9526.058 |
| transcript.whisperx[320].end |
9540.427 |
| transcript.whisperx[320].text |
在努力啦,那我們真的上任,至少上任以來我們的行政部門絕對沒有一天連半夜做夢都在想說要怎麼解決這個問題啦,今天大家一樣啦,我們當然要考慮整個國家的發展,當然剛才說得很好,你如果醫療垮掉什麼就不用說了嘛, |
| transcript.whisperx[321].start |
9551.283 |
| transcript.whisperx[321].end |
9580.125 |
| transcript.whisperx[321].text |
所以這是醫療絕地不能讓我看到我希望為總統、鄉親、議長大家也這樣想你說我心裡這段時間有什麼一直在研究,一定要研究可行性所以我心裡先拜託我們的署長先說說我們最近因為你昨天有報告過今天講的是不是有更已經去跟行政院各部門大家溝通的 |
| transcript.whisperx[322].start |
9580.626 |
| transcript.whisperx[322].end |
9583.973 |
| transcript.whisperx[322].text |
比較具體的一些方案可不可以給大家報告一下 |
| transcript.whisperx[323].start |
9590.905 |
| transcript.whisperx[323].end |
9614.54 |
| transcript.whisperx[323].text |
趙偉還有各位委員還有部長、次長這個因為有一些目前大家都知道說目前正在籌編明年度預算所以最後的確實是多少的金額大概還沒有辦法跟各位報告但是大概幾個方向上我們現在已經在進行中的也跟大家報告就是說在這個 |
| transcript.whisperx[324].start |
9617.482 |
| transcript.whisperx[324].end |
9635.276 |
| transcript.whisperx[324].text |
典值要讓他這個能夠提升那我們所採取的近期當然就是希望說讓這個一屆的付出能夠得到適當的這個回饋所以這個典值的提升當然是第一個要務所以我們在做法上是第一個是把這個總額內部 |
| transcript.whisperx[325].start |
9637.397 |
| transcript.whisperx[325].end |
9658.266 |
| transcript.whisperx[325].text |
有一些支出項目比較偏向公共衛生的改以公務預算來支應這樣的話相對的支出的項目變少但是這些服務不減改由公務預算來支應所以這個是第一項的策略因為目前正在跟行政院爭取中確實的 |
| transcript.whisperx[326].start |
9660.247 |
| transcript.whisperx[326].end |
9686.435 |
| transcript.whisperx[326].text |
這個預算如果編列下來之後我們就可以去精算的去這個計算對點子的影響所以這個是第一個那第二個當然還有一部分是屬於這個癌藥的這個我們叫做癌症新藥基金的設立那當然這個基金的設立呢它還涉及到很多法規的事情那不過呢我們也積極的跟行政院在爭取因為我們從 |
| transcript.whisperx[327].start |
9687.755 |
| transcript.whisperx[327].end |
9702.916 |
| transcript.whisperx[327].text |
今年的總流裡面邊有暫時性支付就是對於我們未來癌藥基金那麼要這個扮演的這個角色對這個一些癌症的新藥那確實有臨床上的 |
| transcript.whisperx[328].start |
9704.177 |
| transcript.whisperx[328].end |
9724.094 |
| transcript.whisperx[328].text |
極破需求,但是臨床的試驗報告或療效上或財務衝擊上,上有一些不確定性的,我們在今年就是用總額的專款,就是暫時薪資部分在支應,這個未來 |
| transcript.whisperx[329].start |
9725.976 |
| transcript.whisperx[329].end |
9748.971 |
| transcript.whisperx[329].text |
那麼明年度我們也在爭取那麼變成是另外一筆由公務預算那麼所支應的這個新藥基金那這樣也會讓總額內部有一些的這個財務壓力那麼由公務預算來支應那這個對這個點值的提升那麼也有它的幫忙那麼這個是在 |
| transcript.whisperx[330].start |
9750.912 |
| transcript.whisperx[330].end |
9767.782 |
| transcript.whisperx[330].text |
第二部分當然還有近期我們也在討論的對於偏鄉因為如果說一致性的保障點子那就會擔心影響到偏鄉的排擠也就是說你在資源豐沛的地方一樣保障 |
| transcript.whisperx[331].start |
9768.902 |
| transcript.whisperx[331].end |
9789.766 |
| transcript.whisperx[331].text |
1.1億元。偏鄉也是1.1億元的結果,勢必就會造成偏鄉的資源會排擠得更嚴重,更不容易包含找尋的醫護人員跟經營的困境會更嚴峻。所以我們在下半年,我們現在也已經通過總額的討論,會先針對 |
| transcript.whisperx[332].start |
9796.668 |
| transcript.whisperx[332].end |
9804.781 |
| transcript.whisperx[332].text |
醫療資源不足地區的所謂燈塔型醫院來做點子的保障,包含適當成長的總額保障。 |
| transcript.whisperx[333].start |
9808.905 |
| transcript.whisperx[333].end |
9825.231 |
| transcript.whisperx[333].text |
考量的是不只是點子的保障因為在這些地區往往面臨的是人口外流所以在減少的情況之下服務量也會下降所以即使保障這個一定的總額也不見得一點一元給他保障也不見得他能夠這個 |
| transcript.whisperx[334].start |
9827.092 |
| transcript.whisperx[334].end |
9828.052 |
| transcript.whisperx[334].text |
等19人等19人、委員蔡易餘等19人、委員 |
| transcript.whisperx[335].start |
9843.357 |
| transcript.whisperx[335].end |
9862.156 |
| transcript.whisperx[335].text |
近期在進行中的當然長期的部分中長期的部分像剛剛部長也特別提到全能照顧分級醫療居家醫療我們也都在今年下半年開始都會陸陸續續的推出上路 |
| transcript.whisperx[336].start |
9863.537 |
| transcript.whisperx[336].end |
9878.507 |
| transcript.whisperx[336].text |
整個醫療資源的使用讓它更適切性那麼也會有助於這個點子的保障所以我想先簡單的說明如果有需要我們再送完整的書面報告再給委員會來參考 |
| transcript.whisperx[337].start |
9881.338 |
| transcript.whisperx[337].end |
9906.785 |
| transcript.whisperx[337].text |
謝謝署長我想我們那個所有的項目可以做的一定都是所有的部門都會想一直去研擬然後要溝通啊大家也知道政府是一個大機器我們每年要什麼預算今年也要寫好你不寫就什麼也沒有所以我們最近當然是把預期可能我們明年要爭取到的譬如說我們把公務預算 |
| transcript.whisperx[338].start |
9907.885 |
| transcript.whisperx[338].end |
9933.235 |
| transcript.whisperx[338].text |
原來是應該用公衛生、用的健保、清清的,這邊我們還要清潔,清潔還要跟國發會這邊溝通,行政會會裁員分配。所以你說要叫我一聲就一聲,當時當時,那個,如果你站在政府的一個,即使再有效率的政府也願意幫忙,他還是有一定的制度要去, |
| transcript.whisperx[339].start |
9933.915 |
| transcript.whisperx[339].end |
9956.108 |
| transcript.whisperx[339].text |
要去進行,但是絕對其實說每天都必須要去行政院開會一直在協調怎麼樣把相關的事情做好其實那個署事長提的事情可以提的事情可以講三點鐘,可能講不完那個是不是我還是請我們最關心這個 |
| transcript.whisperx[340].start |
9957.91 |
| transcript.whisperx[340].end |
9969.402 |
| transcript.whisperx[340].text |
農主席同意那個請林次長他也長期以來也關心很多急重症也很瞭解醫界的心聲可不可以給他有機會講一下好來我們請次長 |
| transcript.whisperx[341].start |
9974.107 |
| transcript.whisperx[341].end |
9997.213 |
| transcript.whisperx[341].text |
好 謝謝主席 謝謝部長、署長還有在場我們所有大院的委員那也跟大家報告說說其實我們都來自醫界我們大家心情都一樣甚至我們以後也要回去醫界所以如果整個系統做得不好我們以後再回去那個場域也都會非常辛苦其實像現在在跟我們反映現況的都是我們自己在醫療界的弟兄姊妹大家都希望說能夠 |
| transcript.whisperx[342].start |
9997.993 |
| transcript.whisperx[342].end |
10000.014 |
| transcript.whisperx[342].text |
等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人 |
| transcript.whisperx[343].start |
10015.462 |
| transcript.whisperx[343].end |
10030.308 |
| transcript.whisperx[343].text |
協會先見了面。地區醫院他們就表示說,他們其實最擔心的事情是,老實說,對啊,署長意思是這樣,地區醫院它即使是一點醫院,你制度沒有給它處理好,他們跟旁邊的醫學中心、大醫院相衝,他們還是非常辛苦。 |
| transcript.whisperx[344].start |
10031.208 |
| transcript.whisperx[344].end |
10055.81 |
| transcript.whisperx[344].text |
所以如何先保障在整個製度裏面不可以或缺但是它的服務必須要能夠維持的這些意願這個我們在製度裏面一定要非常小心也都要講到我們如果起頭的平衡都下去的時候那現行的都沒有改最擔心的事情是某些我們比較困難的這些部分怕會受到影響所以這個部分我們也正在積極檢討如何協助尤其是像我們上次來跟我開會的時候包含說 |
| transcript.whisperx[345].start |
10059.094 |
| transcript.whisperx[345].end |
10075.593 |
| transcript.whisperx[345].text |
張華在園林市可能醫院的量還夠可是只要一出到南彰化可能一斤而已我們在很多地方像這樣的燈塔型醫院甚至包含台北跟新北燈塔型醫院他們也跟我報告過他們也跟我抱怨過說因為典值的大醫院它的這個磁吸太強 |
| transcript.whisperx[346].start |
10076.794 |
| transcript.whisperx[346].end |
10102.228 |
| transcript.whisperx[346].text |
結果他燈塔型醫院再怎麼樣努力他這邊他們都會一直在虧損狀態但是這些燈塔型醫院真的不能讓他沒有因為他真的是照顧我們最醫療資源最缺乏的這些醫院所以整個制度上面我相信大家的目標都一樣讓健保可以永續讓醫療服務可以拿到應該有的這些資源但是這個過程中我想也不可能是說我們做一條就可以馬上完成的 |
| transcript.whisperx[347].start |
10102.788 |
| transcript.whisperx[347].end |
10120.82 |
| transcript.whisperx[347].text |
那其實像今年的這個健康台灣論壇也談過很多科都說希望能夠確保他們的點子比方說在沒有辦法完全平衡的情況之下那有的科就會說那我們的很重要一定要保障我們但是在這種狀況之下我們如何能夠從制度裡面去做一些處理 |
| transcript.whisperx[348].start |
10121.801 |
| transcript.whisperx[348].end |
10137.608 |
| transcript.whisperx[348].text |
那也謝謝委員這邊其實過去都一直很支持我們做分級醫療分級醫療從2016年我們開始那個時候小英政府上來之後我們就開始推分級醫療我們有一段時間也真的開始逐漸落實上下轉的這個制度 |
| transcript.whisperx[349].start |
10138.388 |
| transcript.whisperx[349].end |
10161.225 |
| transcript.whisperx[349].text |
但是因為2020年遇到疫情所以到2022年這段時間整個分級醫療制度的部分比較沒有辦法落實那疫情終於過了之後其實現在很多基層也跟我們要求很多的尤其是其實是地區跟區域醫院也都希望說我們可以趕快再回到分級醫療制度裡面那其實也跟大家報告健保體質跟健保總額絕對跟分級醫療制度有關 |
| transcript.whisperx[350].start |
10162.386 |
| transcript.whisperx[350].end |
10191.078 |
| transcript.whisperx[350].text |
我們都講過非常多次如果這樣同樣的糖尿病控制它可以在地區醫院或是在基層醫療控制那病人就不用到大醫院去可以減少很多大醫院的庸塞也跟各位委員報告各位委員在關心急診庸塞的部分昨天下午我也跟醫事司到相關的兩個幾乎是我們北部急診比較庸塞的地方那帶床的部分其實庸塞我們相信我們在臨床都知道最庸塞帶床通常都是禮拜一 |
| transcript.whisperx[351].start |
10191.798 |
| transcript.whisperx[351].end |
10218.584 |
| transcript.whisperx[351].text |
因為禮拜六禮拜天的很多床是預定手術的人會先住進去但是病人很多時候禮拜一到禮拜五沒有去就診他到禮拜六他才要去醫院的時候沒有門診了結果這個時候反而這些病人就塞在急診所以我們也跟地方的醫院討論我們也跟這些醫院討論過如何在制度裡面鼓勵民眾在我們醫療的門診服務都還有的情況之下盡量在門診服務不要再塞在我們的急診 |
| transcript.whisperx[352].start |
10219.104 |
| transcript.whisperx[352].end |
10219.404 |
| transcript.whisperx[352].text |
等19人等19人、委員 |
| transcript.whisperx[353].start |
10236.96 |
| transcript.whisperx[353].end |
10255.946 |
| transcript.whisperx[353].text |
我們昨天也跟他們承諾說我們要有一些比較自動化的系統什麼叫自動化的系統?就是區域聯防的概念我們之前其實健保署也提過區域聯防我們當然希望不要單純只有一家醫院在承擔所有急重難症所以我們現在在制度裡面也希望能夠更加平衡我們能夠處理急重難症的這些醫療機構 |
| transcript.whisperx[354].start |
10257.026 |
| transcript.whisperx[354].end |
10281.506 |
| transcript.whisperx[354].text |
但是急救難症救護車要把急救難症的病人送到哪裡救護車能不能在送病人之前知道說這些醫院現在緊急狀況之下他的人力已經正在急救某些病人他可能在周邊的其他醫院類似的路程可以送的過去來減少擁捨在同一個醫療院所內部然後造成醫療院所的這些醫療人員的這個服務的量能大量的突然出現 |
| transcript.whisperx[355].start |
10282.527 |
| transcript.whisperx[355].end |
10299.349 |
| transcript.whisperx[355].text |
盡量均衡,我相信是我們希望能夠達到的。在製隊裡面,這個真的是衛福部的責任,我們要來處理。那我們部長最清楚,我們其實一直希望能夠再更加的強化嘉義制度。部長一直就講,要每一個人、每一個民眾都覺得自己有一個自己的嘉義科醫師啦。 |
| transcript.whisperx[356].start |
10300.11 |
| transcript.whisperx[356].end |
10323.817 |
| transcript.whisperx[356].text |
有自己的家醫科醫師其實那個精神就是平常就有被醫生照顧到他才可以避免不用到急診去擁捨這個是我們也在接下來就是說疫情過後重新來把分級醫療制度去做的處理那在健保資源的部分其實委員們也都知道我剛提到了檢查的分級醫療這是我們在之前也曾經提過那當然在對病人最小衝擊對病人的醫療就醫習慣 |
| transcript.whisperx[357].start |
10325.978 |
| transcript.whisperx[357].end |
10344.733 |
| transcript.whisperx[357].text |
不要讓他影響最大的情況的最小的情況之下我們來慢慢來做這種檢查的分級那也感謝委員們的支持之前我們讓檢查的這些資料都有上傳讓很多的醫療院所也可以去查那可以避免一些健保的重複檢查的部分這些持續我們會再把它優化 |
| transcript.whisperx[358].start |
10345.353 |
| transcript.whisperx[358].end |
10373.067 |
| transcript.whisperx[358].text |
那其實在這段時間有一個部分是我們的商保補位健保那我相信很多委員可能由於在場很多是專業的委員都知道過去很多商保是疊加在健保的上面健保有幾副商保才幾副可是這樣回過頭來會變成民眾他們其實會把很多商保應該負擔的壓力進到我們健保裡面來所以商保跟健保之間如何互相不要讓健保這邊受到商保的這個影響反而增加我們健保裡面的支出 |
| transcript.whisperx[359].start |
10373.847 |
| transcript.whisperx[359].end |
10393.838 |
| transcript.whisperx[359].text |
這個在節流的部分我們會特別在接下來繼續努力那其實大家的立場都一樣我們其實就是朝點子的點子能夠友善再來的話我剛剛提到多元微調就是公務預算的部分那讓公務預算的支應能夠把原來健保應該回到健保的部分這個我們正在跟行政院做最大的努力 |
| transcript.whisperx[360].start |
10394.358 |
| transcript.whisperx[360].end |
10416.557 |
| transcript.whisperx[360].text |
那大家所關心的人力的部分我相信在場大家也都曉得其實不只是醫療界啦很多的產業界年輕人對於我們講的Working Life Balance這件事情其實是跟我們這個年代不太一樣所以也跟大家報告我們在這段時間跟醫療這邊有做了一些討論那很多第一線的醫療人員跟我們講就是 |
| transcript.whisperx[361].start |
10417.737 |
| transcript.whisperx[361].end |
10440.391 |
| transcript.whisperx[361].text |
現在的這些醫療人員尤其是護理師還有很多年輕的組織醫師他們不是不在這一行是他們轉到這一行裡面的其他科以昨天我們聽到的就是很多他們都到診所去了因為診所的生活比較能夠平衡收入可能跟在大醫院差不多可是診所的生活比較能平衡 |
| transcript.whisperx[362].start |
10440.971 |
| transcript.whisperx[362].end |
10466.579 |
| transcript.whisperx[362].text |
那這邊我們也在醫師室還有我們接下來還有其他的一些單位我們要處理的,包含如何讓留在醫院裡面的這些醫療人員可以減少他們的某些負擔,包含大家一直個病的、貧健的文書項目等等,那引用一些新的科技能夠減少護理人員跟醫師他們在很多文字記錄裡面可以減少這些loading,減少我們在過去醫療管理上面對他們的負擔。 |
| transcript.whisperx[363].start |
10468.08 |
| transcript.whisperx[363].end |
10480.258 |
| transcript.whisperx[363].text |
報告有點長那簡單來說我們也肯定也跟各位委員的立場都一樣減少一些沒有必要的負擔然後健全應該有的服務好謝謝那接下來我們請陳昭志委員發言 |
| transcript.whisperx[364].start |
10483.225 |
| transcript.whisperx[364].end |
10507.505 |
| transcript.whisperx[364].text |
謝謝主席。我們先用重點式討論,不要一般式的整個描述。第一個,健保法第三條,請問石署長,但你不是說政府每年負擔本保險的總經費不得少於每年保險作者,經費扣除法定收入金額是36%。就是說扣除36%之後,事實上是要由主管機關編列撥補。這個我解讀沒有錯吧。我先,我好好的解點。 |
| transcript.whisperx[365].start |
10511.387 |
| transcript.whisperx[365].end |
10528.755 |
| transcript.whisperx[365].text |
事實上本來就有這個法規就不足的部分本來中央就要撥補這個預算不好意思這是第一個健保法第三條等一下麻煩你說明一下 |
| transcript.whisperx[366].start |
10533.461 |
| transcript.whisperx[366].end |
10539.201 |
| transcript.whisperx[366].text |
二、新藥預算增加暫時性支付等於今年多了兩倍 |
| transcript.whisperx[367].start |
10540.543 |
| transcript.whisperx[367].end |
10569.653 |
| transcript.whisperx[367].text |
大概五、六十億嘛對不對就是加起來五、六十億過去大概二、三十億合計嗎?委員如果說是合計我們新藥新科技去年是三十億今年是七十億但是這裡面包含還有含藥還包含含藥跟那個那個含藥本身就是七十億那是另外一個獨立的預算是那個那個醫材啦就是新技術的部分就是一直對這個都是總的算我了解但是就是今年增加兩倍署長 |
| transcript.whisperx[368].start |
10570.393 |
| transcript.whisperx[368].end |
10595.365 |
| transcript.whisperx[368].text |
整個審查的方式完全沒有改變還是跟以前一樣的非常的嚴酷非常的一動不動就是砍價動不動就是溢價溢不成然後還有這個不合理的那種CAP當然我知道源頭的問題就是還是總共是不夠可是即便你今年增加為兩倍Total增加新藥新科技但是整個審查方法是沒有改變我供署長參考署長就是有一些 |
| transcript.whisperx[369].start |
10595.905 |
| transcript.whisperx[369].end |
10612.596 |
| transcript.whisperx[369].text |
如果你有新的來源或新的資源你其實有時候要跟委員們或是你的屬下稍微說明一下要reflect這件事情我上次去開會就沒有人知道這件事情第三個偏差點子等等我想等一下請署長也先解釋一下為什麼西醫基層他從107年到113年 |
| transcript.whisperx[370].start |
10616.799 |
| transcript.whisperx[370].end |
10636.211 |
| transcript.whisperx[370].text |
經過疫情這個我們可以了解那個點子都不是能夠具有參考性那為什麼在113年他的點子降的比107年還多很多而且你這個是已經都攤扣都處理掉這個數字的差異拜託等一下署長也跟我們說明一下為什麼會是這個樣子 |
| transcript.whisperx[371].start |
10641.495 |
| transcript.whisperx[371].end |
10665.011 |
| transcript.whisperx[371].text |
主導您上次告訴我說門診65%、住院35%當然我們不否認現在很多醫療進步可能可以在門診治療這個你當然也要評估進去當然門診零很多癌症、癌藥等等標靶療法也許相對費用比較高這個你都可以再去做分析但是基本上這麼大的門診量那你要落實醫療分級 |
| transcript.whisperx[372].start |
10670.334 |
| transcript.whisperx[372].end |
10696.822 |
| transcript.whisperx[372].text |
醫療分級現在根本就完全死掉啦在哪來的醫療分級你地區醫院從600家健保開辦到現在剩300家根本就腰斬啦這個根本沒有醫療分級醫療分級可言啦那醫學中心都還在增加區議院也拼命增加整個醫院評鑑是部長是您管的這個整個醫事師的醫車會委辦這個我要求以後醫院評鑑不是只公佈誰合格誰合格名單我們要分數 |
| transcript.whisperx[373].start |
10697.682 |
| transcript.whisperx[373].end |
10719.753 |
| transcript.whisperx[373].text |
我們也要整個衝擊的報告就是說做完一次醫院評鑑我們今年增加了三家醫學中心然後我們會影響什麼等等等等我們地區院又少了等等就是說他要有一個全面性的報告不是那麼簡單的做完以後大家都在猜測然後我上了沒上還是不要再搞什麼辨識度不足這個東西不要再來 |
| transcript.whisperx[374].start |
10723.478 |
| transcript.whisperx[374].end |
10740.784 |
| transcript.whisperx[374].text |
門診的地方還有一條法規,不然你有本事就把它改掉,只是要不給付那你就放了30年都沒有動,當然署長我不是在怪你,這個只是要不給付的是大家都不談今天很多敏感性的問題都不談,那只是要如果只要病人少一次就醫 |
| transcript.whisperx[375].start |
10742.403 |
| transcript.whisperx[375].end |
10760.711 |
| transcript.whisperx[375].text |
在社區要求做明明大家就告訴我前署長、前前署長也都告訴我們說只要少一次就醫就少掉300多億但是大家都避談不要去談這個真相那裡法又在那個地方所以這件事還是要去面對那剛剛好像不曉得是次長還署長有說雖然是7.2 |
| transcript.whisperx[376].start |
10763.632 |
| transcript.whisperx[376].end |
10779.259 |
| transcript.whisperx[376].text |
7.2的數字有問題喔,我們那個NHE是有問題的喔我們明明就是6.1,那薛部長他後來把長照加進去變成7.5但是7.5比起,隨便講一個國家,韓國好了,大家都以前看不太起的國家我們6.1的時候他是8捏,我們7.2、7.5的時候他是9.8欸 |
| transcript.whisperx[377].start |
10785.472 |
| transcript.whisperx[377].end |
10804.167 |
| transcript.whisperx[377].text |
就是這個東西整個健康投資的不足一直都是存在而且分歧醫療從醫院評鑑看根本逆著走啊逆著走啊醫學東西越來越大大家一直蓋醫院啊病床越來越多這個東西不漲我們還是要去面對啦你真的要改革就要去面對這個問題啦賺錢的醫院還是有 |
| transcript.whisperx[378].start |
10807.691 |
| transcript.whisperx[378].end |
10826.094 |
| transcript.whisperx[378].text |
但是辛苦的醫院還是更多這個基本上這個要去調一下這個在醫院評鑑這個部分不是一時能夠調整的但是請不要再犯這個去年底到今年初的一個錯誤又增加而且是在北區最不缺醫療資源的地方本來200萬人要有一家醫學中心 |
| transcript.whisperx[379].start |
10826.955 |
| transcript.whisperx[379].end |
10850.055 |
| transcript.whisperx[379].text |
現在已經爆得一塌糊塗我質詢薛部長他竟然回答我說前面的人也沒有這樣做這是什麼話別人沒遵守我就跟著不遵守而且加碼下去這個不是這樣子談問題的啦那就是我等一下看看能不能今天我就了解一下那個署長就是說為什麼西醫基層會比當時疫情之前猛掉那麼多 |
| transcript.whisperx[380].start |
10850.975 |
| transcript.whisperx[380].end |
10869.509 |
| transcript.whisperx[380].text |
那當然又回到這個浮動點值跟平均點值的事情以後是不是可以讓我們知道真相就是說你越讓大家知道真相你的困難度在那裡其實委員們更能夠幫你去爭取或是處理這些事情那也請部長您多看看我現在還背得出來健保開辦的時候醫學中心12家區域醫院48家 |
| transcript.whisperx[381].start |
10875.333 |
| transcript.whisperx[381].end |
10878.174 |
| transcript.whisperx[381].text |
地區醫院615家,但是25年後醫學中心26家,區醫院84家,地區醫院剩315家請你看看那個圖形會長成什麼樣子所以那個分級醫療,大家都在,三位都會談到分級醫療 |
| transcript.whisperx[382].start |
10892.381 |
| transcript.whisperx[382].end |
10917.419 |
| transcript.whisperx[382].text |
沒有啦,台灣的一分角已經崩潰了,你要不要救?那你不救醫療,那極難重鎮,那就是要大的醫院來承擔啊所以你的問題永遠存在啊那我提到要價差,大家都會躲,每個人都在躲要價差要價差,你要提高醫療的點子,因為他們過去是因為你沒有給他合理的支付他們不得不去使用這個要價差,要價差故意邱部長,我可以幫你問問嗎?要價差現在多少錢? |
| transcript.whisperx[383].start |
10921.121 |
| transcript.whisperx[383].end |
10924.083 |
| transcript.whisperx[383].text |
他知道差不多多少嗎?時俗上你又在...我跟你說啦,六百億跑不上去啦,六百億跑不上去啦。這個部分,你只要把點子弄高就很靠近了啦。你如果每個人這樣一次這個看小病的時候, |
| transcript.whisperx[384].start |
10936.693 |
| transcript.whisperx[384].end |
10959.186 |
| transcript.whisperx[384].text |
那個社區藥水水準很高啊,而且你法在那個地方啊,那邊就減370多億啊,欠債也一千億,有夠了啦所以說很多事情,所以說我知道我要給部長跟這個時間嘛,就是說我要給你們時間就是說,你一定有個優先資訊,你要怎麼做,然後你做的時候你有個時辰沒有人會期待30年問題一夕解決,沒有人會這樣子的 |
| transcript.whisperx[385].start |
10962.529 |
| transcript.whisperx[385].end |
10976.269 |
| transcript.whisperx[385].text |
但是我剛剛點的那些問題他就一直在嘛 署長你多擔待一點啦那個你先解釋一下幫我們解釋一下為什麼那個點子會這樣落差這麼大呢好 謝謝陳昭志委員 那個署長可以回應嗎 |
| transcript.whisperx[386].start |
10978.57 |
| transcript.whisperx[386].end |
10987.493 |
| transcript.whisperx[386].text |
謝謝主席還有陳委員的這個槌尋因為有幾個因為您提了好多個問題我逐一答覆一個是36%健保法第三條的問題那麼這個36%是這樣子計算就是先以這個 |
| transcript.whisperx[387].start |
10994.635 |
| transcript.whisperx[387].end |
11011.014 |
| transcript.whisperx[387].text |
顧主跟民眾自己所付的這些保費,那它的佔率就是等於是64,然後回推成整個大的健保應該多少收入,然後再扣除掉,那麼政府已經依法, |
| transcript.whisperx[388].start |
11011.835 |
| transcript.whisperx[388].end |
11032.25 |
| transcript.whisperx[388].text |
之初的部分不足數那麼再補所以舉例而言在111年那麼政府另外結算後補了883億到健保基金那112年就再補了937億因為那個補充保費比較高所以他就會推估推升整個 |
| transcript.whisperx[389].start |
11032.95 |
| transcript.whisperx[389].end |
11055.618 |
| transcript.whisperx[389].text |
大餅所以他就在這個行政院這邊的結算之後再補進來的就提升了就是937億所以每年都是這樣計算那剛剛部長所提到的是說未來我們為了讓這個健保的餅更大這裡所謂的這個36%政府應負擔的部分只是採記這個健保法裡面規定 |
| transcript.whisperx[390].start |
11056.698 |
| transcript.whisperx[390].end |
11074.203 |
| transcript.whisperx[390].text |
而不要把其他涉伏政府負擔的部分也算進,不然的話就會讓這個政府要再挹注的部分就會下降了。所以這個是剛剛講的這個36%的部分,過去每年行政院都會在結算之後另外剝入。 |
| transcript.whisperx[391].start |
11075.043 |
| transcript.whisperx[391].end |
11090.963 |
| transcript.whisperx[391].text |
不足36%,不足數。未來我們現在在檢討36%的採計基礎以在健保法裡面規定為限,避免受到其他法律的影響而造成政府36%的計算基礎下降。 |
| transcript.whisperx[392].start |
11093.186 |
| transcript.whisperx[392].end |
11105.297 |
| transcript.whisperx[392].text |
何處長這個部分就因為連健保委很多成員的計算的認知都不一樣了解我們要清楚是那第二個呢就是那個門診的點子為什麼這個陳偉業應該關心的是112年還是113年因為113年現在才第一季過去出來因為是應該是112年那112年的點子 |
| transcript.whisperx[393].start |
11118.647 |
| transcript.whisperx[393].end |
11145.296 |
| transcript.whisperx[393].text |
對、對、對、點子當然它相較於就是疫情前108年之所以下降大概我們看起來有兩個主因那麼一個當然是因為服務量的增加服務量的增加就是有疫情的關係那麼跟108年這些類流感包含COVID還有流感等等這些類流感的病人的人數確實是增加所以這個一個是人次所影響 |
| transcript.whisperx[394].start |
11146.856 |
| transcript.whisperx[394].end |
11175.328 |
| transcript.whisperx[394].text |
這次這個量的部分那另外有一個呢是這個單價的影響單價的影響就是來自於我們剛剛提的分級醫療其實過去這個在基層這些診所那麼開出的慢性處方籤的比例是增加的因為過去呢多數這個不是慢性處方籤我們用日資藥費那但是如果你是慢性處方籤那就是每一個藥 |
| transcript.whisperx[395].start |
11176.528 |
| transcript.whisperx[395].end |
11204.014 |
| transcript.whisperx[395].text |
逐筆申報所以他那個單價就會提高所以剛剛提到點子會下降就兩個一個是因為受到COVID流感的影響的人次的增加那這些一般是用日資藥費而已這是量的影響第二個是單價的影響主要是來自於這個藥費的成長也就是本來在醫院拿慢性處方簽的轉移到診所這個大概從疫情當中就開始移動 |
| transcript.whisperx[396].start |
11205.454 |
| transcript.whisperx[396].end |
11229.2 |
| transcript.whisperx[396].text |
讓在基層診所看慢性病拿慢性處方鉛的比例已經成長超過到40我記得是42%了所以從過去就成長上來那這個會造成藥費的增加在基層診所藥費增加就會造成他點子的下降因為藥費是1.1元所以會造成浮動點子的下降所以這個在未來我們做總額 |
| transcript.whisperx[397].start |
11230.82 |
| transcript.whisperx[397].end |
11255.071 |
| transcript.whisperx[397].text |
這四度的成長同時要做分配的時候要把這個因素一併考慮進來那這個也是分級醫療的成果這個是我們覺得這個是一個正向的正向的發展那至於說那個量的不預期就是這些流感或者傳染病的不預期那我們另外在這個總和裡面也有一個叫做非預期風險或非預期政策 |
| transcript.whisperx[398].start |
11256.191 |
| transcript.whisperx[398].end |
11283.112 |
| transcript.whisperx[398].text |
調整的費用,那像去年我們就補入了近90億來做這個總額的調控的這個因為受到這個COVID影響的量大概在點值的部分是這樣那第三個您也特別提到說那個新藥那新藥我們現在的這個核准在上半年其實就已經多核准了這個14個新藥再加上這個擴充,我們也在檢討那個擴充 |
| transcript.whisperx[399].start |
11284.893 |
| transcript.whisperx[399].end |
11290.516 |
| transcript.whisperx[399].text |
李彥秀等19人、委員李彥秀等19人、委員李彥秀等19人、委員李彥秀等19人、委員李彥秀等19人、委員李彥秀等19人、委員李彥秀等19人、委員李彥秀等19人、委員 |
| transcript.whisperx[400].start |
11312.227 |
| transcript.whisperx[400].end |
11324.043 |
| transcript.whisperx[400].text |
我瞭解我瞭解委員都不是專家我請他們要當專家不要再當賺錢的人應該他就去評估這個藥是不是有價值該給付那剩下的問題老實說應該屬或願或這個 |
| transcript.whisperx[401].start |
11327.668 |
| transcript.whisperx[401].end |
11346.149 |
| transcript.whisperx[401].text |
所以就是說我們一方面希望跟這個指引去契合我們的幾付盡量跟指引就是這個臨床指引或國際的指引讓他盡量的契合當然一方面我們也必須跟廠商議價那不然的話這個錢再多恐怕也都是不夠的 |
| transcript.whisperx[402].start |
11347.421 |
| transcript.whisperx[402].end |
11374.569 |
| transcript.whisperx[402].text |
那麼再來就是這個門診的佔率那麼確實從我們過去這十年看起來那麼健保的支出那麼到去年的分析大概透析的部分是佔支出的5%那這個已經改善從過去我們那個新發的這個透析病人就是進入要洗腎的病人其實已經開始微幅下降 |
| transcript.whisperx[403].start |
11375.236 |
| transcript.whisperx[403].end |
11394.69 |
| transcript.whisperx[403].text |
那麼累計的洗腎人數也已經開始反轉了所以這個是好事所以我們整個總額在透析支出的部分已經有一點點控制住那現在大概佔5%那另外門診的部分是成長那麼現在住院的部分大概是30%門診的部分是65% |
| transcript.whisperx[404].start |
11397.572 |
| transcript.whisperx[404].end |
11419.98 |
| transcript.whisperx[404].text |
所以這個門診的成長我們也在分析說那這個成長我們現在看起來那麼以這個疫情後跟疫情前來比較確實在這個醫學中心大醫院這邊它的門診是成長的這也就是我們為什麼希望說委員給我們一點時間因為疫情當中先停下來的分級醫療 |
| transcript.whisperx[405].start |
11421.34 |
| transcript.whisperx[405].end |
11423.061 |
| transcript.whisperx[405].text |
等19人等19人等19人等19人等19人等19人等19人等19人等19人等 |
| transcript.whisperx[406].start |
11446.417 |
| transcript.whisperx[406].end |
11465.183 |
| transcript.whisperx[406].text |
成長最多的就是肺癌乳癌這個大腸直腸癌這些剛好跟我們的癌症的這個流行病是大概相似他們當然多數會在大醫院但是另外有一部分是屬於慢性病像糖尿病高血壓那這個我們目前正在做風險分級因為有一些 |
| transcript.whisperx[407].start |
11466.223 |
| transcript.whisperx[407].end |
11482.287 |
| transcript.whisperx[407].text |
這個低風險的確實他應該要往下轉所以我們現在正在擬定策略那麼要開始會跟部長跟次長報告完之後我們會開始來啟動這個門診減量大醫院的這個分級醫療的這個適當的這個門診的處理所以這個大概是在門診的戰略還有一個就是OTC的幾副 |
| transcript.whisperx[408].start |
11493.59 |
| transcript.whisperx[408].end |
11508.158 |
| transcript.whisperx[408].text |
那麼OTC的幾付當然在健保法裡面對於OTC也就是所謂的只是用藥是不給付那但是在健保開辦的時候那麼他就是沿用了當時候的老保那個故事我知道是30年 |
| transcript.whisperx[409].start |
11509.198 |
| transcript.whisperx[409].end |
11537.092 |
| transcript.whisperx[409].text |
那但是也已經檢討到剩下大概在800項左右啦之前就慢慢減下來了那麼一年的藥費支出大概是20億那但是我們去年呢那麼也嘗試的把一些有OTC的把它退出但是就發現有一個問題比如說過去我們大概在講那個人工肋液就是一個最明顯的例子因為人工肋液在健保收窄裡面有指示用藥也有處方藥 |
| transcript.whisperx[410].start |
11537.972 |
| transcript.whisperx[410].end |
11549.73 |
| transcript.whisperx[410].text |
那麼指示用藥比較便宜,處方藥比較貴所以我們把一個人工肋液從這個指示用藥把它不給付之後結果我們的處方用藥大幅成長 |
| transcript.whisperx[411].start |
11550.831 |
| transcript.whisperx[411].end |
11577.019 |
| transcript.whisperx[411].text |
才會造成人工類異的缺貨。反而造成健保的支出增加,我們得不償失,我們本來以為說把這個指示用藥把它排除幾副健保核省錢,結果沒有,支出反而增加,因為還有另外一個是屬於處方用藥的人工類異。所以換言之,如果我們沒有對整個藥品分類整個做檢討, |
| transcript.whisperx[412].start |
11578.439 |
| transcript.whisperx[412].end |
11587.495 |
| transcript.whisperx[412].text |
同時一個類似的成分又有處方藥又有這個指示藥我們單純的把指示用藥排除之後反而造成 |
| transcript.whisperx[413].start |
11589.066 |
| transcript.whisperx[413].end |
11591.929 |
| transcript.whisperx[413].text |
卻要跟我們健保的支出的增加 |
| transcript.whisperx[414].start |
11611.314 |
| transcript.whisperx[414].end |
11635.846 |
| transcript.whisperx[414].text |
永遠沒有辦法解決永遠沒有辦法解決今天的一些問題所以我跟委員報告我們認同應該把OTC回歸到健保法的規定那麼小病就是這個可能要自己照顧啦不過呢這個整個這個哪一些OTC先優先我們退出健保哪一些我們逐步有一些要保留 |
| transcript.whisperx[415].start |
11636.246 |
| transcript.whisperx[415].end |
11664.06 |
| transcript.whisperx[415].text |
向有些是救命的藥他也是OTC比如說一些小孩子的用藥或者是因為他不容易在外面買你能讓他去藥局這個小兒進行的這個我們要給他保留在健保幾戶裡面急救的用藥像活性炭這個是急救藥可是這解毒的解毒劑但是他也是只是用藥這個我們也必須在健保幾戶所以我們會去檢討哪些還是應該留著啊哪一些我們比較 |
| transcript.whisperx[416].start |
11665.04 |
| transcript.whisperx[416].end |
11681.452 |
| transcript.whisperx[416].text |
沒有這個不會有這個轉替代效果出來變成我們支出更高的來出我想那個比較細節評估的部分就不用在委員會裡面做這麼細的一個討論我們今天主要是針對法條的部分做大方向的討論那我想這個5月15號我們已經召開第一次協商 |
| transcript.whisperx[417].start |
11685.922 |
| transcript.whisperx[417].end |
11713.081 |
| transcript.whisperx[417].text |
然後今天是第二次協商那在委員會我們也召開公聽會也有專報也有質詢其實已經做過非常多的意見的交換那所以我建議我們今天的條文跟委員會保留的附帶決議三項我們就送院會處理那有院會那邊是需要再來召集協商好不好委員會討論的部分其實已經非常的多那如果委員沒有意見的話 |
| transcript.whisperx[418].start |
11715.151 |
| transcript.whisperx[418].end |
11738.669 |
| transcript.whisperx[418].text |
好來部長我還是要表示政府跟對醫界的支持衛福部也願意提出承諾來保障醫界的權益第一個就是說一定盡最大的努力讓點子像剛才說的那些我們來做其實 |
| transcript.whisperx[419].start |
11739.873 |
| transcript.whisperx[419].end |
11760.754 |
| transcript.whisperx[419].text |
你不用要求什麼,一點子就一定到一個最重要的程度第二個就是說我們一定會採取多元的微調檢討公共就是說部分應該是由政府公務預算的總額這個一定我們用最快的適度當然這個要一個一個清不是說那個你講現在 |
| transcript.whisperx[420].start |
11764.546 |
| transcript.whisperx[420].end |
11786.857 |
| transcript.whisperx[420].text |
國建署去做一個某一個項目他原來用健保他還是用這樣在做啊我們如果沒有去爭取經費又怎麼樣所以這個都要真的都要一點時間啦齁那童守文百億癌症基金這個看起來是已經可以馬上來來進行了啦齁那另外就是對護理人力政策整備12項策略計畫這個這個28億齁已經行政院已經通過這個請 |
| transcript.whisperx[421].start |
11793.221 |
| transcript.whisperx[421].end |
11819.804 |
| transcript.whisperx[421].text |
這個護理界我們真的也是盡力去爭取另外還有一個很大的就是健康台灣深耕計畫因為我們台灣的很多醫療模式還是要靠大家各位有智慧的前輩們願意去思考你用你的體系你用你的想法去在人才的培育相關的一個社會的責任這樣子來做這個也在爭取可能到五年五百億的一個程度 |
| transcript.whisperx[422].start |
11820.58 |
| transcript.whisperx[422].end |
11844.337 |
| transcript.whisperx[422].text |
那所以我在這邊還是要代表衛福部誠懇的期待說能不能給我們一點時間把這些事情做好以後我們再來看如果做了一段時間比如說做了一年以後如果大家覺得還是必須要用法來做什麼事情那個時候才 |
| transcript.whisperx[423].start |
11846.446 |
| transcript.whisperx[423].end |
11862.155 |
| transcript.whisperx[423].text |
才來把這個法案定下去。衛務部正在就是這樣的一個呼籲跟請求,也請大院委員來裁決。 |
| transcript.whisperx[424].start |
11864.738 |
| transcript.whisperx[424].end |
11886.388 |
| transcript.whisperx[424].text |
謝謝部長還要補充說明嗎根據剛剛我們所做的討論如果有下一次的協商或者是更具體的內容我們再來做往上的處理不知道這樣的提案有沒有機會讓主席再多了解一下謝謝蘇委員 |
| transcript.whisperx[425].start |
11888.397 |
| transcript.whisperx[425].end |
11903.151 |
| transcript.whisperx[425].text |
我是覺得,我們討論很久了,但我們補充回來,今天也真的協商,這是已經久了久了久了久了久了所以,我想應該是,我宴會韓院長來主持,再來做一間協商,看結論如何,我們就來處理 |
| transcript.whisperx[426].start |
11910.558 |
| transcript.whisperx[426].end |
11924.231 |
| transcript.whisperx[426].text |
我們再說一次,同樣是這麼一回事,再說一次也是這麼一回事。我想這個召委的能力也有限,我們已經召開兩次,還沒有辦法有共識,所以我們應該要敦請這個韓院長,由院會層級再來這個召集協商,我想或許更會有一些圓滿的答案。 |
| transcript.whisperx[427].start |
11935.1 |
| transcript.whisperx[427].end |
11950.577 |
| transcript.whisperx[427].text |
那那個...因為那個條文沒有決定就沒有那個...沒有那個附帶決定就沒有辦法處理到一併保留就到...到院會的協商的時候再處理對...好...沒有咧...我之前在買1.2的耶 |
| transcript.whisperx[428].start |
11953.394 |
| transcript.whisperx[428].end |
11973.548 |
| transcript.whisperx[428].text |
NO 1.2楊耀版本1.2在修正動議部長頭很痛因為時間的關係我想我們今天的條文跟委員會保留的附帶決議三項我們就送院會處理今天協商會議到此結束散會謝謝大家 |
| transcript.whisperx[429].start |
11982.247 |
| transcript.whisperx[429].end |
11983.049 |
| transcript.whisperx[429].text |
韓國瑜、韓國瑜、韓國瑜、韓國瑜、韓國瑜 |
| transcript.whisperx[430].start |
12002.126 |
| transcript.whisperx[430].end |
12006.828 |
| transcript.whisperx[430].text |
等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等19人等 |
| transcript.whisperx[431].start |
12032.096 |
| transcript.whisperx[431].end |
12035.323 |
| transcript.whisperx[431].text |
三、四、五、六、七、八、九、一、六、七、八、九、一、六、七、八、九、一、六、七、八、九、一、六、七、八、九、一、六、七、八、九、一、六、七、八、九、一、六、七、八、九、一 |