| IVOD_ID |
160910 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Clip/1M/160910 |
| 日期 |
2025-05-01 |
| 會議資料.會議代碼 |
委員會-11-3-26-9 |
| 會議資料.會議代碼:str |
第11屆第3會期社會福利及衛生環境委員會第9次全體委員會議 |
| 會議資料.屆 |
11 |
| 會議資料.會期 |
3 |
| 會議資料.會次 |
9 |
| 會議資料.種類 |
委員會 |
| 會議資料.委員會代碼[0] |
26 |
| 會議資料.委員會代碼:str[0] |
社會福利及衛生環境委員會 |
| 會議資料.標題 |
第11屆第3會期社會福利及衛生環境委員會第9次全體委員會議 |
| 影片種類 |
Clip |
| 開始時間 |
2025-05-01T12:18:25+08:00 |
| 結束時間 |
2025-05-01T12:49:40+08:00 |
| 影片長度 |
00:31:15 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/872e8bbe37846fc09b829845cf4c7946f84b180731b6d641c64ac1618a5937c6e766b101dd82558b5ea18f28b6918d91.mp4/playlist.m3u8 |
| 委員名稱 |
劉建國 |
| 委員發言時間 |
12:18:25 - 12:49:40 |
| 會議時間 |
2025-05-01T09:00:00+08:00 |
| 會議名稱 |
立法院第11屆第3會期社會福利及衛生環境委員會第9次全體委員會議（事由：審查
一、委員王育敏等18人擬具「病人自主權利法部分條文修正草案」案。
二、委員劉建國等16人擬具「病人自主權利法部分條文修正草案」案。
三、委員邱志偉等19人擬具「病人自主權利法第八條、第九條及第十五條條文修正草案」案。
【僅詢答】
【4月30日及5月1日二天一次會】） |
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謝謝主席,特別跟主席回報一下剛剛有講說提案委員,如果要提案要增加時間我要給王委員,也希望你可以給我提案更多的時間第二件事情,這個法律基本上 |
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坦白講是應該行政跟立法院有一定程度的共識因為大家都知道這個必須要來推嘛是一個好的法律包含部長在當委員的時候也積極的參與甚至於很多的記者會相關的這樣的一個場合 |
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都有表達這個意願嘛對於變種法這樣的一個推動這樣的一個力道的一個作為 |
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所以一定會有共識的時候我們才會積極來推動要產生共識當然有很多的一個方式第一個委員會第二個公聽會第三個相關的一些協調會我們到時候都還會邀請公部門還有一個醫界 |
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還有病團大家一起包含原有的這個提案的嚴委員包含孫教授等等等大家一起來共同來面對來處理但是今天有一個最大最大的共識我想基本上那病除法這個法律 |
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111.237 |
| transcript.whisperx[5].text |
是要繼續推下去然後所謂的ACP跟簽署AD必須要提高量能這個也不是開今天委員會才產生的結果是剛剛透過部長 透過司長自己本身都有答覆相關委員的這樣垂詢的過程裡面我們所得到的這樣的一個答案也就是說從本法實施到現在 |
| transcript.whisperx[6].start |
112.486 |
| transcript.whisperx[6].end |
133.415 |
| transcript.whisperx[6].text |
每一個人都非常清楚將近六年時間那不到一趴不到0.05趴的這樣的不到0.05的這樣的一個簽署的人數到成儒部長所回應委員相關委員的答詢說這個吻合率我不曉得這個吻合率的定義什麼叫吻合率那當然也有其他委員在追尋 |
| transcript.whisperx[7].start |
134.575 |
| transcript.whisperx[7].end |
156.669 |
| transcript.whisperx[7].text |
真正有照當時簽署的AD然後去執行的這個執行率又是幾%我目前為止是沒有聽出任何答案但是部長有特別提到希望這個簽署AD的時候我們希望更嚴謹我們要提高這樣的品質那要提高品質是從ACP就必須要來處理的 |
| transcript.whisperx[8].start |
158.03 |
| transcript.whisperx[8].end |
166.597 |
| transcript.whisperx[8].text |
但剛剛黃委員也有詮詢不過我並沒有聽出司長針對部長所講的所謂的簽署所謂的這個預例醫療的債務諮商的如何提高品質反而我是聽到司長答詢過程裡面是針對如何提高服務的量能包含從醫院的附屬機構婦女之家然後可以外展諸如此類 |
| transcript.whisperx[9].start |
183.269 |
| transcript.whisperx[9].end |
190.752 |
| transcript.whisperx[9].text |
的這個方向去討論嘛對不對所以到底部長講的這個如何提高這個ACP的醫療照護諮商的品質要如何提高我很抱歉我從早上一直聽到現在我並沒有聽到啦這是第一點 |
| transcript.whisperx[10].start |
200.396 |
| transcript.whisperx[10].end |
222.558 |
| transcript.whisperx[10].text |
那第二點 我有沒有聽到所謂的已經簽署的預歷醫療決定書之後它的執行率到底是多少因為我只聽到吻合率是七成嘛那第三點 這是一個不爭的事實我想各位今天所有的委員應該多數啦多數都覺得說這個ACP的諮商的會用希望以後公部門重建保署 |
| transcript.whisperx[11].start |
223.238 |
| transcript.whisperx[11].end |
226.162 |
| transcript.whisperx[11].text |
等等等來做相關的指引那我們從去年的7月已經有做部分的這樣的一個病症的還有病人的指引那今天5月1號又擴大65歲重大疾病等嘛那因為我聽到 |
| transcript.whisperx[12].start |
239.779 |
| transcript.whisperx[12].end |
257.231 |
| transcript.whisperx[12].text |
這樣的一個發展我當然非常樂觀其成也看到蠻欣慰就是衛福部積極要來面對這個事情處理這個事情甚至要把ACP的相關的幾乎從健保裡面擴大相關的這些對象但是問題來了當 |
| transcript.whisperx[13].start |
260.157 |
| transcript.whisperx[13].end |
286.46 |
| transcript.whisperx[13].text |
當我們市長講說每年兩萬多人我們要提高到四萬多人要增加兩萬五千人基本上我當然是支持但你如何去提高你如何去提高因為剛剛市長所講的幾個面向基本上你要有百分之一百五十的成長還是百分之一二五的成長我是覺得市長是不是要講明確一點你的方法 |
| transcript.whisperx[14].start |
287.831 |
| transcript.whisperx[14].end |
307.919 |
| transcript.whisperx[14].text |
這個法律是正確的這個法律往前走的過程裡面它的執行力它的預期目標我們沒有辦法去在時間內達到那我們現在想要快速的去達到那你把設定一年要增加兩萬五個人這個來參與這個醫療的照護諮商的這個人數你如果去達標 |
| transcript.whisperx[15].start |
314.878 |
| transcript.whisperx[15].end |
327.929 |
| transcript.whisperx[15].text |
我希望你可以明確跟委員會說清楚這是第一點第二點你必須要給委員會一個肆意因為剛剛署長講說5月1號開始擴大65歲65歲的重大疾病等那兩類人數就高達180萬還不包含還不包含他原有的在去年開放的給付的對象 |
| transcript.whisperx[16].start |
346.311 |
| transcript.whisperx[16].end |
367.739 |
| transcript.whisperx[16].text |
也不包含身心健康主動要來簽署的主動要諮商加簽署的都不包含我再簡單的比喻說如果180萬照現金每年執行然有做ACP到簽署的這是兩個層次問題啦我們講說ACP就好2萬180萬除以2萬要幾年才可以完成 |
| transcript.whisperx[17].start |
376.789 |
| transcript.whisperx[17].end |
401.156 |
| transcript.whisperx[17].text |
九十年了如果變成四萬五要錢才可以完成四十幾年了不包括去年開始補助的部分不包括健康的主動要來簽署的要來接受要來要諮商的這是第二件事情那第三件事情這不是我說的吧很清楚北一聯講的 |
| transcript.whisperx[18].start |
406.445 |
| transcript.whisperx[18].end |
419.149 |
| transcript.whisperx[18].text |
部長應該很清楚嘛,今天開這個會,我想牧產單位應該提供相關資料給你當病處法開始正式實施的時候,平均啊,要去做諮商的,要掛多久?一到三個月一到三個月我這邊有北藝連的這樣的一個對外的說法,我有這個花蓮慈濟醫院的說法 |
| transcript.whisperx[19].start |
432.466 |
| transcript.whisperx[19].end |
436.928 |
| transcript.whisperx[19].text |
那如果是這個樣子 你如果兩萬變成到四萬五要怎麼解決 要怎麼處理現在姑且都不修法我們知道這個法律的目標方向是正確但是在執行上 執行率就偏低的情況之下你要如果透過行政的作為 透過相關的補助 |
| transcript.whisperx[20].start |
460.443 |
| transcript.whisperx[20].end |
470.149 |
| transcript.whisperx[20].text |
透過你所講的只有擴大一個小的範圍或怎樣如果讓你可以提升這樣的服務量能兼顧到品質今天是因為有這樣的情況所以才有委員主動的來提供應該朝向修法的這樣的一個範疇來做處理 |
| transcript.whisperx[21].start |
484.7 |
| transcript.whisperx[21].end |
503.406 |
| transcript.whisperx[21].text |
當然啦 當然修啊是不是可以可以就一步到位那也到位必啦但是可能有一些原有在執行的過程裡面我們就開始檢視的第幾條第幾條是不是應該有一些修正有一些放寬甚至有一些必須要更嚴謹 |
| transcript.whisperx[22].start |
504.92 |
| transcript.whisperx[22].end |
532.105 |
| transcript.whisperx[22].text |
剛剛黃委員有特別提到如果已經簽了預立醫療決定書到時候病患家屬有意見的情況之下要怎麼處理我坦白講這條文裡面規範得很清楚如果病患本身已經無意識的情況之下就是要照當時病患所簽的醫院人所簽的預立醫療決定書去執行法律有明文規定 |
| transcript.whisperx[23].start |
533.496 |
| transcript.whisperx[23].end |
546.652 |
| transcript.whisperx[23].text |
他可不可以發生在第七款第十四條的第一項裡面的第一款跟第五款因為他可能是默契但是他意識清楚有可能他想要復活他想要變化他想出來的兩個營養他要去改變嘛對我看也有可能啊 |
| transcript.whisperx[24].start |
550.296 |
| transcript.whisperx[24].end |
575.547 |
| transcript.whisperx[24].text |
但是如果他是在第二款的這個第三款的植物人第二款的昏迷不可逆的情況之下他要怎麼去跟你變他要怎麼跟你再還回他的家屬怎麼可以不依照病患當時還是清楚的情況之下簽訂的預立醫療決定書去做任何改變那有可能火力就定在這邊啊 |
| transcript.whisperx[25].start |
580.636 |
| transcript.whisperx[25].end |
597.529 |
| transcript.whisperx[25].text |
所以我現在是今天從早一直聽到現在我覺得到底是大家覺得這些事情是必須要做的那也覺得這個這個遷鎖量是不足的這個好像應該大家都沒有爭議嘛但是我們怎麼擴大這個量能有很多的方式管道 |
| transcript.whisperx[26].start |
603.261 |
| transcript.whisperx[26].end |
628.876 |
| transcript.whisperx[26].text |
除了行政的作為 除了健保 健保署那修法裡面 難道不是也是解決之一嗎對不對 但是你們好像就把修法 馬上就把它關起來這個我覺得不太對吧我個人感覺不太對嘛不然我最後再講一個啦今天衛福部 坦白講就是要做利益眾生的事情嘛 |
| transcript.whisperx[27].start |
629.89 |
| transcript.whisperx[27].end |
653.805 |
| transcript.whisperx[27].text |
對不對,我們要利益什麼益,要利益什麼眾生很多人都提到,臺灣人口結構就是叫做生不如死嘛CBBC會比較少嘛,對於2021現在這樣,也適當啊再來,我們需要善終的病患,如果一直做無效的醫療他就一定叫做生不如死啊,這是另外一種狀況,狀態嘛對不對 |
| transcript.whisperx[28].start |
657.115 |
| transcript.whisperx[28].end |
683.681 |
| transcript.whisperx[28].text |
那今天我們明明知道病出華來整個實施過程裡面就是為了要讓這些病患還是健康的人未來可能遇到這14條的第一款到第一款的其中一款的情況之下都未雨綢繆的面對自己未來的人生的生命的規劃更有尊嚴更能夠善終我們要降低這種無效醫療這也是 |
| transcript.whisperx[29].start |
685.641 |
| transcript.whisperx[29].end |
699.874 |
| transcript.whisperx[29].text |
這也是在利益眾生嘛那也是利益家屬嘛不要到最後讓家屬就剛剛永遠提到的病患本身可能有所還回還是說家屬有很多的意見我們就是要利益眾生讓家屬不要去尊重當時這個病人自主所簽訂的醫療決定書了嘛 對不對 |
| transcript.whisperx[30].start |
711.405 |
| transcript.whisperx[30].end |
739.601 |
| transcript.whisperx[30].text |
這也是在利益啊不管是利益家屬 不管是利益這個病患也是利益在健保署啊 為什麼這麼講我覺得用補助這兩個字實在是實在是太沉重了也不夠專業但我們知道這個法來實施的情況之下就是可以朝向降低所謂的無效醫療嘛降低無效醫療也就等同於叫做降低健保給付嘛 |
| transcript.whisperx[31].start |
740.563 |
| transcript.whisperx[31].end |
753.682 |
| transcript.whisperx[31].text |
降低健保費用嘛有沒有去做過評估雖然一年兩萬多到現在十萬就像部長所講的五謀率就像執行率到底降低了多少呢無效預料 |
| transcript.whisperx[32].start |
755.366 |
| transcript.whisperx[32].end |
777.831 |
| transcript.whisperx[32].text |
來換算我們今天2500到3500的這樣的擴大相關的群組的補助加總起來 加減起來到底還是幾戶無效一人的幾戶大過於我們現在做這些ACP的諮商的費用多過多少 還是少了多少還是我們必須要在幾年內可以把這樣趕過來 |
| transcript.whisperx[33].start |
779.98 |
| transcript.whisperx[33].end |
787.804 |
| transcript.whisperx[33].text |
所以我想為政者基本上開源節流這樣的一個作為跟智慧跟應變這是必要的條件啦所以我們不能一直在說我們要做這件事就給檢報負擔多少給檢報支付多少我們可能不會管理所以我們現在一百八十萬人一個人三千就五十四億 |
| transcript.whisperx[34].start |
803.683 |
| transcript.whisperx[34].end |
825.053 |
| transcript.whisperx[34].text |
你必須要是休止調整,但是問題是你去度薪多少出來,等你一百八十萬人,卡士都要簽嗎?然後醫療決定書也都簽嗎?對不對,好,阿葛先生也真的度到像你講的穩合率或執行率,差不多20%就好,還是20%我們抓到30%,那可以減少多少的無效醫療的費用? |
| transcript.whisperx[35].start |
827.725 |
| transcript.whisperx[35].end |
850.558 |
| transcript.whisperx[35].text |
不是很清楚啦,我們台灣人平均臥床的時間,這都外界講的,那正確數字是多少?是七年?是八年?是六年?七、八年嘛對不對?七、八年都在那,給他做那個不好的醫療,要花多少錢?多少人?要再花多少錢?加多少人就好喔?但是現在多少人要給他?是要兩千五、三千五的ACP的智商費用 |
| transcript.whisperx[36].start |
852.244 |
| transcript.whisperx[36].end |
872.123 |
| transcript.whisperx[36].text |
所以這個要你們很專業的然後去做這個評估今天在這個委員會我們大家可以好好來討論嘛你們提供出來更精準這個數字嘛好就像ACP我再請教一下ACP育育醫療這個照顧智商算不算一個醫療行為部長我講這麼多你可以先回應我一句話嗎 |
| transcript.whisperx[37].start |
878.855 |
| transcript.whisperx[37].end |
900.865 |
| transcript.whisperx[37].text |
如果諮商應該不屬於醫療行為,但是諮商的內容是在討論醫療行為?是啦,沒有錯嘛,一樣嘛,我今天要去買一個醫療的保險嘛,我今天要去買一個醫療防癌的保險嘛,那我在跟你討論醫療保險,你賣我醫療保險的商品的內容的時候,是不是叫醫療行為? |
| transcript.whisperx[38].start |
902.642 |
| transcript.whisperx[38].end |
915.025 |
| transcript.whisperx[38].text |
相對是不是在討論未來你可能遇到什麼狀況要接受什麼醫療的時候我這個癌症的還是相關的醫療保險要幾戶嘛所以在諮商的範圍裡面我們要如果講說它叫做醫療行為 |
| transcript.whisperx[39].start |
918.658 |
| transcript.whisperx[39].end |
923.002 |
| transcript.whisperx[39].text |
他在討論醫療,沒有錯啊,他是不是醫療行為?跟保險稍微不一樣啦,譬如我舉個例子譬如說病人說你人工輸液營養有1條嘛,上面是維持生命的治療 |
| transcript.whisperx[40].start |
938.374 |
| transcript.whisperx[40].end |
955.502 |
| transcript.whisperx[40].text |
一定你不說什麼叫做維持生命治療 那就很難了是從壓胸插管打強心劑然後漸漸到要不要用抗生素要不要用那個這些東西說實在的我是花了30年 |
| transcript.whisperx[41].start |
957.003 |
| transcript.whisperx[41].end |
972.489 |
| transcript.whisperx[41].text |
照顧過兩萬個默許病人在安寧病房這三十年來慢慢還是協道的所以的確是相當的深奧啦這個品質是無止境我們要去成長所以討論的這個部分的確是需要有專業人員 |
| transcript.whisperx[42].start |
975.045 |
| transcript.whisperx[42].end |
1001.461 |
| transcript.whisperx[42].text |
來表達然後譬如說人工輸液好了在什麼時候不應該去是不是應該用鼻胃管的是不是應該去開個胃躁揉的或者打部分的營養劑或者是前營養劑這其實都是要針對病人的一個狀況這個我相信在ACP的時候一定會去討論人家病人一定會去問啦問的時候我們要怎麼回答要怎麼簽下去 |
| transcript.whisperx[43].start |
1002.935 |
| transcript.whisperx[43].end |
1030.061 |
| transcript.whisperx[43].text |
主要是這樣啦不對這樣啦齁這個法叫做病人自主決定法嘛對不對好那我們現在補助諮商會的是針對有病症的嘛對不對沒有錯嘛好過去是不給護過去不給護在署長之前是把他認定ACP不是醫療行為所以不給護那現在給護了就叫做醫療行為嘛署長就笑了 |
| transcript.whisperx[44].start |
1031.224 |
| transcript.whisperx[44].end |
1037.221 |
| transcript.whisperx[44].text |
這第一點那第二點我們是針對病患的時候或許部長講這樣是一個範疇那像身體健康的 |
| transcript.whisperx[45].start |
1039.468 |
| transcript.whisperx[45].end |
1062.557 |
| transcript.whisperx[45].text |
我是身體健康的我要做醫療諮商的他還是會問後面那我要勾對不對我要勾我要不要接受同意我到時候不做維持生命治療他一定會問你不管你是健康的一定會問啊是啊 那個是遇到14條第一項裡面的1到5款的情況之下 |
| transcript.whisperx[46].start |
1063.217 |
| transcript.whisperx[46].end |
1073.721 |
| transcript.whisperx[46].text |
在那個當下發生的時候才會有所謂的醫療行為嘛但我在諮商的時候怎麼會有醫療行為所以要有專業的一個要有專業的說明啦是專業的說明就是有提供醫療照護諮商是醫療機構管理辦法第四條嘛講得很清楚嘛對不對 |
| transcript.whisperx[47].start |
1082.404 |
| transcript.whisperx[47].end |
1100.594 |
| transcript.whisperx[47].text |
好,諮商機構應組成育立育療這個照護諮商團隊與像解釋諮商團隊至少包括現在人員嘛第一個醫師一人應具有專科醫師資格嘛對不對第二護理人員一人應具有兩年以上臨床實務經驗嘛第三心理師或社工人員一人應具有兩年以上實務經驗 |
| transcript.whisperx[48].start |
1102.415 |
| transcript.whisperx[48].end |
1115.246 |
| transcript.whisperx[48].text |
但是這個第二條第二項諮商機構的就前項第二款或第三款人員折衣設置第一項人員應完成中央主管公告 |
| transcript.whisperx[49].start |
1116.266 |
| transcript.whisperx[49].end |
1135.683 |
| transcript.whisperx[49].text |
至於醫療照護諮商訓練課程也就是說他還是必須要不管你是醫師不管你是護理師不管你是社卿人員你還是要完成所謂的諮商訓練課程嘛對不對醫師四個小時嘛護理 社工 心理六到十一個小時嘛今天這個當時這個管理辦法 |
| transcript.whisperx[50].start |
1141.943 |
| transcript.whisperx[50].end |
1154.427 |
| transcript.whisperx[50].text |
那個時代定下來的情境嘛好,我們現在都是一樣依照這樣去執行啊沒有錯啊但是不講現狀遇到什麼狀況當北醫連這麼講當花蓮慈濟這麼講的時候當相關的醫院這麼樣的醫療緊繃的情況之下醫師還要來做這些事情 |
| transcript.whisperx[51].start |
1171.209 |
| transcript.whisperx[51].end |
1177.934 |
| transcript.whisperx[51].text |
你覺得現狀對醫師是好對想要去做ACP的對象是好這個大家在討論我們有訂建我們有說一定醫師非做不做不可是現今的狀況掛一個號從開始實施開始實施到1080到現在喔就是平均要去掛的就是一個月等到三個月啊現在5月1號 |
| transcript.whisperx[52].start |
1201.052 |
| transcript.whisperx[52].end |
1204.333 |
| transcript.whisperx[52].text |
署長這邊在支付65歲以上的180萬人當然不可能180萬人馬上做也不可能馬上18萬1萬8就好了你怎麼做下去你做不下去啦 |
| transcript.whisperx[53].start |
1216.974 |
| transcript.whisperx[53].end |
1238.859 |
| transcript.whisperx[53].text |
你絕對做不去嘛你現在擴展以後 其實場地 場域也擴展很大診所也都可以做的嘛診所可以做 我堅持我支持啊 可以啊所以應該是那個場域喔擴展到很大啦 沒錯 你是醫生啦那北京也對不對 全國的醫術國會律師隊 台北市醫術國會律師隊這兩屆立委 又撲書 |
| transcript.whisperx[54].start |
1243.174 |
| transcript.whisperx[54].end |
1248.817 |
| transcript.whisperx[54].text |
你開清掃,我來幫你支撐,對不對?跟你看一個備份,你怎麼辦?我當然會預約時間,譬如說我...預約嘛,對,預約嘛。我預約時間,我可以看望鏡,普通人現在都這樣啦,我可以看望鏡,那預約一段時間,有的是去做居家,預約有的是去刷店,他也可以預約在預約,看兩三個房子,這樣來解決他的可能,因為這個有社區醫療群, |
| transcript.whisperx[55].start |
1272.85 |
| transcript.whisperx[55].end |
1274.411 |
| transcript.whisperx[55].text |
我覺得部長我們有一起到過日本參觀過 |
| transcript.whisperx[56].start |
1295.55 |
| transcript.whisperx[56].end |
1322.725 |
| transcript.whisperx[56].text |
不只是日本這個都蠻受到他們那個就是日本的那個評鑑制度跟我們不一樣嘛對不對他們那些評鑑師去列舉的就是優良的很棒的這些互惹人性互惹更好的這樣的一個級別的產道機構我們都有去參訪過嘛那也甚至於有美國的這個NGO團體特別到日本去認證這種機構都是Top的啦 |
| transcript.whisperx[57].start |
1325.441 |
| transcript.whisperx[57].end |
1344.033 |
| transcript.whisperx[57].text |
他們的長照機構很多都是多資種一起進入嘛他們在機構裡面可以申請健保幾戶也一併可以處理可以接保險也一併可以來做雙種處理嘛那我就不清楚吧你當然也可以要你自己想到要開放更寬的這個範疇開放到診所那為什麼長照機構不行 |
| transcript.whisperx[58].start |
1348.959 |
| transcript.whisperx[58].end |
1358.686 |
| transcript.whisperx[58].text |
我就不清楚了,長照機構絕對不是像蘇委員所講的外展服務到長照機構外展可以到長照機構嘛對不對你們開宗明義你們答覆我們的公文,答覆我們的報告書裡面你寫到這三個外國我就看不到了,你把第九條和第十四條你把它分成一團 |
| transcript.whisperx[59].start |
1373.561 |
| transcript.whisperx[59].end |
1401.404 |
| transcript.whisperx[59].text |
我不清楚你為什麼要把這種事情混在一塊啊你至始至終坦白講你對金融機關核准之護理機構、長照機構、心理治療所、心理諮商所、社工師事務所或法人的這個提供的預立醫療諮商、照護諮商這是一件事情,就一個句號嘛你在講經一位醫師診斷後末期這是在講第十四條第一項的第一款嘛 |
| transcript.whisperx[60].start |
1406.38 |
| transcript.whisperx[60].end |
1434.451 |
| transcript.whisperx[60].text |
你為什麼要把兩個兩件事情放在一塊我們要解釋的是說過去我們在機構管理這邊透過醫療機構的外展服務然後那像診所端的其實他的相關的設計人員沒有其實可以不用他自己所謂的專任的這件事情所以在目前的制度執行上面其實有他的彈性空間在然後這一次的擴大的部分的話其實我們也希望用這樣子的量能來做一個擴大 |
| transcript.whisperx[61].start |
1435.171 |
| transcript.whisperx[61].end |
1459.538 |
| transcript.whisperx[61].text |
然後我們144這邊的話其實是很多的醫師受完訓之後他其實是怎麼樣去提供這樣服務我們現在看到的落差的弱點是在不敢去提供服務所以我們會有那個輔導團隊來協助提供服務這樣子增加量能的部分我們覺得是增加量能的嘛 對不對對 增加量能市長你現在答覆跟我要做的事情目標是一致嘛 |
| transcript.whisperx[62].start |
1460.539 |
| transcript.whisperx[62].end |
1481.335 |
| transcript.whisperx[62].text |
寬寡上的落差我覺得是還是有啦還是有我尊重啦但是這兩件事情是不一樣的東西你把它放在一塊就不對嘛我簡單講一下第九條第一項第一款的修正我們是在就像你講的嘛我們要增加的諮商的這個機構嘛不增加目前醫療機構的執行負擔嘛 |
| transcript.whisperx[63].start |
1483.342 |
| transcript.whisperx[63].end |
1511.031 |
| transcript.whisperx[63].text |
我的想法是這樣 我不曉得想法是不是這樣 這第一那第二 我們這次的計劃是針對現在在臨床上遭遇到有困難有障礙的地方來進行處理所以因此必須回歸到現今的醫療現場狀況嘛你現在已經是做得起沒嘛醫事人力真的有這麼充裕嗎 部長所以剛剛有特別提到 台北四連一目前關牌ACP就高達一到三個月啊你可以馬上徵詢嘛 台北執行院也要一個月啊 |
| transcript.whisperx[64].start |
1512.504 |
| transcript.whisperx[64].end |
1536.089 |
| transcript.whisperx[64].text |
跟你講就開始送到現在就是要一到三個月啊有改善了嗎?有改變了嗎?你先保護我這個嘛,有嗎?我要講的是說過去一直大家來講的困境就是對醫院而言incentive也不夠,量也不夠的情況下面要開更多的門診的這件事所以我才會覺得是要開更多的門診對,因為排隊塞車,玉麗之山所以要開更多的門診 |
| transcript.whisperx[65].start |
1539.57 |
| transcript.whisperx[65].end |
1551.624 |
| transcript.whisperx[65].text |
市長 妳是專業的咧沒有 我在講是說過去一直在大家在講的是困境所以我們才會什麼樣的困境當然是有困境妳講的困境跟我認知的困境就不一樣啊 |
| transcript.whisperx[66].start |
1552.692 |
| transcript.whisperx[66].end |
1579.08 |
| transcript.whisperx[66].text |
對 所以我才會是說委員在這邊講的第一個是說塞車這個問題所以我們才會是說如果直覺的反應是開門診的這件事情那為什麼不善用基層的這一塊而且人都學過我沒有反對你要開放基層的這一塊啊我從頭到尾沒有反對啊是你在反對我要擴大這些機構啊因為我們會覺得你不能講 你在反對我反而說我在反對你啊亂講啊 |
| transcript.whisperx[67].start |
1581.926 |
| transcript.whisperx[67].end |
1587.43 |
| transcript.whisperx[67].text |
至此之中,我到現在跟你在對話的過程裡面,誰反對你?看到證書所?我第一次看到一個報告顯成這樣我第一次看到,柏中,你做過兩個月了,你覺得看過這種報告? |
| transcript.whisperx[68].start |
1607.177 |
| transcript.whisperx[68].end |
1622.904 |
| transcript.whisperx[68].text |
你總共收集幾條?你回應我兩條?剩下你給我怎麼回答?不是只有針對回答我,包括王委員,你怎麼回?其餘條文僅部分文字及配合實務運作修正,無影響執行上的成效。我就看你怎麼樣檢視你的執行上的成效了。你,市長,今年你要增加到四萬五喔。我們說四萬二。 |
| transcript.whisperx[69].start |
1636.67 |
| transcript.whisperx[69].end |
1640.831 |
| transcript.whisperx[69].text |
好啦,減五千也沒關係啦我看你要逼死誰啊我看你要逼死誰啊現在已經是五月一號了第二劑過一半了你要從兩萬多變成四萬百分之一百啊擴大診所,我支持 |
| transcript.whisperx[70].start |
1661.2 |
| transcript.whisperx[70].end |
1670.708 |
| transcript.whisperx[70].text |
醫療機構延伸到護理之家 外展我也支持 都沒跟你反對那我請教一下 講這些護理機構 創造機構 心理治療所 心理治療師那你為什麼要反對我們在講的是協作的部分 大家本來都是可以一起參與的因為本來在那個團隊裡面就會有這樣子的職類的人其實大家一起協作是沒有問題的啊是啊 沒有問題的啊 那你講啊 |
| transcript.whisperx[71].start |
1691.048 |
| transcript.whisperx[71].end |
1710.991 |
| transcript.whisperx[71].text |
這個你答覆嘛,有關修正條文,因為這個程序對象會用自應多會後面,愛各界達成共識,所以我們所有委員的提案,提的所有的修正條文,就是沒有一條適用嘛,沒有一條符合要讓整個ACP的服務量能提升,我們所修的每一條, |
| transcript.whisperx[72].start |
1712.014 |
| transcript.whisperx[72].end |
1720.833 |
| transcript.whisperx[72].text |
就是讓要簽署AD的這個量能可以提升我們所修的每一個條文對ACP的品質也沒辦法提升 |
| transcript.whisperx[73].start |
1723.2 |
| transcript.whisperx[73].end |
1739.393 |
| transcript.whisperx[73].text |
AT也沒辦法提升 沒辦法增加對 那沒關係那我們就拭目以待嘛我們就要看你意思思健保署如果今天在5月以後不再擴大我就要看你如何去達標嘛達到你講的嘛那你現在設定這個標兩萬多變成4萬是什麼標是最低標還是中標還是你自己設定的標 |
| transcript.whisperx[74].start |
1751.518 |
| transcript.whisperx[74].end |
1773.053 |
| transcript.whisperx[74].text |
這剛剛講的5月要開始的180萬,你如何把相關的去執行的這樣的一個目標,存給委員會啊,多久可以完成啊。不包含這個啊,包含其他的7月份,包含健康的,要盡早接受育育醫療照護諮商的對象。 |
| transcript.whisperx[75].start |
1781.043 |
| transcript.whisperx[75].end |
1806.889 |
| transcript.whisperx[75].text |
我想我們是非常開放的態度,如果臨床上真的需要改善的或需要修訂的,我們都是完全開放的態度來處理請委員放心,我們都可以來討論來看怎麼樣修正但是最重要就是達到量跟值的一個提升,來照顧我們的病人 |
| transcript.whisperx[76].start |
1808.191 |
| transcript.whisperx[76].end |
1823.039 |
| transcript.whisperx[76].text |
好 沒錯 我想大家都要做對的事情 要做好的事情 要做利益中心的事情嘛 對不對但是不可以記名就有偏見啦也不可以記名就叫自己自己很厲害啦 |
| transcript.whisperx[77].start |
1825.663 |
| transcript.whisperx[77].end |
1834.168 |
| transcript.whisperx[77].text |
我認為當各位議員提出相關的手法案的時候,我認為經濟機關應該是辛苦去面對,不然我就會逼手法,提出更好的,可以達成議員的目標。我簡單說,我們到現在連目標也沒有定。 |
| transcript.whisperx[78].start |
1845.194 |
| transcript.whisperx[78].end |
1871.516 |
| transcript.whisperx[78].text |
是你如果說就變四萬了你如果變四萬 人家是有辦法擴大到所有的你講的這樣的一個範疇什麼時候開始執行什麼時候可以到位 沒有勒也完全沒有勒然後我就跟你講說你這樣會不會造成更緊繃的醫療能力會不會你這個要去思考啊你們都來自醫界啊我這個是善意提醒啦好 謝謝主席謝謝劉建國 趙偉的主席 |