| IVOD_ID |
16865 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Full/1M/16865 |
| 日期 |
2025-08-14 |
| 會議資料.會議代碼 |
委員會-11-3-26-24 |
| 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24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 |
24 |
| 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24次全體委員會議 |
| 影片種類 |
Full |
| 開始時間 |
2025-08-14T08:30:53+08:00 |
| 結束時間 |
2025-08-14T12:56:00+08:00 |
| 影片長度 |
04:25:07 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://h264media01.ly.gov.tw:443/vod_1/_definst_/mp4:1M/bfaf9b39ac01a68549fe9bba21443e53ce50009cd90371cea4a8e3640dc7cc20a999154f766769975ea18f28b6918d91.mp4/playlist.m3u8 |
| 會議時間 |
2025-08-14T09:00:00+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24次全體委員會議（事由：邀請衛生福利部、經濟部、財政部就「美國針對進口藥品、原料藥課稅對我國產業造成影響」進行專題報告，並備質詢。） |
| 委員名稱 |
完整會議 |
| 委員發言時間 |
08:30:53 - 12:56:00 |
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| transcript.whisperx[0].start |
79.738 |
| transcript.whisperx[0].end |
81.991 |
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早安 早安我們的氣象時間要趕快來 |
| transcript.whisperx[1].start |
1782.705 |
| transcript.whisperx[1].end |
1783.746 |
| transcript.whisperx[1].text |
響鐘 |
| transcript.whisperx[2].start |
1813.55 |
| transcript.whisperx[2].end |
1828.572 |
| transcript.whisperx[2].text |
報告委員會 出席委員人數12人 移組法定人數請主席宣布開會好 我們現在開會請議事人員先讀上次會議意思錄 |
| transcript.whisperx[3].start |
1829.488 |
| transcript.whisperx[3].end |
1832.671 |
| transcript.whisperx[3].text |
立法院第11屆第三會期社會福利及衛生環境委員會第23次全體委員會議議事錄時間114年8月6日星期三9時至17時23分地點群賢樓801會議室出席委員陳委員趙姿等15人列席委員黃委員國昌等12人 |
| transcript.whisperx[4].start |
1847.285 |
| transcript.whisperx[4].end |
1870.365 |
| transcript.whisperx[4].text |
列席官員 上午專題報告衛生福利部部長邱太元等相關人員下午審查兒童托育服務法草案衛生福利部政務次長呂健德等相關人員主席劉兆吉委員建國報告事項 宣讀上次會議議事錄決定確定邀請衛生福利部部長 司法院法務部教育部內政部警政署就 |
| transcript.whisperx[5].start |
1871.145 |
| transcript.whisperx[5].end |
1894.836 |
| transcript.whisperx[5].text |
因應近期多起社會重大事件檢討家庭暴力防治法民事保護令制度及執行缺失強化保護令之作為進行專題報告並被質詢本次會議由衛生福利部部長司法院少年及家事廳廳長鍾宗林及法務部檢察司司長張曉雯報告後委員陳昭芝等20人提出質詢均經衛生福利部部長 |
| transcript.whisperx[6].start |
1895.536 |
| transcript.whisperx[6].end |
1918.255 |
| transcript.whisperx[6].text |
內政部警政署副署長廖美玲 法務部檢察司司長 司法院少年及家事廳廳長教育部學生事務及特殊教育司副司長許家倩內政部警政署署長張榮鑫及各相關主管等及習達富委員陳冠廷 陳培瑜 盧憲一 徐欣盈及徐富回所提書面質詢列入紀錄刊登公報 |
| transcript.whisperx[7].start |
1919.196 |
| transcript.whisperx[7].end |
1940.932 |
| transcript.whisperx[7].text |
決定一報告及詢答完畢二委員質詢未及答覆或請補充資料者請相關期關於二週內書面答覆委員另要求期限者從期鎖定討論事項繼續審查行政院函清審議委員分別拟據兒童托育服務法草案等二十案以及審查委員分別拟據兒童托育服務法草案等九案 |
| transcript.whisperx[8].start |
1941.673 |
| transcript.whisperx[8].end |
1967.706 |
| transcript.whisperx[8].text |
一百一十四年五月二十八日第十一屆第三會期本會第十四次全體委員會議由委員提出部分條文修正動議一案同年六月十一日第十六次全體委員會議有委員提出部分條文修正動議七案本次會議由委員林月琴等四人提出部分條文修正動議委員盧憲義等三人提出部分條文修正動議以上共十案決議一本次會議審查結果如下 |
| transcript.whisperx[9].start |
1968.306 |
| transcript.whisperx[9].end |
1996.488 |
| transcript.whisperx[9].text |
瓜湖一 照行政院提案通過第十二條 第十四條及第十七條條文二 瓜湖二 照案通過第三章張明瓜湖三 第十五條修正通過瓜湖四 照委員陳培宇等十九人提案第二十一條委員林淑芬等二十五人提案第二十三條委員陳慶輝等十七人提案第十九條修正通過瓜湖五 不予處理委員王玉敏等二十四人及委員顏寬恒等十六人提案第十七條及第十八條 |
| transcript.whisperx[10].start |
1997.268 |
| transcript.whisperx[10].end |
2023.726 |
| transcript.whisperx[10].text |
瓜湖六保留條文第十一條第十三條第十六條及第十八條委員王玉敏等二十四人及委員顏寬恒等十六人提案第十六條委員陳培宇等十九人提案第十九條委員林淑芬等二十五人提案第二十二條及委員陳金輝等十七人提案第十八條二行政院函請審議審議兒童托育服務法等草案等二十九案保留條文及第十九條以下條文另則其繼續審查 宣讀完畢 |
| transcript.whisperx[11].start |
2029.538 |
| transcript.whisperx[11].end |
2046.563 |
| transcript.whisperx[11].text |
請問委員會上市議事錄有錯誤或遺漏之處沒有那我們議事錄確定本日的會議議程為邀請衛生福利部經濟部財政部就美國針對進口藥品顏料要課稅對 |
| transcript.whisperx[12].start |
2049.204 |
| transcript.whisperx[12].end |
2077.881 |
| transcript.whisperx[12].text |
我國產業造成的影響進行專題報告並備質詢我們現在就介紹在場的委員跟列席官員第一位陳昭之委員王振旭委員我們列席官員衛生福利部部長邱太元食藥署署長江志剛 |
| transcript.whisperx[13].start |
2080.851 |
| transcript.whisperx[13].end |
2107.166 |
| transcript.whisperx[13].text |
中央健康保險署石崇良署長好 歡迎心理健康師 師長陳柏熙好 歡迎醫事師 副師長劉益清好 歡迎中醫藥師 副師長黃淳英好 歡迎經濟部產業發展署副署長周雨欣好 |
| transcript.whisperx[14].start |
2111.007 |
| transcript.whisperx[14].end |
2138.874 |
| transcript.whisperx[14].text |
產業技師檢證記證戴建成 歡迎國際貿易署科長黃昭榮 歡迎 歡迎財政部關稅署檢證集合陳美智 歡迎護稅署專門委員林美惠接下來請我們衛務部邱部長報告 5分鐘 |
| transcript.whisperx[15].start |
2149.065 |
| transcript.whisperx[15].end |
2167.422 |
| transcript.whisperx[15].text |
主席 各位委員 女士先生今天大概第十一屆第三會期社會福利及衛生環境委員會召開全體委員會議本部成要列席報告深感榮幸持就美國針對進口藥品 原料要課稅對我國產業造成影響進行專題報告敬請各位委員 |
| transcript.whisperx[16].start |
2168.263 |
| transcript.whisperx[16].end |
2177.61 |
| transcript.whisperx[16].text |
北京會議室指教 全球經貿情勢正處於快速變革之際面對美國針對進口藥品、營養藥、課金關稅或造成藥品供應之衝擊本部已建構相關應用機制 |
| transcript.whisperx[17].start |
2184.028 |
| transcript.whisperx[17].end |
2204.431 |
| transcript.whisperx[17].text |
措施從健保藥價政策支持及強化藥品供應管理兩大面向確保藥品穩定供應首先在藥價管理措施方面本部於114年12月26號公告全民健保全民健康保險要務幾戶項目及支付標準部分條文修正及全民 |
| transcript.whisperx[18].start |
2204.992 |
| transcript.whisperx[18].end |
2213.608 |
| transcript.whisperx[18].text |
健康保險 藥品價格調整 作為辦法調穩相關支持政策包括 第一支持邪名藥及生物相似藥品 |
| transcript.whisperx[19].start |
2214.571 |
| transcript.whisperx[19].end |
2244.371 |
| transcript.whisperx[19].text |
即使進入市場並推廣使用針對原廠藥預專利期五年內首兩章於我國取得藥品喜口證知國內製造學名藥及生物相似藥品最高給予原廠藥相同價格並自114年8月1號期擴大推動全民健康保險推動使用生物相似藥品及學名藥之鼓勵事辦計畫推廣生物相似藥品及學名藥之使用 |
| transcript.whisperx[20].start |
2245.031 |
| transcript.whisperx[20].end |
2260.558 |
| transcript.whisperx[20].text |
第二 給予國內製造藥品優惠要價若廠商採用國內生產的原料藥國內外通過安全性臨床試驗並獲國際期刊發表最早向主管機關為P4專利聲明且獲准 |
| transcript.whisperx[21].start |
2264.96 |
| transcript.whisperx[21].end |
2283.715 |
| transcript.whisperx[21].text |
核發藥品許可證之國內製造藥品給予加算及三年不調整藥價之優惠第三為確保藥品供應供貨穩定同時符合主管機關公告之必要藥品同分子內有國內製造項目及同分子分類 |
| transcript.whisperx[22].start |
2284.475 |
| transcript.whisperx[22].end |
2313.322 |
| transcript.whisperx[22].text |
未遇三項目等三項條件則當年度 藥價不予調整第四 支持國內藥廠製造創新藥品凡是在十大先進國家首次上市兩年內新藥或是十大先進國家上市已滿五年但屬國內製造之先程份新藥可比照台灣首發新藥給予優惠合價除以上四項支持措施本部亦以爭取特別預算支持 |
| transcript.whisperx[23].start |
2314.631 |
| transcript.whisperx[23].end |
2341.089 |
| transcript.whisperx[23].text |
今年健保總額非疫情風險及非疫情政策改變手續經費分類有20億元立法案並通過應用國際情勢強化經濟社會及民生國安任性特別條例可挹注全民健保安全基金200億元以應用美國關稅措施改變可能造成全球要價浮動及全球供應鏈生態改變至生產成本劇增 |
| transcript.whisperx[24].start |
2342.349 |
| transcript.whisperx[24].end |
2369.038 |
| transcript.whisperx[24].text |
廠商可依法提出價格調整建議確保穩定供藥另外本部持續強化多項藥品供應管理措施首先本部已建立藥品短缺處理機制並於114年2月10日公告修正必要藥品清單當發現藥品有短缺之餘及啟動調查與評估必要時請替代藥品廠商增產 |
| transcript.whisperx[25].start |
2369.918 |
| transcript.whisperx[25].end |
2394.888 |
| transcript.whisperx[25].text |
公開徵求專案進口後製造以強化藥品供應預警其次本部持續關注相關藥品供應情形以完成盤點美國製造之藥品品項請許可證持有廠商確實掌握國外供應情形提升國內製劑及原料藥安全庫存並持續鼓勵藥廠增加原料藥來源 |
| transcript.whisperx[26].start |
2396.704 |
| transcript.whisperx[26].end |
2419.659 |
| transcript.whisperx[26].text |
以降低藥品對單一來源原料藥之依賴另外本部亦透過專案輔導與加速審查協助業者加快取得藥證提升我國製藥產業韌性與自治能力因應國際經貿情勢順息萬變本部將持續強化我國藥品供應鏈之韌性為應用未來可能面臨之挑戰 |
| transcript.whisperx[27].start |
2420.439 |
| transcript.whisperx[27].end |
2448.518 |
| transcript.whisperx[27].text |
將採取更積極的作為全面提升藥品供應的穩定性與應變能力本部課正規劃提升原料藥以關鍵製劑之國產自製能力配合藥價政策積極推廣學名藥使用規劃導入智慧監控系統強化藥品供應之預警與儲備機制並達到醫療資源合理分配保障國人健康潛力以上報告 謝謝 |
| transcript.whisperx[28].start |
2450.25 |
| transcript.whisperx[28].end |
2451.172 |
| transcript.whisperx[28].text |
謝謝 謝謝部長來 我們請經濟部也來報告五分鐘 |
| transcript.whisperx[29].start |
2462.486 |
| transcript.whisperx[29].end |
2479.818 |
| transcript.whisperx[29].text |
主席各位委員大家好經濟部陳蒙貴委員會邀請就美國針對進口藥品原料要課稅對我國產業造成影響進行報告敬請各位委員不吝視角首先跟各位報告我國製藥出口的現況2024年我國製藥產業產值為新台幣1196億元以內銷為主出口至全球金額為9.9億美元其中出口至美國為3.23億美元 |
| transcript.whisperx[30].start |
2492.626 |
| transcript.whisperx[30].end |
2512.533 |
| transcript.whisperx[30].text |
2024年我國出口美國原料藥金額為0.17億美元佔原料藥出口總額9.9%美國為我國原料藥第三大出口國前兩大出口國分別為中國及日本2024年我國出口美國製劑金額約為3.06億美元佔製劑出口總額37.5%美國為我國製劑第一大出口國其後依序為中國及日本 |
| transcript.whisperx[31].start |
2520.296 |
| transcript.whisperx[31].end |
2548.993 |
| transcript.whisperx[31].text |
在產業影響評估的部分美國根據1962年美國貿易擴張法第232條所進行的藥品國安調查旨在評估特定藥品原料藥及關鍵活性成分等的進口是否對美國國家安全造成威脅該調查範圍涵蓋進口藥品藥物原料及衍生產品等本案目前正在調查中美國尚未公佈 |
| transcript.whisperx[32].start |
2551.203 |
| transcript.whisperx[32].end |
2571.638 |
| transcript.whisperx[32].text |
製藥產業溢價及調整彈性有限與其他高毛利高需求量產業相比面對成本增加更為敏感我國對美出口廠商多數年度或長期合約供應美國如啟動課徵關稅因藥品高度法規管制特性短期轉移生產至美國境內製造可行性低 |
| transcript.whisperx[33].start |
2572.478 |
| transcript.whisperx[33].end |
2599.388 |
| transcript.whisperx[33].text |
令我国出口原料药为高技术门槛及生物药品原料药其品质及特殊性优势在国际市场难以取代在因应对策的方面美国实施进口制药产品国安调查能为公布政府除积极向美方争取有利条件并以做好准备协助企业因应行政院已提出因应美国关税我国出口供应链支持方案 |
| transcript.whisperx[34].start |
2600.248 |
| transcript.whisperx[34].end |
2625.8 |
| transcript.whisperx[34].text |
整合跨部會資源擬定九大面向共二十項措施投入經費930億元全力穩定國家經濟及產業發展讓國人生活安心其中經濟部預計投入460億元提供金融支持提升產業競爭力開拓多元市場等三大面向共四項支持措施協助受美國加徵關稅影響業者包括外銷 貸款 |
| transcript.whisperx[35].start |
2627.561 |
| transcript.whisperx[35].end |
2654.076 |
| transcript.whisperx[35].text |
優惠保證加碼中小微企業多元發展貸款加碼協助企業研發轉型及爭取海外訂單針對我國製藥產業經濟部也同時啟動兩大策略說明如下第一 降低單一市場依存度促進多元化透過媒合平台 工協會及國際展會佈局東協 中東及歐盟新興市場拓展新興市場的可能性 |
| transcript.whisperx[36].start |
2655.077 |
| transcript.whisperx[36].end |
2673.318 |
| transcript.whisperx[36].text |
第二 鼓勵技術升級與差異化透過輔導與補助雙軌引導業界加速投入原料藥生物相似藥 緩釋與複合劑型等高技術產品研發並結合智慧製造與數位品質管控降低成本 縮短交貨期增強國際競爭力 |
| transcript.whisperx[37].start |
2675.34 |
| transcript.whisperx[37].end |
2695.489 |
| transcript.whisperx[37].text |
最後經濟部非常重視企業因應美國關稅政策所面臨的問題將持續關注美國關稅政策及國安調查對產業的影響並透過臺美談判小組表達我方的產業立場以爭取產業最大利益 以上報告敬請各位委員指正視教謝謝副副市長 |
| transcript.whisperx[38].start |
2696.294 |
| transcript.whisperx[38].end |
2716.955 |
| transcript.whisperx[38].text |
好 有關本次會議各項書面資料均列入紀錄攤登公報那我們現在開始詢答 做以下先告本委會委員詢答8分鐘 列席委員4分鐘10點半截止發言登記如果有書面質詢 請於上會前提出 一起不受理 |
| transcript.whisperx[39].start |
2718.601 |
| transcript.whisperx[39].end |
2725.526 |
| transcript.whisperx[39].text |
那原則上我們11點半處理臨時提案好 我們現在請第一位委員發言陳昭樹委員謝謝主席 有請邱部長 |
| transcript.whisperx[40].start |
2741.557 |
| transcript.whisperx[40].end |
2758.986 |
| transcript.whisperx[40].text |
部長 川普總統他已經宣布就是說進口藥品他要分階段分階段來課徵最高達250%的一個關稅他也要求實際家跨國的藥廠他要在美國市場要提供全球最低價所謂的最惠國這個藥價 |
| transcript.whisperx[41].start |
2760.647 |
| transcript.whisperx[41].end |
2777.768 |
| transcript.whisperx[41].text |
那根據這個楊交大的康兆周教授分析關稅本身未必直接會衝擊台灣的藥品的要價但是會衝擊剛剛您也報告到出口美國的學名藥廠商那尤其是這個在臨床上比較容易取代的相對也是低價的這個品項 |
| transcript.whisperx[42].start |
2778.749 |
| transcript.whisperx[42].end |
2804.771 |
| transcript.whisperx[42].text |
那當然你也提到這個原料藥那其實台灣的原料品質很好但是因為他的相對價格高一點所以這個又不是經濟規模的生產敵不過那個印度啊中國這個原料大廠所以他大部分就是90%以外銷為主那美國又排在前幾名其實還是有很大的影響那台大醫院余中仁院長也提醒高關稅可能造成加速這個全球叫做碎片化這個是名詞 |
| transcript.whisperx[43].start |
2806.492 |
| transcript.whisperx[43].end |
2825.089 |
| transcript.whisperx[43].text |
那藥廠會針對不同的市場做獨立的定價跟供貨策略那台灣是小市場啊台灣是小市場啊很難獲得這個優先供應那雖然我國目前對藥品是採取零關稅但是美國政策本身可能會這個對於改變各國各個藥廠他在全國的這個佈局全世界的佈局 |
| transcript.whisperx[44].start |
2830.154 |
| transcript.whisperx[44].end |
2847.869 |
| transcript.whisperx[44].text |
那間接就會影響在台灣的這個藥價或供貨穩定性因為這個是遷移法動全身那部長就是我上述這些觀點您同意嗎您對這個關稅藥品要加上這個關稅的部分您做了美國的關稅的部分您做了影響評估嗎影響的評估 |
| transcript.whisperx[45].start |
2851.707 |
| transcript.whisperx[45].end |
2868.805 |
| transcript.whisperx[45].text |
我想我們一直都在做影響評估那謝謝委員提供這麼專業跟精闢的一個分析我們不管是在確保台灣的一個藥品穩定的供應的策略 |
| transcript.whisperx[46].start |
2869.879 |
| transcript.whisperx[46].end |
2890.001 |
| transcript.whisperx[46].text |
以及因為他隨著他關稅的一個可能的變化我們也都有相應相對應的一個對策部長這樣好了我們來具體來談幾個點我知道也許您不是很喜歡這樣聽但是我還是要講台灣藥品的這個供應的脆弱點 |
| transcript.whisperx[47].start |
2891.222 |
| transcript.whisperx[47].end |
2914.652 |
| transcript.whisperx[47].text |
並不在於一定在於國際的供應鏈的一個變動那事實上健保還是有一些相當的影響長期是壓低要價的那當然是來自財務的問題長期壓低要價缺乏韌性的管理我們一點一點來討論第一個健保砍價跟缺藥其實是個惡性循環那要價這個長期往下修導致國內的這個國內外廠商其實都會退出這個低價市場 |
| transcript.whisperx[48].start |
2915.773 |
| transcript.whisperx[48].end |
2921.69 |
| transcript.whisperx[48].text |
那已經達到地板價的這個藥品很容易缺貨請問健保署你有因應措施嗎 |
| transcript.whisperx[49].start |
2923.24 |
| transcript.whisperx[49].end |
2949.853 |
| transcript.whisperx[49].text |
就是我先就這一點來談砍價跟缺藥其實是惡性循環那個委員所關心的這件事情也是大家所關心的啦因為我們一定要讓我們的藥廠能夠在地製造能夠在地製造而且要鼓勵的一個措施所以所以這一年來其實在健保署也做了很多的措施來扶植在藥價的合理性有做了 |
| transcript.whisperx[50].start |
2950.373 |
| transcript.whisperx[50].end |
2976.733 |
| transcript.whisperx[50].text |
很多的一個改善但是缺貨還是在啊署長你的因應措施是什麼跟委員報告有一些是屬於到地板價的我們在健保上都有保護的措施不在下調那這些所謂到達地板價的多屬於這個學民藥或者是OTC或者是在國內生產為主所以我們有相對的這個政策那你允許他們有一些申訴的管道嗎 |
| transcript.whisperx[51].start |
2977.333 |
| transcript.whisperx[51].end |
3004.806 |
| transcript.whisperx[51].text |
有有有我們都可以來提高這個像我們過去的這個發生著點滴的事件那麼我們也調高了它的要價你從你的觀點說我保護它但是事實上相對他們的感受呢就是說我們都有調整要價的機制不是只有往下調也有往上調我們過去這一年就調高了200項所以它是你只要合理的成本提出來之後呢我們是可以調整的 |
| transcript.whisperx[52].start |
3005.106 |
| transcript.whisperx[52].end |
3033.52 |
| transcript.whisperx[52].text |
我知道您也允許他們來申請條帳如果是因為這些尤其是關稅這些影響那你知道要多少時間嗎從他的申請到共理會然後到生肖你估大概要多少時間如果他有我們應該這樣講在我們的這個基本的藥品裡面呢我們都有預警制度說如果你要可能會有缺藥的情形你六個月之前就應該要來通報所以他要提前來提那麼另外一個當然就是你調整 |
| transcript.whisperx[53].start |
3034.54 |
| transcript.whisperx[53].end |
3060.613 |
| transcript.whisperx[53].text |
要提高要價我們有的程序所以這個應該我們都會試他的緊急情形跟必要情形那麼來處理那你目前有簡單的數據說這些申請調漲的廠商他被通過允許通過的我們也有一些特殊的情形下他可以跳過這個共理會我們上次在點滴的處理的事情都是當周就決定了 |
| transcript.whisperx[54].start |
3061.674 |
| transcript.whisperx[54].end |
3090.436 |
| transcript.whisperx[54].text |
點滴實在是太一個沉痛的教訓了這是第一個 砍價的問題第二個 全球供應的優先次序台灣處比劣勢吧 你同意吧因為當跨國藥廠這個面臨美國的降價壓力他可以有其他方法他其他國家漲價或是說他減量供應減量供應台灣為什麼 台灣市場小嘛你給價又給的低啊大家台灣的藥價是有名的低啊那你常常被排在這個次次藥跟次次藥那個藥廠所謂的第三波啊 |
| transcript.whisperx[55].start |
3091.296 |
| transcript.whisperx[55].end |
3111.042 |
| transcript.whisperx[55].text |
就是說這個是一個不容這個來這個否定的一個現實但是我要請問健保署你知道藥品他要經歷所謂MBAMBA就是收窄車價量的一個一個協議嘛那又有PVA用量高你又要跟他跟他要求他有一些的這個回饋還有今年的藥價差這個藥價差已經高達30%那未來你要依據國際最低價來去調整它 |
| transcript.whisperx[56].start |
3116.744 |
| transcript.whisperx[56].end |
3139.729 |
| transcript.whisperx[56].text |
那請問署長你有信心台灣的市場藥品市場不會被邊緣化嗎國人會不會將來用不到先進的藥品我想跟委員報告我們也不需要太我們當然要戒慎恐懼但是也不需要妄自菲薄那麼台灣在相對於許多的國家還是相當具有競爭力那麼以在整個亞洲來講呢那我們的 |
| transcript.whisperx[57].start |
3140.589 |
| transcript.whisperx[57].end |
3155.074 |
| transcript.whisperx[57].text |
全民健保明年就已經趨近兆元所以在這個健保的支出上具有相當的這個一致性的溢價能力跟當初是不一樣我講的是先進藥品國產的是一個基礎 |
| transcript.whisperx[58].start |
3155.834 |
| transcript.whisperx[58].end |
3170.633 |
| transcript.whisperx[58].text |
对 先进药品也是一样我们很多的先进药品在亚洲很多国家没有进我们也进了所以这个是健保因为这个全民健保的是一个单一的保险人的制度所以它具有这样的 |
| transcript.whisperx[59].start |
3171.033 |
| transcript.whisperx[59].end |
3190.749 |
| transcript.whisperx[59].text |
我们是第三波新药发明我们是第三波才引进那两位首长就药价差这问题一直百烂不处理现在每年700亿我现在要谈的就是说医师开方如果跟药价差扣连在一起其实这是很不恰当之前我有提到中部的一些医学中心它已经开始有所谓的索药 |
| transcript.whisperx[60].start |
3193.292 |
| transcript.whisperx[60].end |
3204.587 |
| transcript.whisperx[60].text |
鎖黨 正是在開放的時候提醒醫師就是某些是藥價差 利潤比較好的藥品這件事情部長你怎麼看這個是好的醫療行為嗎利用藥價差來扣連醫師處方那這個會影響病人權益啊 |
| transcript.whisperx[61].start |
3207.574 |
| transcript.whisperx[61].end |
3225.94 |
| transcript.whisperx[61].text |
我想我們非常非常不同意的一個用管理的機制來影響到病人的權益跟醫療的專業但是部長它存在啊它存在啊而且越來越多人效法因為沒有去處理啊我想我們是不容許這樣的情況 |
| transcript.whisperx[62].start |
3227.58 |
| transcript.whisperx[62].end |
3247.149 |
| transcript.whisperx[62].text |
醫學中心是表率醫院的醫學中心率先這麼多其他醫院當然效仿啊如果讓民眾都知道原來是靠藥價差的利率因為你給付的不夠嘛有一些可以檢討的我是相信協大多數的醫院是不會去影響到醫師的專業的一個潛力的這個部分很容易被醫師法定出來 |
| transcript.whisperx[63].start |
3248.109 |
| transcript.whisperx[63].end |
3271.223 |
| transcript.whisperx[63].text |
今年6月6號有給工協會一些函第四點提到因美國之對等關稅政策以盤點相關的健保用藥廠商若因為關稅問題依法可以提出價格調整建議必要時本署將爭取額外你剛剛有提到額外的預算來指引來及時反映市場價格調整這個要價這是針對關稅的這個部分請問這個及時 部長請您回答 部長這個及時是多久 |
| transcript.whisperx[64].start |
3272.003 |
| transcript.whisperx[64].end |
3299.695 |
| transcript.whisperx[64].text |
您給的函你說要及時反映藥品市場價格而且是因應關稅問題您覺得這個及時多久要花多少時間我想在健保的總預算裡面我想委員長期擔任過相關的一個委員都很清楚我們有一個風險的相關的基金這個是隨時可以用因為絕對不能讓我們的國人有缺藥的現象 |
| transcript.whisperx[65].start |
3300.755 |
| transcript.whisperx[65].end |
3325.769 |
| transcript.whisperx[65].text |
價格調整過程 大家都知道嘛 專家共理會然後等等 這個他們是根據過去財務的狀況來分析嘛這個署長如果您自己不到這個委員會裡面說按照法規的一個從寬來處理或是說 因為他們習慣 我在那邊太久了嘛習慣用這個財務衝擊嘛總共我要花多少錢來決定要不要這個速度跟委員報告 我們都在做改善你發了這個文 |
| transcript.whisperx[66].start |
3327.71 |
| transcript.whisperx[66].end |
3352.766 |
| transcript.whisperx[66].text |
這個我們現在是這樣子今年呢我們在要價正式調整是4月1號所以我們在3月初就會發函給所有的這個廠商有調價的廠商廠商如果提出他有要價不符我們就會凍結所以在4月1號就不會調然後之後我們在審視他的合理成本之後才正式做最後的調整所以我們這個就是所謂的即時反應的 |
| transcript.whisperx[67].start |
3353.186 |
| transcript.whisperx[67].end |
3374.22 |
| transcript.whisperx[67].text |
我才請教您說到底最後通過多少專家還是不給啊因為你們過去就是教專家要怎麼看預算啊你從來不會去看關稅銀行現在都是在看成本我們看成本你現在有改變一點點做法嗎您的向前一直沒有下達據我瞭解您的向前沒有下達你在這邊承諾我的常常都沒有出現在真正審議的委員會好那我想說這次我們對於關稅還在未以籌謀幾個點請再跟首長分享供應鏈的這個 |
| transcript.whisperx[68].start |
3384.173 |
| transcript.whisperx[68].end |
3401.239 |
| transcript.whisperx[68].text |
評估跟預警剛剛你有提到是不是報告就你已經有盤點了嗎國內用藥仰賴跨國供應你不能否認這一塊那這個關鍵藥品你有做了什麼處置嗎有提前通報嗎就是關鍵藥品過去比較沒有處理這一塊那避免出現突發性的缺藥這是第一點 |
| transcript.whisperx[69].start |
3403.519 |
| transcript.whisperx[69].end |
3421.927 |
| transcript.whisperx[69].text |
那第二點 要價差的部分我還是請大家不要我是希望署長您又根據這個不同生命週期的譬如說它是單元 單一來源的譬如說它是必要藥品譬如說它已經靠近這個地板價還有過專利小品你可以有不同的類型的藥品它的要價差 |
| transcript.whisperx[70].start |
3423.367 |
| transcript.whisperx[70].end |
3441.835 |
| transcript.whisperx[70].text |
我希望你已經有這個數字我希望你兩周內給我這個數字可以嗎你有要價差 你有強大的電腦你一直在收集這個採購價格我想知道說這不同類別不同類別的要價差有什麼樣的不同 樣態不同那我們再來研究討論怎麼來處理這些事情署長你可以給我這個資料嗎 |
| transcript.whisperx[71].start |
3444.632 |
| transcript.whisperx[71].end |
3459.701 |
| transcript.whisperx[71].text |
我刚刚提到的是很中性的东西这个我们把整个因为这里有些会涉及到厂商的商业机密你又来了所以我们可以把整体的统计的资料大概没有办法给个别的item |
| transcript.whisperx[72].start |
3460.302 |
| transcript.whisperx[72].end |
3479.424 |
| transcript.whisperx[72].text |
兩週可以嗎 兩週到辦公室可以可以因為我們可以制定根據不同類型去制定不同的管制力道這個是你管理對這個很重要避免那個要價被邊緣化那國產藥品的部分我覺得不只是考慮那個價格你要考慮那個量你如果平常沒有給他那個量那到時候有缺的時候他也供應不來嘛 |
| transcript.whisperx[73].start |
3480.405 |
| transcript.whisperx[73].end |
3496.432 |
| transcript.whisperx[73].text |
整理食鹽水永豐的就是一個非常慘痛的這個教訓所以到底這個部分給量的部分你要怎麼處理所以是不是要考慮這個過專利企業品在醫院是要並存的就是說他平常要有一些市場的一些保障那當然定型化企業或許可以保障量 |
| transcript.whisperx[74].start |
3497.032 |
| transcript.whisperx[74].end |
3525.374 |
| transcript.whisperx[74].text |
重點不只是保障價格因為它沒有量到時候就沒有辦法配合國家的政策來供應所以我覺得這個是一個非常重要的時機所以你一旦不但要保護國產藥品那當然你要兼顧輸入藥的一些公平性當然剛剛也提到要鼓勵本土廠商要做一些比較研發性的一些產品那我要講說兩位署長江署長跟石署長您在這個國會殿堂上你們已經握過手了 |
| transcript.whisperx[75].start |
3526.135 |
| transcript.whisperx[75].end |
3549.395 |
| transcript.whisperx[75].text |
手牽手了對不對 我一直說上游跟下游要合作嘛你們手牽手了 應該有進一步的關係發展吧有 他們兩個有繼續做嗎兩個非常密切的合作進一步發展是什麼那我最後再提一個 就是讓部長也一起瞭解台灣有幾家藥廠我們要鼓勵本土藥廠 保護本土藥廠台灣有幾家本土藥廠你現在說出來 等一下說不出來 |
| transcript.whisperx[76].start |
3552.61 |
| transcript.whisperx[76].end |
3576.779 |
| transcript.whisperx[76].text |
報告委員我們這邊現在國內的製劑廠300家然後我們的原料廠呢有將近有40家左右那整體來講剛才委員特別提到工藝任性任性的部分我們其實在今年度特別針對二月份做所謂的必要藥品的部分我們其實有做幾百家藥廠你可以想台灣這麼小他在國內就自己在那邊競爭就自相殘殺嘛 |
| transcript.whisperx[77].start |
3578.82 |
| transcript.whisperx[77].end |
3605.06 |
| transcript.whisperx[77].text |
所以一定要做一些事情有時候我們要去做一些比較長遠的事情嘛大家都沒有辦法走出去所以我們也希望我們台灣的藥廠可以打國際盃啊不是在國內搶市場啊這也是我們在省醫療法的精神啊你如果生技產業都集中在台灣那你應該讓他出去嘛走出去嘛我們其實在二月份我on board之後其實跟學名藥廠 原廠藥廠生物理事用藥藥廠各類的其實做了很多的公協會的 |
| transcript.whisperx[78].start |
3606.221 |
| transcript.whisperx[78].end |
3620.234 |
| transcript.whisperx[78].text |
陸陸續續extension下去我們持續在努力當中兩位要牽手的署長相對年輕我想你們在這個你們職場上還很有可為啦希望你們做的事情是比較長遠的一些事情啦好 謝謝 謝謝三位謝謝主席謝謝 謝謝好 謝謝陳委員 謝謝部長那接下來我們請林業勤委員質詢 |
| transcript.whisperx[79].start |
3634.918 |
| transcript.whisperx[79].end |
3638.779 |
| transcript.whisperx[79].text |
主席麻煩我們的邱部長和我們的石署長部長跟署長早首先先感謝衛福部廣納民間意見為什麼 因為我今天看書面報告蠻開心的因為都有針對我過去的呼籲都有回應去接納我們的意見我覺得這事實上是一個好事 |
| transcript.whisperx[80].start |
3663.926 |
| transcript.whisperx[80].end |
3692.447 |
| transcript.whisperx[80].text |
那今天大概就是我覺得今天召委排這個議題我覺得有點操之過急為什麼因為到底整個狀況現在還不是很明確當然美國總統川普為了讓藥品在美國製造關稅可能要調整到250%針對這個問題當然台大醫院的院長余中仁也在10號表示說川普的政策已經造成全球的碎片化台灣應該要加強我們的學名藥製藥能力才能減少衝擊 |
| transcript.whisperx[81].start |
3693.248 |
| transcript.whisperx[81].end |
3710.774 |
| transcript.whisperx[81].text |
不過醫院過去會缺藥大部分事實上是因為藥廠沒有辦法供應所導致可是前陣子許多藥廠也開始生產學名藥而如果之後原料藥真的事實上是因關稅沒有辦法進口那真的確實事實上是一個可能會影響到後續的生產 |
| transcript.whisperx[82].start |
3712.716 |
| transcript.whisperx[82].end |
3721.989 |
| transcript.whisperx[82].text |
所以想問部長這邊過去台美雙方的藥品進口事實上是相互零關稅如果美國真的把藥品關稅提升到250%的時候 |
| transcript.whisperx[83].start |
3723.927 |
| transcript.whisperx[83].end |
3742.83 |
| transcript.whisperx[83].text |
並對台灣出口到美國的藥品課徵這個恐怕這影響恐怕不是只有商業利益的得失啦而是逼著台灣是不是要去認清我們自己藥品的供應韌性能不能不要依賴進口的事實而是要加強我們在地生產的量呢那你的看法是什麼 |
| transcript.whisperx[84].start |
3743.001 |
| transcript.whisperx[84].end |
3768.439 |
| transcript.whisperx[84].text |
好 謝謝委員這麼專業的一個新聞我們衛福部當然持續在推動發展國內協名藥的一個產業也就是剛剛委員所提到的包括第一個我們輔導國產的協名藥來產製必要藥品來平衡我們現在目前國內所需要的第二個我們提升協名藥的一個競爭力 |
| transcript.whisperx[85].start |
3769.84 |
| transcript.whisperx[85].end |
3784.084 |
| transcript.whisperx[85].text |
來拓展這個利基型的一個學名藥第三個我們也是建議大眾國內的民眾能夠對學名藥的一個信賴度普及學名藥的一個使用第四個我們也希望我們國內的學名藥能夠 |
| transcript.whisperx[86].start |
3786.406 |
| transcript.whisperx[86].end |
3800.698 |
| transcript.whisperx[86].text |
進入國際的市場這個部分衛福部跟外交部其實也攜手合作在拓展這樣的一個市場希望也是能夠持續這是台灣藥品供應的現狀這上次我在公聽會有提過藥品許可證的數量 |
| transcript.whisperx[87].start |
3802.12 |
| transcript.whisperx[87].end |
3823.921 |
| transcript.whisperx[87].text |
國產比跟進口事實上是83.1783比17原料藥品許可證的廠商僅佔15%進口原料要佔85%數量可是在健保我們的支付費用上健保用藥學名藥佔69%可是僅得利是28%這也是我上上個會期都有 |
| transcript.whisperx[88].start |
3825.083 |
| transcript.whisperx[88].end |
3842.465 |
| transcript.whisperx[88].text |
諮詢過的那扣除掉13.6%的進口學名藥剩下14.4%的費用是用122家的製藥公司來競爭此外多數專利都已經超過5年的藥品學名藥對原藥廠的藥品替代率還是很低 |
| transcript.whisperx[89].start |
3843.246 |
| transcript.whisperx[89].end |
3860.117 |
| transcript.whisperx[89].text |
那余院長也說面對我們的藥品的全球碎片化的解方便是台灣藥品在地化所以具體來說便是學民藥產業要能夠站穩腳步以這樣的結果來看學民藥能夠撐起台灣藥品的需求供應嗎我到署長這邊 |
| transcript.whisperx[90].start |
3862.098 |
| transcript.whisperx[90].end |
3886.267 |
| transcript.whisperx[90].text |
跟委員報告確實全世界各國面對這些高價的新藥都是以發展學名藥那麼來降低整體藥費的支出才能夠補這個新藥的這個高價所以我們在去年開始也研擬一些修法今年開始我們就開始實施了所以用台灣的原料藥的我們的藥價加10%那另外 |
| transcript.whisperx[91].start |
3886.927 |
| transcript.whisperx[91].end |
3915.726 |
| transcript.whisperx[91].text |
刚过专利期五年内你来申请这个学名药或生物相似药我们前两张合给的药价跟原厂药一样所以这个也是一种鼓励措施那再来如果是列在我们的基本用药里头那么那一项呢是三那个那一组同药理特性的在三个品项以下那有台湾制造的我们保障药价当年度不调药价就不会往下调 |
| transcript.whisperx[92].start |
3916.767 |
| transcript.whisperx[92].end |
3944.124 |
| transcript.whisperx[92].text |
保障之外如果有不符成本來提我們還可以提高要價所以我們有很多的措施在鼓勵這個學民要在地製造是 這很好可是就算撐得住也是產難經營那我就想說請問包含衛福部的部立醫院教育部的大學附屬醫院 附設醫院還有國防部的三總退福會的榮總各自主管的公立醫院 |
| transcript.whisperx[93].start |
3944.904 |
| transcript.whisperx[93].end |
3963.026 |
| transcript.whisperx[93].text |
他們自己就是說你們這樣子自己政府部門的用學名藥嗎跟委員報告您提到一個重點剛剛講的是產業端的鼓勵但是實際上呢這個醫療端也要鼓勵他們用所以我們去年開始先針對一些這個生物相似藥 |
| transcript.whisperx[94].start |
3964.387 |
| transcript.whisperx[94].end |
3989.862 |
| transcript.whisperx[94].text |
給這個獎勵就是開了這些生物相思藥有獎勵那讓這個生物相思藥的佔率從7%提高到了12%所以還是可以再成長所以我們今年又擴大那個化學化療藥癌症的化療藥的這個學民藥使用我們也有獎勵所以今年8月開始所以希望明年也可以上升像我們隔壁的台大醫院來說學民藥的使用量佔百分之多少 |
| transcript.whisperx[95].start |
3991.284 |
| transcript.whisperx[95].end |
4017.746 |
| transcript.whisperx[95].text |
它是相當低的好 那再來詢問是之前永豐輸液的缺藥的事件裡面那一支的事件出事情的輸液市場那佔高達市場市場是7% 8%一出事 其他兩層的藥廠根本沒有辦法在短時間內能夠把貨補足那市場勢必 市場可能就會產生缺藥 |
| transcript.whisperx[96].start |
4018.746 |
| transcript.whisperx[96].end |
4044.476 |
| transcript.whisperx[96].text |
這問題的根本是在我們的市佔率第二名第三名的公司跟第一名相差太遠了衛福部有沒有去扶持我們的第二名第三名的所謂的市佔率的政策的規劃跟委員報告確實這個寡佔的藥品會造成缺藥的風險提高所以我們會剛剛您提的這個蘇伊我們就有把它的價格提高那另外一個藥價差是一個問題 |
| transcript.whisperx[97].start |
4046.211 |
| transcript.whisperx[97].end |
4068.92 |
| transcript.whisperx[97].text |
過低的藥價就是它的藥價差拉太大那表示可能在品質上會有一些問題所以我們現在都會密切去關注那個藥價差太大的我們會把這個品項送給食藥署去進行查查來確保它的品質避免用低價競爭那反而拉低其他的這個寡占市場 |
| transcript.whisperx[98].start |
4070.04 |
| transcript.whisperx[98].end |
4084.551 |
| transcript.whisperx[98].text |
這個我們已經在做了那藥品韌性就是要保持六個月不缺藥的那個能力那我本席在6月19號的公聽會特別去提醒就是說一季的原藥廠跟學名藥 |
| transcript.whisperx[99].start |
4085.211 |
| transcript.whisperx[99].end |
4111.912 |
| transcript.whisperx[99].text |
占率各為50%的藥品的話一旦發生原藥廠中斷供應的話單靠我們的學民藥還可以維持三個月的供應可是在這三個月期間所庫存的原料另外要能夠生產三個月的藥品如此才能夠撐過六個月大幅來提升六個月後藥品恢復穩定供應的機率那日本健保給付學民藥的市占率的標準是過去的80% |
| transcript.whisperx[100].start |
4113.813 |
| transcript.whisperx[100].end |
4126.008 |
| transcript.whisperx[100].text |
那經歷九年提升到現在的85%對此我們可以確定日本政府要確保我們的藥品供應的韌性的行動力所以請問衛福部你們的目標是什麼 |
| transcript.whisperx[101].start |
4128.129 |
| transcript.whisperx[101].end |
4153.054 |
| transcript.whisperx[101].text |
跟我們報告我們剛剛那個說的選民藥的目標現在差不多40%而已選民藥的戰力40%我們希望拉到70%做目標那個70%目標你預計大概逐年非常我們之前那個生物相似藥是希望從7%拉到30%是三年的時間那我們也希望未來這三年可以讓他從目前的40%拉高到70% |
| transcript.whisperx[102].start |
4154.534 |
| transcript.whisperx[102].end |
4180.424 |
| transcript.whisperx[102].text |
希望這個目標能夠儘速能夠達成謝謝委員針對任信這邊提到六個月不缺藥這個基本非常重要的議題所以我們在原料藥的儲備上面其實我們希望能夠extension更長的時間雖然是規定是半年內缺藥的部分但是原料藥的儲備時間是可以更長對於學名藥的部分我們目前學名藥的藥廠144家當中我們目前是希望在所謂關鍵的藥物能夠進入修法 |
| transcript.whisperx[103].start |
4181.244 |
| transcript.whisperx[103].end |
4199.936 |
| transcript.whisperx[103].text |
進一步讓它的分配跟我們可以調動跟可以做一些行政上面的支持能夠做一些協調讓這個涵蓋面是打區域聯防共同來為我們的學民要以及用藥的韌性而努力這個是在政策上我們會持續努力在這個方向努力的地方好 走下去因為我們當然也很希望 |
| transcript.whisperx[104].start |
4200.316 |
| transcript.whisperx[104].end |
4222.509 |
| transcript.whisperx[104].text |
未來能夠70%可以達標另外我在公聽會上也提出多數的病人其實並不會影響用藥為了促進國產學名藥我覺得首先要的這也是我之前公聽會有提出來就是說應該是鼓勵醫生使用學名藥因為民眾並不會知道醫生到底是開進口藥還是學名藥那當然的確你們在 |
| transcript.whisperx[105].start |
4223.47 |
| transcript.whisperx[105].end |
4241.277 |
| transcript.whisperx[105].text |
那個去年的7月1號就有事辦那本計畫事實上是一年編列2億的預算用加碼給附醫生150點的費用來鼓勵醫生開立特定的生物相似性的用藥而到今年為止的藥品佔率大概從2030年2023年的7.38%提升到13% |
| transcript.whisperx[106].start |
4246.919 |
| transcript.whisperx[106].end |
4272.429 |
| transcript.whisperx[106].text |
這個政策呢以戰略30%為目標為期三年所以我本期非常期待這個鼓勵政策要納入更多的學民藥的品項所以請問健保署在2026年度有沒有擴大計畫範圍提高到整體的學民藥那個戰略的積極作為那是不是可以譬如計畫中的品項從化療學民藥到癌症學民藥 |
| transcript.whisperx[107].start |
4273.729 |
| transcript.whisperx[107].end |
4278.708 |
| transcript.whisperx[107].text |
化療選民藥擴大到癌症選民藥的再逐步擴大到所有的選民藥這邊 |
| transcript.whisperx[108].start |
4279.98 |
| transcript.whisperx[108].end |
4306.849 |
| transcript.whisperx[108].text |
跟委員報告就是去年我們是用聲勢相似要做目標那成效不錯所以我們試辦之後今年的下半年就7月1號開始我們就擴大到化療的學名藥大概是100多個品項那打算明年1月開始再把所有的這個癌症的用藥的學名藥通通把它納進來然後再逐步虧打那些有一些基本用藥需要的那個學名藥 |
| transcript.whisperx[109].start |
4308.272 |
| transcript.whisperx[109].end |
4311.563 |
| transcript.whisperx[109].text |
這個鼓勵使用玄冥藥的計畫預算會放在哪裡 |
| transcript.whisperx[110].start |
4313.324 |
| transcript.whisperx[110].end |
4336.56 |
| transcript.whisperx[110].text |
目前我們這個預算是在我們的總額裡面的這個P4P的獎勵計畫健保總額有限建議可不可以列在我們藥物韌性整備計畫當中這個請你們去做考慮現在健保署找到對的方法就應該持續擴大而且已經專利期過五年的原廠藥在其他國家也有像台灣這樣子能佔有60%甚至到90%的市佔率嗎 |
| transcript.whisperx[111].start |
4340.643 |
| transcript.whisperx[111].end |
4354.095 |
| transcript.whisperx[111].text |
很高 我們很高耶60%到98%是嗎所以我覺得請部長跟署長對的事情要堅持去做衛福部去年就提出了我們的韌性國家醫療整備計畫到2027年將投入總金額76.63億元 |
| transcript.whisperx[112].start |
4359.6 |
| transcript.whisperx[112].end |
4376.175 |
| transcript.whisperx[112].text |
這個計畫一開始就是要建立國家因應緊急災難的復原力可是經歷了政府跟民間一整年的討論今年又面對到我們美國關稅所掀起的全球的藥品供應鏈的高度的不確定性這個計畫 |
| transcript.whisperx[113].start |
4377.216 |
| transcript.whisperx[113].end |
4388.669 |
| transcript.whisperx[113].text |
仍然會再拿出來好好的檢視的必要性那林靜儀次長於6月19號的公聽會有提到食藥署正盤點我們的藥品供應鏈的那個韌性請問盤點後的狀況如何 |
| transcript.whisperx[114].start |
4394.083 |
| transcript.whisperx[114].end |
4421.371 |
| transcript.whisperx[114].text |
這邊跟委員做進一步報告那我們針對現在盤飲品的現況它涵蓋面相當的廣從原料藥到學名藥的國造化跟國際化那進一步我們希望所謂生物藥物的自主化跟一些關鍵的藥物的在地化那我們對此外我們對藥品以外對醫材也一鏡的進入我們的計畫向下我們另外一個部分是我們本身的 |
| transcript.whisperx[115].start |
4422.771 |
| transcript.whisperx[115].end |
4450.655 |
| transcript.whisperx[115].text |
台灣的市場小所以我們另外一部分就是分布的就是能夠去供應能夠平衡所以對於所謂智慧的監控能夠完善我們的供應鏈那此外我們對於這次也有對於我們的醫師法藥治法的二七條之三裡面希望能夠更多的能夠去做一些調控政府介入的機制此外呢我們也在目前積極跟國際之間做國際的合作跟互助的聯盟這是我們持續在做 |
| transcript.whisperx[116].start |
4451.175 |
| transcript.whisperx[116].end |
4477.229 |
| transcript.whisperx[116].text |
所以如果有一點點時間對於剛才的學名藥特別提台灣所有的藥廠都是PIX GMP的藥廠我們對我們的藥品其實有絕對的信心我們是非常非常嚴格的那國內藥廠也非常努力對於學名藥的品質我相信是一定是沒有問題的希望國人能夠更多更多的一個瞭解是 我們真的要去扶持我們自己國內的那請問在提升原料藥來源的政策上目前的進度如何 |
| transcript.whisperx[117].start |
4479.741 |
| transcript.whisperx[117].end |
4504.399 |
| transcript.whisperx[117].text |
目前剛才提到原料藥廠我們現在有30家但它產值的部分其實將近量50億左右那這個部分呢因為大部分是所謂輸外那我們希望它能夠進一步來製作因為原料藥它特色是對於環境的一些衝擊比較大所以我們在跨部會裡面請環境部跟有順利跟日本歐盟等友好國家達成互助協議了嗎 |
| transcript.whisperx[118].start |
4506.121 |
| transcript.whisperx[118].end |
4520.542 |
| transcript.whisperx[118].text |
這個部分其實歐盟在所謂的關鍵藥品的韌性上面有些需要原料藥的部分他們其實在我們ICMRA的一個向下我們其實被承認已經是他們的關鍵一些藥物裡面的一個來源國以上 |
| transcript.whisperx[119].start |
4521.004 |
| transcript.whisperx[119].end |
4536.63 |
| transcript.whisperx[119].text |
那對於扶持我們國產的抗生素 血液製劑的政策規劃現在進度如何 有具體的計畫嗎這個是有具體的計畫我們也有具體的相次這邊容我們在持續的努力在我們的關鍵的任性裡面在努力的地方好 |
| transcript.whisperx[120].start |
4537.423 |
| transcript.whisperx[120].end |
4566.83 |
| transcript.whisperx[120].text |
那最後就是我覺得在部長在8月8號表示要為避免美國提高關稅可能衝擊到我國藥品進口跟供應鏈的穩定微博部包括食藥署跟健保署共同的擬了剛剛講的四大政策不過另外大家特別條例裡邊中有200億的經費要優先用在藥品價格調整的等穩定的用藥那個措施我國2024年的原藥料進口的 |
| transcript.whisperx[121].start |
4567.21 |
| transcript.whisperx[121].end |
4594.275 |
| transcript.whisperx[121].text |
就是出口的額度金額事實上是1.7億美元對美出口佔總金額的只有10%那制劑事實上是出口額8.1億美元對美國的出口額事實上是新台幣3億那佔總出口額的事實上是37%因應美國藥品關稅可能從0%要提高到最高250%本息事實上是支持200億金幣優先的使用方式那但 |
| transcript.whisperx[122].start |
4595.175 |
| transcript.whisperx[122].end |
4618.001 |
| transcript.whisperx[122].text |
長久之計還是要達到藥品自主可控的實質韌性所以建議健保署這筆錢之外另外是不是可以再爭取51到100億來成立我們的藥品韌性基金或專款來優先穩定必要我們的藥品跟抗生素的供應並用來鼓勵公立醫院優先採購國產學名藥那你的看法是什麼 部長 |
| transcript.whisperx[123].start |
4619.413 |
| transcript.whisperx[123].end |
4633.3 |
| transcript.whisperx[123].text |
我想這是一個應該努力的方向所以最後就覺得 美國進口藥品關稅還沒有確定可是政府應該事先做好準備這些問題我這邊會再持續盯著謝謝我們會繼續努力 謝謝好 謝謝林業勤委員 謝謝部長來 繼續我們請陳慶輝委員質詢 |
| transcript.whisperx[124].start |
4646.234 |
| transcript.whisperx[124].end |
4650.944 |
| transcript.whisperx[124].text |
謝謝主席 謝謝官員 我想請邱部長還有食藥署還有健保署委員好 |
| transcript.whisperx[125].start |
4658.037 |
| transcript.whisperx[125].end |
4681.334 |
| transcript.whisperx[125].text |
謝謝邱部長上禮拜呢我們有探討了一位其實在各方面都有違反到不管是醫療法醫事法等等還牽涉到國稅局法務部那您上禮拜說衛福部將嚴格的查辦所以在這邊也想問我們各部門的進度因為這個醫師可能在訴前的諮詢就已經違規還請病人貸款 |
| transcript.whisperx[126].start |
4684.156 |
| transcript.whisperx[126].end |
4704.183 |
| transcript.whisperx[126].text |
那私底下有匯款還有他告訴很明確的告知病人說這個手術他除了申報健保以外還請你私下再付費給我然後我再另外做一些數試然後我們請健保署可以去追查他是不是所有的手術都是這樣做食藥署的話是因為他已經主動告知個案 |
| transcript.whisperx[127].start |
4705.303 |
| transcript.whisperx[127].end |
4722.055 |
| transcript.whisperx[127].text |
這個人匯過來的錢他是去大陸幫他買大陸的醫材過來做手術有沒有違規還有最後您說您一週內會發函給法務部以及國稅局等等的所以想請問您各部門的進度現在如何了 |
| transcript.whisperx[128].start |
4722.95 |
| transcript.whisperx[128].end |
4749.907 |
| transcript.whisperx[128].text |
好 謝謝委員的隨行我想我們了解到這個訊息以後馬上就站在專方主管機關的一個角色我們就會要去了解到地方衛生局處理的一個過程那所以其實他已經就讓他就沒有再繼續做醫療行為那至於他剛剛委員所提到的各種狀況 |
| transcript.whisperx[129].start |
4750.968 |
| transcript.whisperx[129].end |
4763.277 |
| transcript.whisperx[129].text |
各種問題我們都一個一個必須要去了解它是不是違反相關的規定跟法令一定要依法辦理那這個部分請議事室看進度報告一下 |
| transcript.whisperx[130].start |
4764.417 |
| transcript.whisperx[130].end |
4791.329 |
| transcript.whisperx[130].text |
是跟委員報告這個事情我們一直跟高雄市政府衛生局保持密切的聯繫那麼據我們所知在這個事件發生很快的時間內高雄市衛生局就去查了而且確實查到非常多不法的行為那包含有這個醫材是大陸的進口有違規的問題還有收費有稅務的問題這一些高雄市衛生局都已經移情給相關的機關來做敘處了 |
| transcript.whisperx[131].start |
4793.49 |
| transcript.whisperx[131].end |
4817.307 |
| transcript.whisperx[131].text |
我們得知的訊息是這樣子包含國稅局他們也也已經函送了然後以及這個違反醫材他會送檢調來進一步的查明這樣子跟委員報告這個我們非常的關注這個事情所以請分區業務組針對這一名醫師還有這個醫院擴大把他全面的這個病例都要做專業審查 |
| transcript.whisperx[132].start |
4818.388 |
| transcript.whisperx[132].end |
4828.193 |
| transcript.whisperx[132].text |
然後之後我們會精算出這個額度然後會擴大回推去扣這個20倍 最高到20倍的罰款同時最終給他處以庭業處分 |
| transcript.whisperx[133].start |
4831.751 |
| transcript.whisperx[133].end |
4850.347 |
| transcript.whisperx[133].text |
針對食藥署的部分有關於醫師使用是不是大陸的醫材的部分因為當初他是主動提所以我們跟高雄市的衛生局他們已經進行積極的調查我想在有一段段會立刻來跟大家做公佈以上好 謝謝請三位署長可以回座 |
| transcript.whisperx[134].start |
4851.843 |
| transcript.whisperx[134].end |
4874.159 |
| transcript.whisperx[134].text |
再來這個必須要給部長還是稍微鼓勵啦因為經過了非常非常多委員幾乎快要一年的質詢所以昨天您的這個狼藝平台上線了可是許多民團他還是沒有那麼滿意那以下我跟你列出幾點是因為之前呢您曾經在說成立狼藝平台的時候 |
| transcript.whisperx[135].start |
4876.041 |
| transcript.whisperx[135].end |
4892.012 |
| transcript.whisperx[135].text |
說爛咖沒有這麼多 所以不用可是我們看教師他們有很詳細的一個教師系統可以讓新的學校去聘任教師的時候在其他沒有公開資訊但是學校會知道說這個教室有沒有不良的紀錄 |
| transcript.whisperx[136].start |
4892.933 |
| transcript.whisperx[136].end |
4912.443 |
| transcript.whisperx[136].text |
那律師的話他除了查有沒有照他還可以去查他有沒有被懲處過以及有沒有違反律師倫理連這個律師忘記幫客戶上訴都會被列在上面為了這些所有客戶他在聘請律師之前有一個公開清楚的資訊那昨天呢 |
| transcript.whisperx[137].start |
4913.123 |
| transcript.whisperx[137].end |
4938.546 |
| transcript.whisperx[137].text |
大家就說奇怪你們覺得爛咖沒有這麼多難道你們是覺得教師的爛咖很多或是律師的爛咖很多所以必須成立這個平台嗎再來你把平台公佈以後大家就有點震驚是因為這個平台公佈還有三位還在執業現在還在執業然後因為他還沒送懲戒這個懲戒也是我們一年來跟你討論的問題 |
| transcript.whisperx[138].start |
4940.047 |
| transcript.whisperx[138].end |
4968.127 |
| transcript.whisperx[138].text |
還有這個是性平有關於病人可能你們定義為脆弱族群的可是他性平有牽涉到同行就是說醫師或者是護理師其實很多都上新聞也都沒有在這上面還有判刑確定才被放上去判刑確定都已經是三四年後的事情了行政調查結果出爐的也沒有上去這個是昨天許許多多的人反映的意見 |
| transcript.whisperx[139].start |
4969.648 |
| transcript.whisperx[139].end |
4994.304 |
| transcript.whisperx[139].text |
那這邊就跟你討論這個也是之前你們的林靜儀次長曾經跟一個法律的教授在網路上比戰他在講說這個懲戒到底要依照哪一款才可以送那你們也一再的說無罪推定原則所以要判刑後才可以送懲戒等等好 剛剛其實伊絲絲副市長講得非常的好 |
| transcript.whisperx[140].start |
4995.265 |
| transcript.whisperx[140].end |
5012.938 |
| transcript.whisperx[140].text |
高雄市衛生局的動作比你們快很多他上禮拜馬上就做了行政調查調查了上百個病例然後馬上送懲戒馬上送懲戒以後又暫時停止他現在準備要開懲戒委員會所以我想要知道的是 |
| transcript.whisperx[141].start |
5014.406 |
| transcript.whisperx[141].end |
5029.507 |
| transcript.whisperx[141].text |
這一年來我們跟你討論的醫師法第25條第28支4條到底是你們覺得很不好用還是不敢用還是你們沒有辦法做出清楚的定義所以不知道怎麼用 |
| transcript.whisperx[142].start |
5034.3 |
| transcript.whisperx[142].end |
5049.142 |
| transcript.whisperx[142].text |
謝謝委員的垂行我們看第一頁其實要這樣的一個公佈公佈也是要從技術面跟專業面各方面做一個很 |
| transcript.whisperx[143].start |
5050.223 |
| transcript.whisperx[143].end |
5074.211 |
| transcript.whisperx[143].text |
一直陸續的討論也要徵詢譬如說這個我們也跟司法院一直聯繫但是這個部分在嫁接上還沒有完全的直接嫁接所以這個還是用手工的以後我們會就是說去找我們以後希望跟相關的就直接連結就是沒有漏網之魚第二個就是說其實 |
| transcript.whisperx[144].start |
5077.915 |
| transcript.whisperx[144].end |
5098.332 |
| transcript.whisperx[144].text |
我們有關於涉及性品事件是不是要停止這個停止只要有涉及的話是不是要停止這個事情我們會在8月下旬邀請醫事人員的團體法規專家來召開會議來看看這樣的情況怎麼樣在合法又合乎大家期待的情況下來進行 |
| transcript.whisperx[145].start |
5099.833 |
| transcript.whisperx[145].end |
5115.179 |
| transcript.whisperx[145].text |
那另外就是在剛剛講的另外懲戒事有關於違背醫學倫理的這個函式我們現在也在演繹當中我們希望來針對這個做一個比較明確的函式那這個名剛剛那個說 |
| transcript.whisperx[146].start |
5121.862 |
| transcript.whisperx[146].end |
5142.999 |
| transcript.whisperx[146].text |
那咖啡那麼多 這個不是我講的啦這是醫事長講的衛福部官員講的我平常用詞是很尊重人家的啦那個每一個不管是誰我們都應該尊重他的這個就是您剛講到韓式啦這個韓式是我5月就提案的 |
| transcript.whisperx[147].start |
5143.96 |
| transcript.whisperx[147].end |
5156.253 |
| transcript.whisperx[147].text |
這五月就提案現在已經是八月中了那你中間有開過會還是你八月底才要開第一次會來跟專家討論這個意思是要不要最後一個回答 |
| transcript.whisperx[148].start |
5157.13 |
| transcript.whisperx[148].end |
5180.278 |
| transcript.whisperx[148].text |
跟委員報告兩件事剛剛講的是在調查期間就給他停職這個是要開會討論那韓式的部分我們已經都準備好那先前當然也有一個研商的過程那我們預定是在8月中旬就可以把這個補充這個違背醫學倫理的內涵提供給各縣市衛生局衛生局還有醫事工會你也可以提供是是是好謝謝 |
| transcript.whisperx[149].start |
5181.698 |
| transcript.whisperx[149].end |
5210.677 |
| transcript.whisperx[149].text |
再來我們就要講到說好剛剛你提到的停權的問題這個也是我想跟你討論剛才第28條為什麼上禮拜這個新聞出來民眾很震驚是因為民眾還可以上網掛他的號他在10天內發生了兩起減重手術死亡然後被開了記者會家屬出來公布一些這個與醫師互動的截圖以後結果發現他居然還在看診還可以掛號才發現說 |
| transcript.whisperx[150].start |
5212.618 |
| transcript.whisperx[150].end |
5238.589 |
| transcript.whisperx[150].text |
原來讓一個醫師停權不是很容易結果最後高雄市衛生局用的這個我們也覺得很奇怪因為他用的是第36條他是用行政執行法第36條行政執行法很少用在醫生行政執行法是為了要維持公共秩序的他是阻止犯罪危害發生或是避免急迫危險那即可以及時強制對於人的管束等等的 |
| transcript.whisperx[151].start |
5240.471 |
| transcript.whisperx[151].end |
5262.908 |
| transcript.whisperx[151].text |
這個問題其實幾乎每一個胃黃委員會的委員都問過你了還有外委員會也問過你了我們現在是28條法源不足嗎不足高雄市衛生局來對他做緊急的停權嗎那醫師法到底有沒有修法的必要性還有我也想問你們用28-4條到底這三年來近幾年來到底適用了幾個人 |
| transcript.whisperx[152].start |
5263.849 |
| transcript.whisperx[152].end |
5279.008 |
| transcript.whisperx[152].text |
還是其實根本裁罰的數量很少這個我可能會再用書面跟你們追數據可是如果你可以現在告訴我的話也OK報告委員我們我現在手上是沒有這個資料然後我們會後會來做補充好 |
| transcript.whisperx[153].start |
5282.578 |
| transcript.whisperx[153].end |
5297.414 |
| transcript.whisperx[153].text |
那你會覺得你們是因為不敢用還是你認為有修法的必要因為現在高雄市衛生局是用這種很少用在醫生的法律才對他進行停權那你醫師法存在的目的是什麼 |
| transcript.whisperx[154].start |
5298.161 |
| transcript.whisperx[154].end |
5323.186 |
| transcript.whisperx[154].text |
我想高雄市一定是N你相關的法令可以做的但是先保障我們民眾的權益嘛所以先用這樣行政執行法第36條先來處理那自己說是不是說在醫師法裡面的一個規定需要我們再把相關的資料整理一下然後再檢討看看他這樣的效果效力是不是說需要調整我們 |
| transcript.whisperx[155].start |
5323.846 |
| transcript.whisperx[155].end |
5346.413 |
| transcript.whisperx[155].text |
那今天會後我會再跟你們要這個資料就是你們近幾年利用28-4到底有裁罰了多少的人最後只是一個延伸啦就是說很多醫生他會覺得您成立這個平台不管是獵醫或是良醫也是為了保障病人當然然後也為了保障其實我們大多數的醫生都是好的 |
| transcript.whisperx[156].start |
5347.293 |
| transcript.whisperx[156].end |
5376.114 |
| transcript.whisperx[156].text |
所以除了性平的這些判決或是行政調查也有 大家都會在新聞上看到長期倒刷健保卡 偽造病例違法用密醫 使用非法的療法等等的如果他是有懲戒的決議也應該要揭露因為上禮拜其實您看到這個案例也非常非常的生氣我是想表達的是說衛護部長您是否有考慮把獵醫良醫這些事都列進去考量假使這些尋求愛美追求壽身的人 |
| transcript.whisperx[157].start |
5376.715 |
| transcript.whisperx[157].end |
5389.196 |
| transcript.whisperx[157].text |
他事先可以知道這些資訊的話比如說這個醫生嚴重的違反醫學倫理嚴重的違反醫師法醫療法他都事先知道我們可以可能有機會挽救第二條人命不是嗎 |
| transcript.whisperx[158].start |
5392.314 |
| transcript.whisperx[158].end |
5410.753 |
| transcript.whisperx[158].text |
當然我們絕對保障民眾的權益不管是他知的權益或者他接受醫療的就醫的一個安全性這個是最高的準則我們就是團隊就是潛力在往這方面來努力所以需要做怎麼樣的工作我們都一定潛力來努力 |
| transcript.whisperx[159].start |
5411.153 |
| transcript.whisperx[159].end |
5433.141 |
| transcript.whisperx[159].text |
因為林淑芬委員等一下可能會問這題所以我只是先延伸告訴你說其實除了狼醫性平事件還有很多病患需要知道的資訊我們就是為了保障其他99.9%以上好的醫生還有病人這樣子好嗎那之後我再用書面書面跟你們詢問 謝謝謝謝主席 |
| transcript.whisperx[160].start |
5438.025 |
| transcript.whisperx[160].end |
5455.062 |
| transcript.whisperx[160].text |
謝謝陳慶威委員來 接續我們請邱正軍委員質詢那跟大家報告王一鳴委員質詢我們休息十分鐘好 謝謝主席主席好我們要先請我們的邱部長還有食藥署好了 |
| transcript.whisperx[161].start |
5460.461 |
| transcript.whisperx[161].end |
5483.458 |
| transcript.whisperx[161].text |
委員好部長好那我根據食藥署的數據全台有效藥品許可證有11454張國產佔72.6%但原料廠有75%至80%是仰賴中國和印度進口那現在美國準備對全球藥品關稅開刀那台灣也有被波及這不是單純的這個出口問題而是藥價缺藥健保產業的適從這個夾擊 |
| transcript.whisperx[162].start |
5489.562 |
| transcript.whisperx[162].end |
5512.019 |
| transcript.whisperx[162].text |
那實際處方藥廠 藥市場進口藥品佔比大概超過六成這代表什麼 代表你們的國產比例是紙面數據實際上上藥的架上的藥 十包裡面有六包是進口的那我想請問一下所有 所以有多少藥品是真的在台灣生產佔比啦 佔比就好 |
| transcript.whisperx[163].start |
5513.069 |
| transcript.whisperx[163].end |
5536.761 |
| transcript.whisperx[163].text |
這邊跟委員做進一步的報告的確我們現在的原料藥的部分在應用的以中國跟印度的佔比相當相當高分別是27%跟26%所以在這種情形之下我們的原料藥的依存度呢的確是非常非常高的我們必要藥品上清單有大概584項有多少是在台灣生產 |
| transcript.whisperx[164].start |
5539.086 |
| transcript.whisperx[164].end |
5562.922 |
| transcript.whisperx[164].text |
這部分我可能要精確的確定一下你們是主管機關 這個必須要確實掌握因為現在是 我認為是全球在重新洗牌我們這個供應鏈全部重新在洗牌所以我們這些東西應該要確實掌握因為任何一個主要的來源果出問題我們的醫療系統就會出現缺口 對不對 |
| transcript.whisperx[165].start |
5564.109 |
| transcript.whisperx[165].end |
5572.264 |
| transcript.whisperx[165].text |
所以我看到我爸剛剛你講的如果反映在成本到這個成本反映到藥價上是健保吸收還是我們人民吸收 |
| transcript.whisperx[166].start |
5578.901 |
| transcript.whisperx[166].end |
5600.577 |
| transcript.whisperx[166].text |
因為我們的健保是單一個保險機構我這樣講啦 我問了那麼多你們都好像搞不太清楚狀況因為你們是主要的這個主管機關那所有藥品的製造輸入販賣都必須登錄在藥品許可證的這個資料庫是你們的職責嘛 對不對那照理說你們隨時應該都可以查出來隨時都可以查出來 |
| transcript.whisperx[167].start |
5601.337 |
| transcript.whisperx[167].end |
5625 |
| transcript.whisperx[167].text |
那我不希望說這個東西到後來變成一個萬一真的發生了那我們怎麼去面對這個問題這個才是我比較擔心的好第一個我們絕對會盡力不要增加人民的就醫的負擔包括要價的一個負擔所以我們很早就做好各種美國的關稅的一個變化我們有強化 |
| transcript.whisperx[168].start |
5626.181 |
| transcript.whisperx[168].end |
5641.18 |
| transcript.whisperx[168].text |
供應的一個疫情這個一定不能讓他缺藥我有看到你的缺藥平台有做就是你的缺藥平台你的缺藥平台等他已經這個數據出來的時候就是已經發生的事情對不對我要的是你們在更之前能夠確實掌握我們這個藥品的數量謝謝委員的提點 |
| transcript.whisperx[169].start |
5645.245 |
| transcript.whisperx[169].end |
5668.513 |
| transcript.whisperx[169].text |
因為針對預警的平台我們是西藥劑醫療器材的供應的平台短缺平台平台的登錄其實我們會在藥事法裡面希望在就已經規定在半年內致濟的是半年內就提出來所以在提前的時間內在還沒有缺藥之前這個部分我希望你 你講致濟的部分其實我們國產的致濟其實佔了73.64%的是屬於國產的 |
| transcript.whisperx[170].start |
5672.694 |
| transcript.whisperx[170].end |
5699.655 |
| transcript.whisperx[170].text |
那這個部分呢我們化學藥的部分其實是95.09原料咧原料咧那我們原料藥的部分相對是比較低目前的占比只有接近15%左右所以這部分是我們持續在努力的一個地方好啦那我跟你講就是剛剛講這些我希望你能夠確實掌握確實掌握那另外當然缺藥平台很重要可是我認為你們內部應該有一個提早的一個機制不能夠等 |
| transcript.whisperx[171].start |
5703.177 |
| transcript.whisperx[171].end |
5726.632 |
| transcript.whisperx[171].text |
這個數字顯示出來的時候再來處理另外剛剛講說我們有現在在扶植要本土藥廠我們當然就是多了一層保障但是我們可能馬上面臨的問題我們比較擔心說我們的患者會不會受到影響因為你現在才要扶植它並不是那麼快 對不對 |
| transcript.whisperx[172].start |
5727.994 |
| transcript.whisperx[172].end |
5754.406 |
| transcript.whisperx[172].text |
跟委員報告這個剛剛提到的這個我們整個健保有幾副的藥品品項大概一萬四千多種那這裡面呢就如方剛剛提到的70%的量是這個等於是學名藥或者是在台灣製造那30%是靠進口那進口裡面我們最需要掌握的就是在專利期內的因為你這個去扶植都沒有用因為它是專利保護 |
| transcript.whisperx[173].start |
5755.326 |
| transcript.whisperx[173].end |
5768.122 |
| transcript.whisperx[173].text |
專利保護的品項大概是214項那麼大概金額大概在390億左右然後這裡面呢還有一些是沒有辦法替代品項很少的那這個大概在275項 |
| transcript.whisperx[174].start |
5771.966 |
| transcript.whisperx[174].end |
5795.032 |
| transcript.whisperx[174].text |
那金額大概在200億左右所以我們才會有特別的編列那個特別預算爭取在特別預算因應未來這個專利期內的這些藥就是6到18個月嘛對不對然後保持那我們健保的一樣是健保去吸收成本嘛那這樣的話健保會不會到時候的壓力又越來越大我們在什麼時候情況下會再做調整 |
| transcript.whisperx[175].start |
5796.037 |
| transcript.whisperx[175].end |
5822.966 |
| transcript.whisperx[175].text |
當然我們目前是行政院有在這個我們這個因應國際情勢的特別條例特別預算裡頭是有編列給健保200億的這個健保基金來因應這樣的變局啦但是長期來講當然也會造成健保保費的壓力確實是這樣對 你現在講的是健保那萬一是自付這個自費的部分呢自費的藥品呢這些部分 |
| transcript.whisperx[176].start |
5824.284 |
| transcript.whisperx[176].end |
5853.442 |
| transcript.whisperx[176].text |
的成長你們有掌握嗎自費的我們就沒有這樣的資料就沒有資料那萬一柏仁生病怎麼辦這邊跟委員也進一步說明剛剛也有特別提到我們的要自治國產的部分因為國內的市場相對比較小所以有時候是比較供應其實是供需上面需要有很好的調控所以我們特別把所謂的希望做智慧監控的導入在未來在我們的藥事法修法在27之3上面也希望在我們的藥品 |
| transcript.whisperx[177].start |
5853.962 |
| transcript.whisperx[177].end |
5881.971 |
| transcript.whisperx[177].text |
在有短缺的情況之下都能夠進入我們能夠調控的一個機制之內未來也需要多委員給我們很多的支持好啦 我希望不管是健保藥品或者是自費的藥品我希望一步一步都要確實掌握啦因為這些都關乎我們國人的健康那麼台灣不只會藥變貴我這樣看但是我更擔心是這個藥買不到這個更是重點我希望大家能夠把這個螺絲拴緊好不好 |
| transcript.whisperx[178].start |
5883.752 |
| transcript.whisperx[178].end |
5892.566 |
| transcript.whisperx[178].text |
那再來我請教部長就是我們PM2.5直接影響這個疾病負擔死亡統計與健保支出這是不是衛福部的業務 |
| transcript.whisperx[179].start |
5896.638 |
| transcript.whisperx[179].end |
5920.356 |
| transcript.whisperx[179].text |
有嗎就是P2.5的死亡統計跟健保的支出那世界衛生組織2019年統計很清楚P2.5造成的過早死亡將近七成是心臟病與中風那14%是慢性阻塞性肺病14%是肺炎另外4%是肺癌所以我先問這個部分我們是衛福部的核心公共衛生問題 |
| transcript.whisperx[180].start |
5921.536 |
| transcript.whisperx[180].end |
5946.228 |
| transcript.whisperx[180].text |
好我想不管任何的因素影響到健康這是我們衛福部應該要去我們有數據嗎哪一方面的數據就這個這個部分我們有做過調查嗎影響健康各方面影響健康我想這個這個2023年在那個我記得一個期刊那個Science的研究第一是把PN2.5 |
| transcript.whisperx[181].start |
5947.048 |
| transcript.whisperx[181].end |
5960.783 |
| transcript.whisperx[181].text |
按照來源分開發現藍莓火力發電的這個PM2.5致死風險是其他來源的2.1倍美國因此每年多死了4萬3千人20年間累積了46萬人這代表 |
| transcript.whisperx[182].start |
5963.55 |
| transcript.whisperx[182].end |
5976.466 |
| transcript.whisperx[182].text |
在這個所有的這些致命的疾病背後有相當的比例的風險來自於藍莓這種加倍致命的污染源不然我請問你有沒有針對藍莓P2.5做過全國的健康這個衝擊的評估 |
| transcript.whisperx[183].start |
5982.054 |
| transcript.whisperx[183].end |
5997.229 |
| transcript.whisperx[183].text |
我想過去幾年多年來我也在這邊當過八年的立委幾乎都是在質詢這個問題所以你應該很了解當然我們這個跟環境部跟衛福部都有當然這是跨部會的 |
| transcript.whisperx[184].start |
5997.95 |
| transcript.whisperx[184].end |
6022.739 |
| transcript.whisperx[184].text |
但是你們這個部分因為一個空污的狀況或PM2.5這個部分它的來源我們要看看它的來源是對嘛 別人都有在做嘛分析的來源以外第二個就是說要科學的分析科學的分析就是要有足夠的證據力對啊 結果呢 你有做嗎拿一兩篇paper就來說不是 我現在就是請教你嘛我們有沒有做嘛就是沒有嘛 |
| transcript.whisperx[185].start |
6027.435 |
| transcript.whisperx[185].end |
6040.318 |
| transcript.whisperx[185].text |
對不對我們來瞭解國衛院他們現在的應該有相關的一個相關的我不希望這樣國衛院有做那你衛福部不是要掌握嗎這個不是關乎我們國人的健康嗎 |
| transcript.whisperx[186].start |
6042.314 |
| transcript.whisperx[186].end |
6062.144 |
| transcript.whisperx[186].text |
我們當然是很關心所以我認為啦你的立場跟環境部的立場有時候我們必須要以國人的健康作為出發來去做提點不管他們未來他們要怎麼去這個施政或者他的政策方向怎麼走那至少我們要進到我們衛福部應有的一個立場我這樣講沒錯吧 |
| transcript.whisperx[187].start |
6064.59 |
| transcript.whisperx[187].end |
6089.138 |
| transcript.whisperx[187].text |
我想空污跟各種疾病的相關相連性它有強弱之別我們都會去看看國內外的文獻來做好我們政策的分析一定要儘量減少對我們民眾的影響我想這個部分是我們基本要去做的事情 |
| transcript.whisperx[188].start |
6089.938 |
| transcript.whisperx[188].end |
6115.233 |
| transcript.whisperx[188].text |
好啦我是希望我們衛福部盡到自己的這個業務的這個職責不要讓我們台灣人用廢發電尤其我們中火他就已經佔了一半以上所以這部分真的是非常非常嚴重請我們這個主管機關不要這個當作沒事一樣不要要勇於挑戰因為上面的政策是怎麼樣這是一回事那我們 |
| transcript.whisperx[189].start |
6116.033 |
| transcript.whisperx[189].end |
6135.17 |
| transcript.whisperx[189].text |
的業務我這是我的責任我應該說清楚的我還是希望大家來說清楚好不好對我們會按照科學的根據然後有有科學的根據來做最好是這樣不要變成這個幫我們這個能源政策化妝啦好不好我講重點在這裡我們會站在人民的健康立場來分析好謝謝部長謝謝 |
| transcript.whisperx[190].start |
6141.946 |
| transcript.whisperx[190].end |
6160.512 |
| transcript.whisperx[190].text |
好謝謝邱委員還有謝謝部長來王一鳴委員質詢那再來王一鳴委員質詢完畢休息10分鐘好謝謝主席我們有請邱部長委員好 |
| transcript.whisperx[191].start |
6168.055 |
| transcript.whisperx[191].end |
6191.222 |
| transcript.whisperx[191].text |
部長好 部長請問解決少子化的這個關鍵的做法是靠聯誼嗎謝謝王委員給我這個機會澄清我想我們面對少子化國家有那個我們我有一直在媒體講有四大政策都很積極在進行 |
| transcript.whisperx[192].start |
6193.002 |
| transcript.whisperx[192].end |
6213.577 |
| transcript.whisperx[192].text |
那最後我才提到說因為最近剛好這幾天六師聯誼會六師我想蘇昭偉都有深度的參與會計師 律師 現職師 中醫師 醫師 牙醫師他們常常在聚會對國家的一些政策做討論以外 |
| transcript.whisperx[193].start |
6214.378 |
| transcript.whisperx[193].end |
6230.557 |
| transcript.whisperx[193].text |
也做一些公益的活動包括煎雪的活動做得很好他們最近剛好要辦一個聯誼希望大家很工作忙碌的環境之下能夠有機會來互動這個部分我們也覺得相當好 |
| transcript.whisperx[194].start |
6231.358 |
| transcript.whisperx[194].end |
6255.591 |
| transcript.whisperx[194].text |
那其實各個公務機關也都有辦這樣的一個聯誼活動我們台北市議事公會也每年都一定辦這個而且還促成了好幾對我們都非常高興所以你是把希望放在這個聯誼活動上不是啦 那只是一個多元化的一個原因少子化的原因有很多我們一個一個要去負責當然也包括家庭一個制度 文化 |
| transcript.whisperx[195].start |
6256.731 |
| transcript.whisperx[195].end |
6272.665 |
| transcript.whisperx[195].text |
還有性別的一個平等的觀念等等的這些因素我們都一個一個要去解決在四大策略以外我希望你多強調這個四大策略我本來就強調四大策略為什麼大家會去注意到 |
| transcript.whisperx[196].start |
6274.006 |
| transcript.whisperx[196].end |
6302.117 |
| transcript.whisperx[196].text |
我看你被批評的蠻兇的就是大家都直接講說你的少子化的解方是要鼓勵你我想這個是道果為因啦不用再這樣子我用了偏乎九成的偏乎在講四大策略最後才提到說我們剛好最近有一些相關的所以你被斷章取義了我要提醒這個部長事實上我看到我們現在少子化的問題還是非常嚴重 |
| transcript.whisperx[197].start |
6302.817 |
| transcript.whisperx[197].end |
6325.01 |
| transcript.whisperx[197].text |
今年恐怕出生人口數還要再跌 跌破13萬你看到這個歷年來 這個真的一年比一年低我們到目前為止都沒有止跌的訊號南韓已經止跌了 臺灣我們完全沒有止跌的訊號那我今天要特別問你的就是 之前其實衛福部一直有在研議要有一個少子化的專責單位 |
| transcript.whisperx[198].start |
6326.351 |
| transcript.whisperx[198].end |
6355.603 |
| transcript.whisperx[198].text |
一度你們說已經快要爭取到了但現在又完全沒有消息了我要問部長是現在這個有關演繹少子化的專責單位你們演繹到哪裡什麼時候會正式這個組織會做一些調整跟改革我覺得這個才是正辦你現在坦白講你衛福部沒有一個單位是專責在做這件事情的大家業務都非常的龐雜非常的龐大整個行政院也沒有一個專責的單位好好來思考 |
| transcript.whisperx[199].start |
6356.943 |
| transcript.whisperx[199].end |
6376.915 |
| transcript.whisperx[199].text |
這個整個少子化危機是國安危機啊但是我覺得現在包括賴總統包括卓院長他們都沒有重視這個問題也沒有一個專責單位也沒有專人都沒有人在在好好思考這個問題到底要怎麼解決啊那這個問題當然就一直惡化我們看到人數就是一直掉啊滴滴落啊 |
| transcript.whisperx[200].start |
6377.452 |
| transcript.whisperx[200].end |
6392.038 |
| transcript.whisperx[200].text |
包委員 我想少子化的政策在以我在行政團隊裡面我會感受到行政院是非常的重視非常重視也一直參考國際間的經驗但都提不出解方我們的策略 這些策略 |
| transcript.whisperx[201].start |
6393.098 |
| transcript.whisperx[201].end |
6415.916 |
| transcript.whisperx[201].text |
當然也一直在思考為什麼這樣的策略做下去還是少子化的趨勢還是一直在所以我們真的我行政院也一直在政委或者甚至院長也指示說幾次部長我告訴你我們相較於日本南韓跟新加坡我們就是沒有專責單位而且力道不足 |
| transcript.whisperx[202].start |
6416.596 |
| transcript.whisperx[202].end |
6431.768 |
| transcript.whisperx[202].text |
新加坡他也他的少子化問題也很嚴重今年年初我訪問新加坡的時候然後就看到他們在這個少子化政策他沒有破例啊第三胎如果女生第三胎他一胎是40萬我們我們台灣多少 |
| transcript.whisperx[203].start |
6433.288 |
| transcript.whisperx[203].end |
6458.475 |
| transcript.whisperx[203].text |
你差人家差太遠了他的魄力是這樣子南韓在住宅政策如果你今天結婚然後你有預備生小孩他在住宅政策他是可以給你非常非常大的優惠台灣有嗎沒有嗎所以我們所有的力道通通都是不足的那我剛講的這個專責單位就你現在知道的進度到底有沒有設立前陣子你們說有喔現在是不是又沒有了 |
| transcript.whisperx[204].start |
6459.864 |
| transcript.whisperx[204].end |
6460.988 |
| transcript.whisperx[204].text |
專責單位 兒少專責單位 |
| transcript.whisperx[205].start |
6463.673 |
| transcript.whisperx[205].end |
6490.479 |
| transcript.whisperx[205].text |
兒少專者單位這個專者單位我們非常重視什麼時候要成立也在做組織的一個盤整因為這個牽涉到要跟人種爭取那進度呢 今年年底會成立嗎跟委員報告 一直在努力進行當中所以我們現在在人事方面為什麼有些偏頂在那裡就是希望成立一個相關的單位你的目標什麼時候要成立 |
| transcript.whisperx[206].start |
6493.681 |
| transcript.whisperx[206].end |
6495.823 |
| transcript.whisperx[206].text |
我都沒有看到具體的期程年底會成立嗎我們希望能夠在年底努力要突破所有的困難我想委員很清楚過去我擔任立委的時候跟您也常常在參加像兒童相關的一個 |
| transcript.whisperx[207].start |
6515.263 |
| transcript.whisperx[207].end |
6534.697 |
| transcript.whisperx[207].text |
像李鴻基教授這是我的老師他一生的信念就是這個所以你現在握有行政資源你現在擔任部長的角色你就應該要盡全力去爭取好不好這個我希望你剛說的年底的目標可以完成接下來我要問的是今天主題跟藥品有關的 |
| transcript.whisperx[208].start |
6538.419 |
| transcript.whisperx[208].end |
6558.447 |
| transcript.whisperx[208].text |
當時你們在這個特別條例裡面爭取了200億的經費就是來因應這個關稅那我要問的是你們當時所設定的假定的那個條件美國要加我們的關稅是幾%在藥品的部分你們提了200億當時設定的模型是幾%要加幾%的關稅 |
| transcript.whisperx[209].start |
6560.427 |
| transcript.whisperx[209].end |
6574.453 |
| transcript.whisperx[209].text |
是250%嗎 當時有預知說川普要那麼高的一個關稅跟委員報告我們當時候並不知道他會有多少%沒有辦法預設但是我們盤點 |
| transcript.whisperx[210].start |
6578.194 |
| transcript.whisperx[210].end |
6604.904 |
| transcript.whisperx[210].text |
因為會被最容易風險最高的是專利期的藥因為我們最沒有溢價空間他沒有其他學名藥可以替代所以在專利期內的進口藥全部不只只有美國全部進口在專利期內的藥是214項健保金額是390億但是這裡面被列為叫做必要藥品的絕對不可以缺的大概是75項金額大概是200億 |
| transcript.whisperx[211].start |
6606.044 |
| transcript.whisperx[211].end |
6618.66 |
| transcript.whisperx[211].text |
所以我們用這樣來就是75項的200億可以維持多久一年對不對那我接下來要問的就是那一年過後呢因為關稅一調漲就是在這裡了 |
| transcript.whisperx[212].start |
6620.051 |
| transcript.whisperx[212].end |
6648.833 |
| transcript.whisperx[212].text |
然后它就是涨了就是在这个水位了所以度过第一年之后你接下来的因应的策略是什么涨健保费吗跟委员报告当然这最后会回到总额里头那我们会编这个是因为总额都是在前一年度谈定所以如果在今年发生这些费用的变动是总额没有办法因应的所以你会调高总额还是涨健保费那未来就会回到总额里面去检查看实际上增加了多少对我是在问你你的因应策略是什么 |
| transcript.whisperx[213].start |
6649.796 |
| transcript.whisperx[213].end |
6654.973 |
| transcript.whisperx[213].text |
總額當然就回到我們的健保的機制那麼總額成長多少再回過頭來算費率 |
| transcript.whisperx[214].start |
6656.095 |
| transcript.whisperx[214].end |
6679.217 |
| transcript.whisperx[214].text |
所以就是有可能會牽動到保費的調整對不對如果說這個川普他硬要做這樣子的一件事情的話那多出來的成本最終就是政府的這個因應措施也只能是一年的措施之後如果變成常態就必須回歸到大家全民共同分擔這個就是你們看到的情況這個要講清楚啊 |
| transcript.whisperx[215].start |
6679.437 |
| transcript.whisperx[215].end |
6706.927 |
| transcript.whisperx[215].text |
跟委員報告我們的健保最近一兩年在大家的幫忙之下尤其是行政院的支持之下我們的成長率是達到最高所以在無形中它有比較充分的空間來因應不同變化因為像今年就多了700多億的一個預算所以我們不管是在急重症因為現在民眾最焦慮的是他的藥變貴了譬如說那個新聞講的可能一個癌友 |
| transcript.whisperx[216].start |
6707.507 |
| transcript.whisperx[216].end |
6721.972 |
| transcript.whisperx[216].text |
的病患他一年可能要多30萬的成本那對一般小家庭來講可能是負擔不起的所以是需要政府有個很明確的政策是可以來支持他我們不管是健保的或者是智慧剛剛食藥署有提到都是要監控 |
| transcript.whisperx[217].start |
6722.312 |
| transcript.whisperx[217].end |
6749.932 |
| transcript.whisperx[217].text |
好 最後一個我要幫家瑜的鄉親問的這次我們看到你是有一個政策蠻值得被肯定的就是你首度啟動無人機送藥的這件事情在風災當中我覺得對於一些路已經斷掉然後又有藥品需要的人這個是運用高度科技去達到醫療的效果我覺得是非常棒的一個政策但是我要問的是你現在好像無人機你只有幾台 五台 |
| transcript.whisperx[218].start |
6750.912 |
| transcript.whisperx[218].end |
6769.974 |
| transcript.whisperx[218].text |
還是三台量不多對不對這個因為還在沙盒啦還在沙盒所以並沒有大量的一個製造我認為這個事情是現在這個極端氣候是很常見的那像嘉義縣它又是多高山的地方一斷掉 |
| transcript.whisperx[219].start |
6770.535 |
| transcript.whisperx[219].end |
6791.791 |
| transcript.whisperx[219].text |
真的就是路不通喔那但是病人有用藥的需求我認為你們這個計畫很好然後應該要去爭取就是擴大那如果要擴大的話優先這種山區這個像嘉義這種高山的地方我認為你們也應該要配備好不好你們要優先去研議這個部分我認為這是一個非常棒的 |
| transcript.whisperx[220].start |
6792.411 |
| transcript.whisperx[220].end |
6812.502 |
| transcript.whisperx[220].text |
謝謝委員的鼓勵這個計畫是我們衛福部去研發出來的那結果有一個總統的總統盃的黑克松比賽得到應該是算第一名所以我們很重視這樣的一個智慧來弄到人民的身上那這當中我們當然現在這階段還在沙盒的階段我們要 |
| transcript.whisperx[221].start |
6813.802 |
| transcript.whisperx[221].end |
6828.257 |
| transcript.whisperx[221].text |
克服到一些法律上規定的事情還有實際上技術的問題比如說他必須要在10公里裡面然後兩邊都要有4梨5梨這一邊的一個情況之下那這個部分前天 |
| transcript.whisperx[222].start |
6829.258 |
| transcript.whisperx[222].end |
6856.894 |
| transcript.whisperx[222].text |
卓中泰院長也特別肯定也是支持這樣的說我們要克服困難來達到這樣子也謝謝王委員這樣子我們會陸續來把它在法律的規定之下來把它發展得更好我希望這件事情你們加速我覺得這是一個非常有特色而且非常有前瞻性的計畫那我就是要求這一種特別多山的地方像嘉義縣這樣的地方也要優先成為你們的試點來實施好的 我們要再瞭解看嘉義的狀況 |
| transcript.whisperx[223].start |
6857.794 |
| transcript.whisperx[223].end |
6875.632 |
| transcript.whisperx[223].text |
好 謝謝王一鳴委員 謝謝部長我補充一下 新加坡如果夫妻照顧第一個小孩一年的免稅額是100萬台幣那第二胎是150萬台幣 第三胎200萬這負稅處 怎麼可以改名啊再拚 再拚 繼續拚好 我們現在休息10分鐘 |
| transcript.whisperx[224].start |
6913.588 |
| transcript.whisperx[224].end |
6914.152 |
| transcript.whisperx[224].text |
要先進入... |
| transcript.whisperx[225].start |
7577.455 |
| transcript.whisperx[225].end |
7586.184 |
| transcript.whisperx[225].text |
好 我們現在繼續開會那接續我們請廖偉祥質詢現在情形變得很好了謝謝主席 請邱部長 |
| transcript.whisperx[226].start |
7600.785 |
| transcript.whisperx[226].end |
7614.896 |
| transcript.whisperx[226].text |
文豪部長好部長這個川普總統宣佈對於進口藥品要課徵最高250%的關稅那雖然說跟這個我國的藥品出口 |
| transcript.whisperx[227].start |
7616.042 |
| transcript.whisperx[227].end |
7643.451 |
| transcript.whisperx[227].text |
對美國的規模相較於其他產業可能相對來說並不算很大但是台灣在2024年呢對於美國的藥品出口金額也達到10億美金那佔醫藥品的總出口量的30%所以其實也不能輕忽長期所帶來的影響那上週的時候部長有承諾一週要給評估報告我這邊想要追問一下這個是否能夠準時提出 |
| transcript.whisperx[228].start |
7644.807 |
| transcript.whisperx[228].end |
7663.332 |
| transcript.whisperx[228].text |
好 謝謝委員的隨行我想我們在關稅的一個變化 國際情勢的變化最重要就是我們要確保我們藥品的穩定供應的狀況所以我們一直這段時間來 沿你的四大策略來穩定我們的一個 |
| transcript.whisperx[229].start |
7665.995 |
| transcript.whisperx[229].end |
7679.194 |
| transcript.whisperx[229].text |
這個衝擊評估一週內 原因一週要到了 請問最相關的評估 因為它關稅的一個變化都有它的變化嘛所以我想食藥署也一直在評估要不要食藥署檢要跟委員報告一次 |
| transcript.whisperx[230].start |
7680.255 |
| transcript.whisperx[230].end |
7698.023 |
| transcript.whisperx[230].text |
委員好 針對我們現在的藥品剛才委員特別提到我們國內的藥物的產值大概37.38億美金那整個我們的外銷的部分是佔9.9億那我們去美國的部分致濟其實3.06億加上我們原料藥大概是0.17億 |
| transcript.whisperx[231].start |
7699.804 |
| transcript.whisperx[231].end |
7722.53 |
| transcript.whisperx[231].text |
那因為這個部分是牽涉到我們輸出去的我們輸出去如果是關稅目前連疊加裡面藥品其實是一直零關稅是國際的共識希望照顧對 署長其實這個等一下我也會跟您討論到我想要知道就是說有沒有做好一個全面性的衝擊評估除了這個出口的部分其實它要牽扯到蠻多的包含美國總統他說8月6號宣布說將對進口 |
| transcript.whisperx[232].start |
7726.131 |
| transcript.whisperx[232].end |
7739.967 |
| transcript.whisperx[232].text |
藥品分階段的課稅嘛初期先用實施低關稅但是一年至一年半之後可能調升至150%最終到達250%那麼另外在7月底川普也致函17家主要的這個藥企 |
| transcript.whisperx[233].start |
7741.828 |
| transcript.whisperx[233].end |
7763.534 |
| transcript.whisperx[233].text |
強硬的要求擴大最惠國的價格這個政策要制涵蓋制所有的醫療補助計劃用藥並且在60天之內他要實施一定要實質的降低藥價要有感的降低藥價所以也就是說在9月底前呢美國境內的所有的藥價都要有感調降也可能造成全球各大藥廠 |
| transcript.whisperx[234].start |
7764.634 |
| transcript.whisperx[234].end |
7782.465 |
| transcript.whisperx[234].text |
會在其他國家的市場要彌補這個利潤可能會採取個別市場的這個提高價格的策略但是這個部分對於我們市場規模較小的台灣而言在我們要價的談判空間上面可能會相對有弱勢顯然可能只有被要求漲價的 |
| transcript.whisperx[235].start |
7784.666 |
| transcript.whisperx[235].end |
7811.073 |
| transcript.whisperx[235].text |
所以這部分我就是剛剛想要談的請問部長在這個川普在藥價上的最惠國的價格他是不是也會對我國的藥品供應尤其是專利期內的這種藥品可能有調漲的風險所以我想我們要問這個衝擊評估最重要的是除了藥價之外很要擔心的就是所謂缺藥的風險那現在在跨國的藥廠在專利期內的這些藥價的漲價可能是勢在必行 |
| transcript.whisperx[236].start |
7811.713 |
| transcript.whisperx[236].end |
7823.904 |
| transcript.whisperx[236].text |
那萬一說這些健保要價沒有辦法調整的話那我們到底有什麼解決方案因為我們現在擔心的其實最終還是這些病人用藥的這個權益我想說是 |
| transcript.whisperx[237].start |
7825.218 |
| transcript.whisperx[237].end |
7849.307 |
| transcript.whisperx[237].text |
病人用藥的權益這是最重要的不管他怎樣的變化那我剛才有報告過我們先穩定我們國內的一個狀況公藥的狀況然後培植我們本土的產藥的狀況這個一直都在做那至於因應方面的話食藥署也有引領一個計畫就是我擔心短期的衝擊太大我們要怎麼樣在短中長期有一個方案 |
| transcript.whisperx[238].start |
7849.947 |
| transcript.whisperx[238].end |
7879.287 |
| transcript.whisperx[238].text |
这边首先跟委员做报告因为刚才提到我们出口的部分我们先讲我们出口我们要怎么去帮助国内这些产业其实是迫在眉睫因为目前我们出口到美国的目前还算是免税的清单接下来我们的原料要出国比例相对是少0.17亿少5亿元但是制剂厂其实是占我们输出的第一名我们以目前来讲对等关税短期来讲我们内需市场是大的 |
| transcript.whisperx[239].start |
7880.047 |
| transcript.whisperx[239].end |
7909.064 |
| transcript.whisperx[239].text |
出去美國的事小所以如何再轉我們國內其實在國內的學民藥製劑的能夠加以採用待會我知道我們跨部署裡面也有進一步除了這以外我們看到的是對於實際廠商我們去詢問的其實是加速出口到拓展所謂非美國的市場那我們在這部分我們國內廠商PIX GMP所以目前多家廠商我們實際詢問他們給回覆的是目前情勢不明 |
| transcript.whisperx[240].start |
7909.684 |
| transcript.whisperx[240].end |
7929.895 |
| transcript.whisperx[240].text |
必要時要調整對美要價甚至他們覺得必要時可能在美國設廠以及拓展其他美國以外市場大概是這些的節奏希望能夠及時謝謝署長 謝謝署長和部長其實我想要講的比較是我之所以會問這個原因是因為今年4月宣布關稅的時候其實有許多的癌症病友團體表示 |
| transcript.whisperx[241].start |
7931.817 |
| transcript.whisperx[241].end |
7945.136 |
| transcript.whisperx[241].text |
對於這個關稅導致要價調整的擔憂他就主要是對於關稅導致要價調整的擔憂我倒不是完全想要針對剛剛的部分我想要講的是比較像是這些病人用藥的問題那那個時候部長你記得你的回應是什麼 |
| transcript.whisperx[242].start |
7946.397 |
| transcript.whisperx[242].end |
7961.806 |
| transcript.whisperx[242].text |
你的回應是說任何還沒有發生的事情不一定會發生的事情我們可能先不要擔心但是現在看起來對比現在的狀況你還覺得不用擔心嗎還是覺得對於這個癌症病人我是說不用擔心但是要好好準備我們要記恐慌症 |
| transcript.whisperx[243].start |
7963.627 |
| transcript.whisperx[243].end |
7980.177 |
| transcript.whisperx[243].text |
對 所以川普關稅跟剛剛我所會提到的但是要好好準備是 部長所以我說川普關稅跟我剛剛提到最惠國價格政策所導致的這個要價問題我想可能是已經即將要發生的事實喔那你也最近承認說是短期會有影響但我很怕 |
| transcript.whisperx[244].start |
7981.719 |
| transcript.whisperx[244].end |
8008.522 |
| transcript.whisperx[244].text |
部長或者是我們所有同仁我們國家的相關的行政部門過於樂觀會覺得說關稅反倒會使這個台灣用藥受惠或是覺得只有短期的影響所以我剛剛提說你們到底這個報告衝擊報告有沒有完善的去做好那對於希望這件事情可以希望你們嚴正以對不要用喪事喜辦的方式因為我覺得關心的還是最終的是用藥這些病患的權益 |
| transcript.whisperx[245].start |
8010.239 |
| transcript.whisperx[245].end |
8028.245 |
| transcript.whisperx[245].text |
我想我們健保署跟食藥署針對這個問題的應應計畫幾乎是每天在溝通在討論隨著外面的變化但是我們提出一個最核心的一個基礎部長我想要提醒你我知道你剛講這些就是我覺得還是比較像是在打周邊太極 |
| transcript.whisperx[246].start |
8029.085 |
| transcript.whisperx[246].end |
8053.993 |
| transcript.whisperx[246].text |
就是學民藥協會理事長製藥工會同業工會理事長這個陳怡芬也指出當然剛剛有提到剛剛署長有講到我們世界貿易組織基於人道因素所以幾乎這種原料藥的貿易都是採零關稅但是美國政府提高藥品關稅導致不對等這是不合理的但換句話說對於藥品以人道主義精神採零關稅的措施川普在這個實施之前其實是常態 |
| transcript.whisperx[247].start |
8054.873 |
| transcript.whisperx[247].end |
8083.932 |
| transcript.whisperx[247].text |
但是現在美國政府沒有要跟你講這個人道精神這一套他就是要務實的說他覺得美國的藥很貴你就是要在美國內你就是要給我變便宜所以這也呼應了上週美國國務院他的前幕僚惠頓說台灣如何失去川普這一文中的批判基本上就是我們在談判的時候一直說我們要主張什麼樣的價值啊等等的但是你沒有站在他們的或是川普的立場去想的時候你的這個談判可能都會出問題啊 |
| transcript.whisperx[248].start |
8085.073 |
| transcript.whisperx[248].end |
8110.609 |
| transcript.whisperx[248].text |
所以這部分是我想要請部長也提醒談判團隊怎麼樣去務實面對而且我們自己也要務實面對說他這一系列的政策可能會不會導致我們國內缺藥所以您剛剛有提到衛福部有提出這四大的因應美國關稅的威脅措施一個是強化供應預警然後提升藥品儲備確保藥價合理還有鼓勵在地生產 |
| transcript.whisperx[249].start |
8111.59 |
| transcript.whisperx[249].end |
8128.715 |
| transcript.whisperx[249].text |
那行政院在4月份的時候表示將特別預算中就編列大概200億元優先用在藥品價格調整的穩定用藥措施那現在立法院也通過特別條例那請問第一會期會編列多少經費預注健保 |
| transcript.whisperx[250].start |
8129.355 |
| transcript.whisperx[250].end |
8155.198 |
| transcript.whisperx[250].text |
然後部長我也想要提醒你這裡面也有包含立法院的附帶決議第一個是健保基金所獲得的撥補預算中優先用於增進我國藥品供應戰性那第二個附帶決議是抑制這個抑制這個健保基金的預算數不得低於各期預算的總數的12%所以想要請教部長我們剛剛問了第一期你們打算編多少 |
| transcript.whisperx[251].start |
8158.376 |
| transcript.whisperx[251].end |
8180.641 |
| transcript.whisperx[251].text |
第一期就一住多少第一期這個這個特別條例的部分啊應該就是這樣的200億吧差不多你你說會吧會變200億嗎對不對因為算下來如果是5450億的話12%大概是654億3年所以其實你說200億我是覺得第一期因為這第一年啊 |
| transcript.whisperx[252].start |
8181.201 |
| transcript.whisperx[252].end |
8200.186 |
| transcript.whisperx[252].text |
現在的關稅衝擊更高我是認為200億或許你要想一下第一期是不是應該要再拉高一點或許是250億你們可能要回去精算一下兩位署長和部長都頻頻點頭我想你們也知道這一年第一年可能衝擊會比較大所以這部分部長是不是可以250億還是多少 |
| transcript.whisperx[253].start |
8204.741 |
| transcript.whisperx[253].end |
8210.547 |
| transcript.whisperx[253].text |
因為你因為我剛已經算出來嘛12%就是654億嘛你第一期你這也有辦法承諾變多少 |
| transcript.whisperx[254].start |
8211.869 |
| transcript.whisperx[254].end |
8236.411 |
| transcript.whisperx[254].text |
好的因為這個要價的一個要價的提升來經費的來源當然又包括健保的總和他本來也有準備那我們的健保總和這次也大家的努力之下行政院的支持之下也確實增加到有史以來最高所以我們剛好也可以來配合來應應現在的一個變化 |
| transcript.whisperx[255].start |
8239.273 |
| transcript.whisperx[255].end |
8262.101 |
| transcript.whisperx[255].text |
那這樣的一個情況之下我們會再看剛剛署長又提到有一些部分特別要去保護的這個部分大概我們估算大概200億應該是可以來應應目前的200億你確定沒有要再拉高一點因為你三年要編完654億你第一期 |
| transcript.whisperx[256].start |
8262.941 |
| transcript.whisperx[256].end |
8287.594 |
| transcript.whisperx[256].text |
沒關係你們回去好好研究一下那你至少你現在是答應說200億至少不會低於200億嘛所以對是嗎這個就是按照會議我們答應通過的我想來編列預算對之所以我會希望說你們可能要謹慎以對甚至是把這個經費往上拉一點就是因為當初其實 |
| transcript.whisperx[257].start |
8288.675 |
| transcript.whisperx[257].end |
8305.03 |
| transcript.whisperx[257].text |
我想我們都很擔心說短期的衝擊過大然後對於病人啊或對於健保產生太大的衝擊喔所以我也在接下來再問說那當藥品缺短缺的時候會不會因為急救張或應變不急再發生當初 |
| transcript.whisperx[258].start |
8305.45 |
| transcript.whisperx[258].end |
8332.682 |
| transcript.whisperx[258].text |
像這個輸液之亂的情形所以我想要請教部長是否要針對必要藥品進行所謂的安全存量的管控那之前目前是說有缺藥是六個月前通報嘛那我們是不是可以再把這個包含這個安全存量提高到一年啊或者是由政府另尋專款協助必要的藥品提供的藥廠是不是要將這個庫存量提高 |
| transcript.whisperx[259].start |
8333.502 |
| transcript.whisperx[259].end |
8337.587 |
| transcript.whisperx[259].text |
然後由政府來想辦法去補助他的倉儲或者是行政管理費 |
| transcript.whisperx[260].start |
8339.637 |
| transcript.whisperx[260].end |
8365.098 |
| transcript.whisperx[260].text |
當然如果存量能夠越多越好但是它是牽涉到的多元化的一個平衡的因素是不是請江署長來報告一下委員這邊提到問題是非常非常關鍵在藥品韌性在供給的部分那台灣市場小所以在供給的部分我們目前看到常常供給上跟的有時候叫做控藥控制為什麼因為要均分到需要用的病人身上他就可以所以我們 |
| transcript.whisperx[261].start |
8365.979 |
| transcript.whisperx[261].end |
8383.77 |
| transcript.whisperx[261].text |
姜藥計畫裡面是用智慧導入做這樣的平台目前也在積極在修法藥事法二十七之三條裡面針對藥品短缺相關的用藥的時候能夠達到我們行政讓介入調控的一個機制未來也在提到大約的時候也請要多多的支持 |
| transcript.whisperx[262].start |
8384.19 |
| transcript.whisperx[262].end |
8402.762 |
| transcript.whisperx[262].text |
那至於這個部分六個月的部分目前我們看起來在這樣的調控的機制之下還上稱是可以去運作因為也牽涉到整個藥品產業它就相對是很弱勢那這個整個儲備量又提升等等對他們的壓力也是很大所以整個調控之下我覺得能夠去調控這一塊 |
| transcript.whisperx[263].start |
8403.743 |
| transcript.whisperx[263].end |
8425.601 |
| transcript.whisperx[263].text |
比現在提升到幾個月以上相對我們對原料藥的提升的調控的時間的確是拉長一般的一些製劑的部分我們是照兩個月以上的一個存量目前是這樣謝謝署長我其實還是回歸到那個剛剛說半星缺藥的問題然後還有短期充給假設說你的健保藥價跟不上會不會有藥廠受不了 |
| transcript.whisperx[264].start |
8426.121 |
| transcript.whisperx[264].end |
8451.261 |
| transcript.whisperx[264].text |
或者是剛剛說的他為了要這個全世界拉高因為他現在美國的藥價要下降嘛代表他的獲利一定也下降那會不會從其他國家拉高那我們的市場比較小沒有跟他談判的籌碼之後變成是這些藥廠會不會最後就決定說退出台灣市場那你這個時候你來不來得及反應這是我們擔憂的所以我在這裡要是在提醒部長和兩位署長 |
| transcript.whisperx[265].start |
8452.122 |
| transcript.whisperx[265].end |
8479.449 |
| transcript.whisperx[265].text |
那再來去年7月也有開始針對這個生物相似藥提供獎勵政策那這個政策也有這個成功的降低健保藥的藥費的支出那今年健保署也在今年的8月1號剛開始實施所謂的學名藥的獎勵政策那也調出15個成分的這個學名藥的化療藥物那大概總共是100個品項包含乳癌啦肺癌啦腸癌啊 |
| transcript.whisperx[266].start |
8480.229 |
| transcript.whisperx[266].end |
8500.975 |
| transcript.whisperx[266].text |
未來這個醫療的院所開立這些藥品每張處方也可以獲得150點的獎勵嘛對不對那希望將學民藥的這個佔率從43%提升到70%那想要請教部長因為日本的學民藥政策設定好像80%以上的使用率那到2024年底的他們已經普及喔他個性是普及到了79%以上 |
| transcript.whisperx[267].start |
8502.375 |
| transcript.whisperx[267].end |
8517.142 |
| transcript.whisperx[267].text |
那我想各國也都是在想辦法降低藥費支出那我國的部分呢現在當然配合鼓勵在地生產的措施要擴大這個是不是要怎麼樣設定我們的目標因為像日本他有明確的在設定這樣的目標那我們的我們有設定嗎 |
| transcript.whisperx[268].start |
8519.351 |
| transcript.whisperx[268].end |
8544.69 |
| transcript.whisperx[268].text |
跟委員報告我們是逐步所以去年是先從這個BioSimulator那也很成功的看到成長從去年是7%到今年已經到了將近12%戰略已經我們目標是定30%那今年的7月開始我們又擴大把這個癌藥的化學藥品學名藥納入目標是希望三年內到70%三年內到70%對對對 |
| transcript.whisperx[269].start |
8547.592 |
| transcript.whisperx[269].end |
8576.779 |
| transcript.whisperx[269].text |
那明年初我們會再持續擴大所有的癌症的用藥的學名藥一起都納入好 謝謝署長所以你的目標就是三年內要達到70%好 那這個我有得到答案 謝謝但是因為對方已經這個日本已經到79%對 希望這個署長這邊再努力一下降低藥費支出所以總結就是部長我們的藥品供應穩定的建構當然是需要剛剛說的時間三年時間跟經費的支持 |
| transcript.whisperx[270].start |
8577.386 |
| transcript.whisperx[270].end |
8588.932 |
| transcript.whisperx[270].text |
那本席和貴部當然從去年到今年有一起努力所以今年4月26號有公告修正這個相關的支付標準啊等等的條文啊那其中一項是鼓勵國內的藥廠製造創新藥品並給予優惠的這個合價 |
| transcript.whisperx[271].start |
8593.194 |
| transcript.whisperx[271].end |
8617.97 |
| transcript.whisperx[271].text |
那此外對於國內的製造學名藥的還有聲勢相似藥的這個優惠的合價並穩定供藥確保藥品穩定供應但是因為新制我們才剛開始出行就是剛開始推動就遇到現在川普關稅還有剛剛一連串的政策國際政策的影響所以目前的政策介入可能效果發揮也是很有限幾乎是沒有 |
| transcript.whisperx[272].start |
8618.73 |
| transcript.whisperx[272].end |
8646.621 |
| transcript.whisperx[272].text |
所以本席當然是希望透過特別預算多多的挹注不僅是要降低健保藥費的支出也希望可以透過增加這個藥品供應韌性來達到避免缺藥的現象一再重演所以希望這個貴部再繼續努力然後也跟這個行政院在特別預算的部分多多的爭取爭取可以再多一點來必經保障全民健康應該是不分任何黨派不分藍綠白以上謝謝 |
| transcript.whisperx[273].start |
8649.838 |
| transcript.whisperx[273].end |
8665.788 |
| transcript.whisperx[273].text |
謝謝六委員的發言現在請蘇清泉委員謝謝主席 請邱部長還有石壯亮署長 |
| transcript.whisperx[274].start |
8675.401 |
| transcript.whisperx[274].end |
8689.465 |
| transcript.whisperx[274].text |
我兩天前在那個大宴會那邊質詢因為時間有限因為風災的特別條例明天要三度那費用本來是560億現在整個提高到600億了我現在有特別提供 |
| transcript.whisperx[275].start |
8694.389 |
| transcript.whisperx[275].end |
8704.497 |
| transcript.whisperx[275].text |
醫療院所如果有受損的或者是一些病人就醫的一些補助我再次強調就是說醫療人員在整天在那裡 |
| transcript.whisperx[276].start |
8710.04 |
| transcript.whisperx[276].end |
8729.751 |
| transcript.whisperx[276].text |
可以比照COVID-19 按個人 讓他們補起來 給他們獎勵一下這是最高的 不然他們家裡的都是受災婦就像八八風災的時候 我們召回醫生那個家裡 他們的家都陰水了 那個時代就大家在那裡打拚現在這件事也很嚴重 所以六八月你有分就多少 |
| transcript.whisperx[277].start |
8737.105 |
| transcript.whisperx[277].end |
8757.521 |
| transcript.whisperx[277].text |
報告委員在風災跟或者是雨災引起的災情其實對我們非常感謝我們第一線的醫療院所的團隊還是依然在崗位上鞦韆來照顧病人像這個部分 |
| transcript.whisperx[278].start |
8758.761 |
| transcript.whisperx[278].end |
8777.647 |
| transcript.whisperx[278].text |
我們值得肯定但是當然一切都要以安全為第一優先那第二個就是說再分幾個方面我們在第一時間也請健保署相關的部門能夠第一個照顧災民那當然有災民包括他就醫怎麼樣來 |
| transcript.whisperx[279].start |
8779.307 |
| transcript.whisperx[279].end |
8796.916 |
| transcript.whisperx[279].text |
給他更方便然後給他來協助他的負擔 減輕他的負擔那在醫療院所的方面如果有受到相關的損傷的話那當然我們也會我意思是說 現在就提高到600了你剛才說檢保幫我們做的 你用檢保的保留款檢保裡面一些特別專案的 |
| transcript.whisperx[280].start |
8805.581 |
| transcript.whisperx[280].end |
8811.644 |
| transcript.whisperx[280].text |
拿來補助那個我們補一米啦就是說這裡公務一生你也要多少錢去掙出來來預租啊這像 我說年輕人年輕人我便宜小子不敢去小學那個時候但是你就要補到到位這就 |
| transcript.whisperx[281].start |
8825.154 |
| transcript.whisperx[281].end |
8851.601 |
| transcript.whisperx[281].text |
名字跟身份證 要直接匯到他的戶頭等等這個是對我們義務人員的獎勵不然的話我很怕到時候又見 大家又哄 又再反彈這個我們一定會照顧你特別 關稅特別一算五千多 三度過那你有證書就有兩百元嘛有兩百元嘛 對不對 請救啦 |
| transcript.whisperx[282].start |
8853.198 |
| transcript.whisperx[282].end |
8876.599 |
| transcript.whisperx[282].text |
再加減一點去澳國 那個衛生庫裡面這麼大還要啊 現在有什麼什麼當然我們預算是需要去幫忙我們一定要去協助 需要照顧一定要去照顧中間所需要的預算當然有各種來源啦那一定不管是從部分 會從健保方面的一個來 |
| transcript.whisperx[283].start |
8877.86 |
| transcript.whisperx[283].end |
8900.771 |
| transcript.whisperx[283].text |
他本身就有他一定的預算在那邊不 可不可以說衛生所啦 醫療養育所那個年貼的手信 手信的要用一些公務預算給他補助啦不然的話讓他趕快復原嘛好 這個我們會來現在也納入高雄 屏東啦陳其邁也在發聲 屏東我也在發聲所以這個既然有特別條例不夠在編嘛 對不對 |
| transcript.whisperx[284].start |
8903.553 |
| transcript.whisperx[284].end |
8916.202 |
| transcript.whisperx[284].text |
我們一直有在評估醫院或診所以及衛生所謝謝委員對偏向衛生所的一個關心他的受損狀況我們都有掌握我很肯定部長跟署長跟南區健保都很怕病 |
| transcript.whisperx[285].start |
8925.731 |
| transcript.whisperx[285].end |
8936.372 |
| transcript.whisperx[285].text |
把你撐住 抱抱下去繼續這不是說最好但是要繼續努力嘛是的 是的好 那我們請石耀署還有我們經濟部 |
| transcript.whisperx[286].start |
8947.918 |
| transcript.whisperx[286].end |
8960.646 |
| transcript.whisperx[286].text |
我請教我們台灣一年一年製藥產業的產值才1196億然後我們的藥廠有300多家100?平均一間就做3億所以我的質疑是因為我認識的藥廠很多都是有 |
| transcript.whisperx[287].start |
8976.926 |
| transcript.whisperx[287].end |
8986.594 |
| transcript.whisperx[287].text |
藥證 但是他沒在審慎你委託 想說我有藥證 我有藥廠但是我是沒在審慎委託保定的藥廠沒在審慎不然經濟規模嘛 太小了啊所以真的有在審慎的藥廠是幾間我今天問的都比較親切你要問我 要是不知道你要給我回答我清楚真的有在審慎的藥廠有幾間我實際沒在審慎的藥廠只有10間 |
| transcript.whisperx[288].start |
9008.229 |
| transcript.whisperx[288].end |
9029.539 |
| transcript.whisperx[288].text |
這個我們在談這件事情就委員召委這邊特別提到的我們面對的是有藥證但是它有些是切結不生產有一些目前不生產那因為在藥品供應任性上面我們希望能夠確確知道哪些是有生產所以我們同仁們最近非常積極的跟這些廠商在溝通 |
| transcript.whisperx[289].start |
9030.239 |
| transcript.whisperx[289].end |
9054.55 |
| transcript.whisperx[289].text |
能夠協助確確下來實際上能夠供應的才能夠把後面的韌性能夠建立起來所以這邊能夠進一步去做最後的盤查目前盤查已經有一定的進度在整體來講 整體的確是140支家製劑廠30家的所謂原料藥廠我們的產值的確是剛好是37億美金左右所以是千億 儲起來很小 |
| transcript.whisperx[290].start |
9056.551 |
| transcript.whisperx[290].end |
9074.379 |
| transcript.whisperx[290].text |
所以我今年在三四月的時候跟學民藥的藥廠的溝通跟原料藥廠溝通裡面我特別提到國內的規模小必須要做協作因為在學民藥專利期過大家評估出來都是一樣的學民藥要再做所以網內互打變免費 |
| transcript.whisperx[291].start |
9076 |
| transcript.whisperx[291].end |
9095.796 |
| transcript.whisperx[291].text |
價位更低 造成它出口的時候的價格被定的又更低所以必須要有一些所謂的介入跟輔導的所以目前有在學民要有幫忙的地方要落實管制啦 也要查好情緒你要查住了才要花因為它每一家都在生產溫室耶 |
| transcript.whisperx[292].start |
9098.077 |
| transcript.whisperx[292].end |
9113.902 |
| transcript.whisperx[292].text |
產值那麼小 幾億元然後要齊一堆人 那有可能啦所以索索的 整間有在做這才能掌握 你要任性就是這樣啊 對不對再來我問經濟部這川普政府在那裡亂舞一場要把藥物棄給他藥啊 |
| transcript.whisperx[293].start |
9118.695 |
| transcript.whisperx[293].end |
9129.783 |
| transcript.whisperx[293].text |
他們進口的顏料藥跟進口的成品藥要蓋關稅蓋到250%可能沒有但是他的目的是什麼是要讓他有錢都回去美國省省顏料都在美國省省這樣他還沒好他還沒笑鋼鐵也回去汽車也回去什麼都回去美國有那麼多人嗎美國人很噁心的很噁心的 |
| transcript.whisperx[294].start |
9148.36 |
| transcript.whisperx[294].end |
9172.885 |
| transcript.whisperx[294].text |
懶到爆耶 我有親戚朋友從亞利桑那剛回來他說那個美國人瘦到胖大 已經很歹毒 五點一覺東西扁扁的就下班了 台灣人去都加班 加到十一點所以阿嬤都在扁扁 現在最近回來 說很累了我說美國人完全沒行 |
| transcript.whisperx[295].start |
9175.703 |
| transcript.whisperx[295].end |
9196.469 |
| transcript.whisperx[295].text |
所以川普的目的是什麼你跟我說一下目的我覺得是跟委員報告基本上川普政府還是希望讓製造業回到美國生產但是您剛才所提到的一些疑慮其實跟我們國內的產業界跟世界上的一些學者其實看法是很接近的所以他能不能成功其實還是未定數 |
| transcript.whisperx[296].start |
9197.529 |
| transcript.whisperx[296].end |
9223.413 |
| transcript.whisperx[296].text |
不過他因為即使不成功他也可以從國外的這些廠商把貨品賣進美國這些廠商獲得關稅的利益所以他可以把這些關稅利益做在美國政府內政的一些做一些政策的一些資用他們預估他這樣亂搞一通一年可以拿到3000億的關稅那這3000億的關稅我看有一半是美國人自己要付吧美國的消費者自己要付嘛 |
| transcript.whisperx[297].start |
9224.076 |
| transcript.whisperx[297].end |
9246.327 |
| transcript.whisperx[297].text |
那有可能人家出口去那裡的抽象都要自己吸收那就到了所以美國人自己也要負擔我相信一半一定有的啦所以CPI一直在起嘛那以後得到什麼我記得到最後一定是一團亂然後一場空有的抽象出口東西不一定我帶了人家抽象就跟歐洲差不多啊跟羅馬的抽象差不多啊 |
| transcript.whisperx[298].start |
9250.626 |
| transcript.whisperx[298].end |
9277.943 |
| transcript.whisperx[298].text |
就是哪有這種政府這樣搞我們就要對他一直笑好 他的目的是要有美國的藥 比較便宜如果是這樣應該他出國來我們台灣的藥也不會棄價 要怎麼棄價我們如果買不到 我們就來歐洲買來日本買 日本的藥也很先進的歐盟也有很先進的藥我們就一定要有美國的藥才買江雙 我說話有力嗎 |
| transcript.whisperx[299].start |
9279.341 |
| transcript.whisperx[299].end |
9296.729 |
| transcript.whisperx[299].text |
我一直想不通我們剛剛跟他我們頭腦都那麼好的人去跟他一個瘋子在那邊怎麼搞周偉這邊講的我個人覺得是非常欽佩非常非常的精準在面對這個因為我們採購的範圍他關稅單一他們的所謂的出口他們進口 我們出口 |
| transcript.whisperx[300].start |
9297.569 |
| transcript.whisperx[300].end |
9314.867 |
| transcript.whisperx[300].text |
那市場不是只有單一個美國的市場全面的市場在我們接下來的評估裡面現在蘇美的廠那些有限的會受到衝擊所以他們很快速在評估未來是要轉身去其他地方還是真的會到裡面去設廠 |
| transcript.whisperx[301].start |
9315.988 |
| transcript.whisperx[301].end |
9331.842 |
| transcript.whisperx[301].text |
還是說最後的條價negotiate如何去達到一個合理的利潤之下能夠存活下去目前我們在跟國內市特別是藥劑中心非常專業地做完評估之後大概是先是這樣有一部分是觀望有一部分是其實很大一部分是 |
| transcript.whisperx[302].start |
9332.923 |
| transcript.whisperx[302].end |
9352.38 |
| transcript.whisperx[302].text |
選擇要左右轉特別往歐盟 往北邊然後往東南亞的部分那國內的藥廠其實全部都是PIX GMP這麼嚴格的藥廠其實獲得的是世界的肯定所以在這個同時呢我們也希望國內的也一樣的肯定所以我們看到目前對於國內學名藥的一些支持 |
| transcript.whisperx[303].start |
9353.379 |
| transcript.whisperx[303].end |
9366.355 |
| transcript.whisperx[303].text |
也是我們現在食藥署在政策導引上面很重要的一個方向我們的顏料要85%都從印度 東歐大陸進口那如何強化我們的顏料要的製造商有40家嘛 有那麼多嗎我看 我知道有4間而已你告訴我40間 |
| transcript.whisperx[304].start |
9371.994 |
| transcript.whisperx[304].end |
9386.707 |
| transcript.whisperx[304].text |
我們現在手上是30家啦大概二九三十幾的時候實際上有的生產我們部長我們的原料要直接做出來的原料要先煮比較高所以我們台灣的ZMP藥廠不一定買得起所以他們做出來都要九萬塊 |
| transcript.whisperx[305].start |
9387.808 |
| transcript.whisperx[305].end |
9403.407 |
| transcript.whisperx[305].text |
對不對 是不是這樣我們有一個這個BPNA 培南類的其實全世界供應都是台灣單一一個廠商供全球所以我們也有可以化醉更當的原料藥所以我們對於我們自己的品質的部分 |
| transcript.whisperx[306].start |
9403.948 |
| transcript.whisperx[306].end |
9428.843 |
| transcript.whisperx[306].text |
的確是只是說原料藥在整體的環境的評估的部分其實我們在韌性裡面也有在跨部會裡面去共同思考能夠讓這個所以原料藥的污染性相對高所以他必須另外一部分是需要做區域的性的一些整合所以這也是我們在做跨國區域性你的200億裡面要補助這些原料藥製造商強化他們的有沒有200億裡面有沒有要強化 |
| transcript.whisperx[307].start |
9431.807 |
| transcript.whisperx[307].end |
9436.465 |
| transcript.whisperx[307].text |
經濟部也有在將來我們這裡有嗆本土的 學密藥廠 有沒有 |
| transcript.whisperx[308].start |
9437.891 |
| transcript.whisperx[308].end |
9462.389 |
| transcript.whisperx[308].text |
我們在計劃向下裡面其實這個都在規劃裡面我有提一個臨時提案是附加提案是二十億嘛是協民教協會請我幫忙提有加進去在裁委會裡面啦我以前為咱現在遇到川普政府硬要睡覺說一項馬上睡醒再說一項早上吃飯再說一項咱對於咱哭哭笑 |
| transcript.whisperx[309].start |
9466.403 |
| transcript.whisperx[309].end |
9474.43 |
| transcript.whisperx[309].text |
不需要這樣啦我們就不變 硬換變 我們就倒倒來我們要怎麼強化我們的原料藥學名藥廠 要怎麼強化健保署看要怎麼強化看要給一聲 給兩聲 給三聲對不對我們真的很多 市長真的很多你為什麼說你沒有強化這樣這很死耶 保證 這比較重要啦醫療本身大家都很怕命 |
| transcript.whisperx[310].start |
9491.444 |
| transcript.whisperx[310].end |
9498.527 |
| transcript.whisperx[310].text |
醫療院所所有的醫護人員啊所有藥廠的人都戰戰兢兢啊台灣的這些人的素質小到好這個都要聽哨啦真的啊公務人員也要聽哨啦不可以跟人家打招呼啦我都跟人家鼓勵真的要勤奮啦 |
| transcript.whisperx[311].start |
9506.871 |
| transcript.whisperx[311].end |
9526.407 |
| transcript.whisperx[311].text |
報告委員 其實針對原料藥以及所謂製劑的部分 甚至醫材的部分 我們在特別的計畫向下是非常努力的 其實有編列 這邊就容我們努力的去做然後未來有些成績能夠跟大家做一些報告 以上好 謝謝謝謝這幾天委員的發言 |
| transcript.whisperx[312].start |
9540.427 |
| transcript.whisperx[312].end |
9567.003 |
| transcript.whisperx[312].text |
好 那接續我們請盧縣議委員質詢謝謝主席 有請部長部長請委員好部長好昨天我參加了一個下午的我們所謂的六百億的防災的那個特別條例我不知道我們衛福部有沒有派人去參加 |
| transcript.whisperx[313].start |
9569.572 |
| transcript.whisperx[313].end |
9576.837 |
| transcript.whisperx[313].text |
會不會有派人參加嗎我們沒有被指派600億你們不想要 |
| transcript.whisperx[314].start |
9581.419 |
| transcript.whisperx[314].end |
9604.938 |
| transcript.whisperx[314].text |
我是因為他各種需要的項目是不是我們已經有需要去那邊做討論其實我特別問的原因就是說可能他們在指定的時候比如說可能是房屋的修繕或者是農損的這些賠償我是覺得說我們應該剛才趙有提到我就是要講我們衛生單位的不過等一下再說 |
| transcript.whisperx[315].start |
9605.758 |
| transcript.whisperx[315].end |
9624.961 |
| transcript.whisperx[315].text |
就關稅來講我一直在擔心的就是我們護理人員的待遇那其實會不會造成我們護理人員的更壓縮呢更等不到所謂的護理人員的薪資調整呢其實今年3月6號我們國民黨團我們羅志強委員陳金威委員還有王玉美委員有開個 |
| transcript.whisperx[316].start |
9626.102 |
| transcript.whisperx[316].end |
9646.842 |
| transcript.whisperx[316].text |
記者會嘛來抨擊你們之前所說的月薪7萬塊的事情那其實實際上的情況大家應該都知道那我再拿幾個數據讓大家知道那我先請問部長台東大學的護理系為什麼沒有核定通過台東大學護理系 |
| transcript.whisperx[317].start |
9652.048 |
| transcript.whisperx[317].end |
9668.074 |
| transcript.whisperx[317].text |
我想這個都是有經過依照現在的醫療資源然後專家會議的一個評審因為我們一直說護理方如果有任何地方上如果有任何意見其實都可以再提出來來討論 |
| transcript.whisperx[318].start |
9669.614 |
| transcript.whisperx[318].end |
9681.85 |
| transcript.whisperx[318].text |
那我因为看到这个新闻就想问然后结果我们现在只要开放开所有的文献啊新闻啊去查一下美国的护理薪资的话真的是很吓人现在美国的护理薪资是360万台币 |
| transcript.whisperx[319].start |
9682.802 |
| transcript.whisperx[319].end |
9708.177 |
| transcript.whisperx[319].text |
所以很多我們台灣的其實在台灣念護理系的大學尤其是大護他們根本就不是要留在台灣的他們是想拿完學歷就去美國了那你有沒有一個配套措施去想一下我們的關稅已經這麼嚴謹了可是這個部分我們還是要解決那你多沒有人去幫他們想辦法的話這個事情會雪上加霜 每況愈下那我們再往下看 |
| transcript.whisperx[320].start |
9708.797 |
| transcript.whisperx[320].end |
9737.215 |
| transcript.whisperx[320].text |
其实就平均薪资来说我们看一下其实就40岁到50岁其实都还在190万将近200万的台币的水准那我们台湾其实大家都可想而知然后我们就OECD来看这个排列的话卢森堡300万台币然后我们都看就大概中间数我们跟我们台湾比较接近的公益制度的因果是140万台币下一页那再下一页下一页 |
| transcript.whisperx[321].start |
9738.035 |
| transcript.whisperx[321].end |
9746.809 |
| transcript.whisperx[321].text |
那日本的話的起薪大概是在54萬台幣然後大概如果是做了24年的話大概150萬左右的水準那韓國 |
| transcript.whisperx[322].start |
9750.619 |
| transcript.whisperx[322].end |
9779.979 |
| transcript.whisperx[322].text |
韓國的話大概是大概140萬左右這是他們的預期大概2030年我們也是預期這樣所以我想知道到底下一張我們的預期是差不多150萬2030年的時候那現在是大概50幾萬60萬台幣的水準這個水準應該是衛福部公告上去國外才會做這樣的一個所謂的推測那我想說你們是有一定的一個步驟還是說你們有配套措施讓我們護理人員以後有 |
| transcript.whisperx[323].start |
9780.459 |
| transcript.whisperx[323].end |
9809.417 |
| transcript.whisperx[323].text |
得到这么多的钱吗怎么国外可以得到我们这一个预测呢谢谢委员的推行我先几点回报告第一个那护理系的一个资源那个是核定是教育部的那这个部分教育部有它的一个资源或者由护理的教育的专家们他们去评估可是就我们在野党的理解会说因为台东大学在台东县 |
| transcript.whisperx[324].start |
9810.337 |
| transcript.whisperx[324].end |
9824.417 |
| transcript.whisperx[324].text |
會不會加惠了那邊的人那就故意不讓他通過因為那邊的人會去念台東大學的可能都是台東的原住民那就故意不讓他通過會不會有這方面的疑慮不可能 我們很希望當地的大學都是當地的 |
| transcript.whisperx[325].start |
9826.099 |
| transcript.whisperx[325].end |
9847.719 |
| transcript.whisperx[325].text |
對啊 因為他沒有通過的話大家就會這樣的想法如果能夠在那邊唸我相信在那邊生根的機會會大很多啦所以有的時候要適時的解釋第二個就是有關於護理薪資的問題真的我們這幾年來用了多少策略希望把從 |
| transcript.whisperx[326].start |
9848.98 |
| transcript.whisperx[326].end |
9873.693 |
| transcript.whisperx[326].text |
護理工作的工作環境的改善那當然薪資其實牽涉的到比較多但是我們說因為我們要鼓勵護理人員的留任或者鼓勵他們的辛苦所給的不管是健保多家的給付其實我們的健保署都很要求包括我們夜班的包括我們三班互併比的這些獎勵 |
| transcript.whisperx[327].start |
9878.896 |
| transcript.whisperx[327].end |
9903.232 |
| transcript.whisperx[327].text |
那另外剛剛有提到說其實原來我們在兩三年前曾經在趙復師在有一個網站就讓各個醫院所有的醫院幾百家醫院通通把他們的護理人員薪資弄在上面那只是他們醫院的真實的去呈現那中位數或者是一個呈現那讓大家覺得好像跟事實上有 |
| transcript.whisperx[328].start |
9903.672 |
| transcript.whisperx[328].end |
9925.794 |
| transcript.whisperx[328].text |
其實為什麼我會提特別這個就是說但是那個是醫院真的他很真實的去提出來部長因為時間的關係我的意思就是說因為600億昨天應該是可以去爭取的那我想說那麼多人加班為了這個颱風很多醫護人員都是所以其實這個時候應該去幫他們爭取一點以南區來講我們有南區的分組他們有做這方面的討論有給他們 |
| transcript.whisperx[329].start |
9927.575 |
| transcript.whisperx[329].end |
9956.727 |
| transcript.whisperx[329].text |
那個有給他們鼓勵跟一些相關的一個措施我是希望因為部長來自嘉義科來自基層有的時候多放一點心思在偏鄉地區我們很重視偏鄉我們還有一點時間談一下防災任性其實我們不想塑造英雄可是每次有颱風就會看到很多英雄那這些英雄產生的原因就是因為我們國家的不努力國家的怠惰一而再再而上的發生我們渥台鄉鄉長永度那個 |
| transcript.whisperx[330].start |
9957.367 |
| transcript.whisperx[330].end |
9971.959 |
| transcript.whisperx[330].text |
那個野蜥 這個其實是非常危險的事情然後納瑪夏 它可以通的路可能只有到甲鮮要走路要走一天才會到最遠的部落 達嘎諾然後這個桃園 他們要送藥到對面是用流籠 |
| transcript.whisperx[331].start |
9973.3 |
| transcript.whisperx[331].end |
10000.987 |
| transcript.whisperx[331].text |
就是我們平常送農產品的流籠送過去我的意思就是說明明我們就有無人機團隊然後我們也有所謂的防災任性的計畫然後衛福部也有一些經費其實可以用一個小組就是我們無人機小組然後如果是衛福部的話可能放在哪一個地方每次其實會發生這些事情的都是特定區域其實你可以提早佈建 |
| transcript.whisperx[332].start |
10001.747 |
| transcript.whisperx[332].end |
10017.887 |
| transcript.whisperx[332].text |
就不會每次都有這麼厲害的事情發生會讓人家覺得真的是那個如果你有去過現場你會覺得很不可思議這個鄉長可以過那個河流因為這不是一般人可以過的所以我相信啦 |
| transcript.whisperx[333].start |
10019.208 |
| transcript.whisperx[333].end |
10033.921 |
| transcript.whisperx[333].text |
國人都在看然後不要每次的災害都是一樣重複發生那昨天我們比較偏遠的山地門鄉也發生了就是集體要遷村的這個過程剛才我在主席台上他們還打電話來在哭說希望我們能夠再 |
| transcript.whisperx[334].start |
10034.541 |
| transcript.whisperx[334].end |
10063.741 |
| transcript.whisperx[334].text |
跟我們中央單位說他們的處境是非常非常的辛苦所以我還是要請部長尤其是這個防災的部分還可以去多想一下微電網的設置我們在網路上面如果在颱風的時候要怎麼讓他暢通如果病人來就醫的話他至少可以上網去登打他的處方而不是又要等到災後以後才可以去登打已經過兩三天了又被健保局勾擊說這個不正常 |
| transcript.whisperx[335].start |
10064.401 |
| transcript.whisperx[335].end |
10071.29 |
| transcript.whisperx[335].text |
所以一而再再發生這樣的事情的時候其實要想辦法早點來解決才會真正覺得國家有在努力好不好 |
| transcript.whisperx[336].start |
10071.755 |
| transcript.whisperx[336].end |
10098.109 |
| transcript.whisperx[336].text |
好 薛委員我想補充報告一下就災害防變災防中心應變中心其實有針對這些問題都一直在討論那昨天三點半下午三點半賴總統也親自到災防中心那也非常關心這樣的一個尤其是偏鄉的一個這樣的狀況那我相信我們都非常那個從政府是非常注重到 |
| transcript.whisperx[337].start |
10099.63 |
| transcript.whisperx[337].end |
10120.862 |
| transcript.whisperx[337].text |
各種災區在討論的當中也特別提醒到無人機看看能不能再能夠更大的擴散它原來現在是一個沙盒那必須要克服一些困難那未來是不是能夠使用在這樣的情況我們非常樂意來發展來處理我們期待明年可以完成謝謝謝謝盧委員 謝謝部長 |
| transcript.whisperx[338].start |
10128.29 |
| transcript.whisperx[338].end |
10131.932 |
| transcript.whisperx[338].text |
圖前級委員改書面質詢來 接著我們請林淑溫質詢好 謝謝主席 事實上請我們邱部長 |
| transcript.whisperx[339].start |
10151.198 |
| transcript.whisperx[339].end |
10162.827 |
| transcript.whisperx[339].text |
委員好部長千戶萬患使出來你們的所謂的狼醫平台的建制本來是要為了強化民眾的知情權和保障病人的安全結果千戶萬患使出來面紗一揭開這就是對立法院虛擬委員有做就好 做高台的堂設敷衍我們這些立委堂設敷衍我們這個社會 |
| transcript.whisperx[340].start |
10180.882 |
| transcript.whisperx[340].end |
10199.215 |
| transcript.whisperx[340].text |
那現行的制度啊他只揭露目前為止只揭露112年以後性平判決確定的案件這樣的標準真的能夠回應社會大眾的擔憂嗎我要再講你們醫事司的司長強硬的表示他只這樣子做 |
| transcript.whisperx[341].start |
10199.955 |
| transcript.whisperx[341].end |
10203.517 |
| transcript.whisperx[341].text |
現在出名的都是副市長發言 現在是議事司都沒有市長還是他長大都不用出來 密帖保證後面還是聽說密帖時署長後面 署長你謙遜啊 你謙遜啊 很大的 |
| transcript.whisperx[342].start |
10218.763 |
| transcript.whisperx[342].end |
10222.106 |
| transcript.whisperx[342].text |
我現在舉幾個例子你們認為嚴不嚴重但我還要再問你們這幾個案子都在現行的制度裡面平台裡面都不會被揭露第一個案子 |
| transcript.whisperx[343].start |
10239.329 |
| transcript.whisperx[343].end |
10263.448 |
| transcript.whisperx[343].text |
他在診間台北的紅杏狼醫在診間假借指示護理師修改醫令多次強制猥褻明知對方明確的拒絕還要持續的猥褻109年判決確定110年遭懲戒到現在仍然任要職你知道他為什麼不會被揭露嗎 |
| transcript.whisperx[344].start |
10271.005 |
| transcript.whisperx[344].end |
10284.118 |
| transcript.whisperx[344].text |
跟委員做報告 他不是不會被揭露是我們有一部分的資料還是要跟司法院去揭所以是資料會再加上 我要叫你保定回答判決確定了 109年就判決確定了 |
| transcript.whisperx[345].start |
10288.766 |
| transcript.whisperx[345].end |
10305.318 |
| transcript.whisperx[345].text |
我們不好意思 報告委員我們第一個階段先把112年性平三法開始實行以後的的一個112年以前要多久要多久對啊 您現在先公佈112年以後判決啊以前的要多久 要花多久時間這些東西這麼困難嗎要多久 |
| transcript.whisperx[346].start |
10320.236 |
| transcript.whisperx[346].end |
10341.324 |
| transcript.whisperx[346].text |
回答不出來我們現在現階段先我知道啊如果說大家的意見要所以嘛 我想說不會被揭露因為問題112年以前的要多久會被揭露你回答不出來你說我們不是不做是未來要做那未來是要多久的時間以後才會做你回答不出來這不是在給我們爭笑嗎 |
| transcript.whisperx[347].start |
10345.694 |
| transcript.whisperx[347].end |
10361.915 |
| transcript.whisperx[347].text |
再來我們總是要有一個一個開始的時程對啊那我問你的期程規劃112年以前的要花多久時間啊我們目前當然是先規劃112年 姓平主席我告訴你這時間暫停 |
| transcript.whisperx[348].start |
10363.837 |
| transcript.whisperx[348].end |
10376.135 |
| transcript.whisperx[348].text |
他都答非所問 我在問他112年以前判決的他的規劃的期程 要花多久時間他會讓大家都可以查詢的出來他還在講112年以後 還在講112年目前 |
| transcript.whisperx[349].start |
10380.171 |
| transcript.whisperx[349].end |
10406.059 |
| transcript.whisperx[349].text |
我再問他 要花多少的時間他會輸定不來 補定不知道你整個制度是在規約什麼你沒辦法回答得出來我們一直都有規約在討論而且我們親自主持那112年以前的到底要追溯到多久不是追溯到多久是你要準備多久才能夠讓我們可以完整的查詢妳要補充嗎 |
| transcript.whisperx[350].start |
10411.482 |
| transcript.whisperx[350].end |
10436.619 |
| transcript.whisperx[350].text |
跟委員報告 事實上我們前段的做法是你昨天為什麼都不來 都要靠你靠外延對外發言也是都靠你 是怎麼樣呃 劉市長一直有在處理這個事情我現在看到媒體上發言也不是他 已經很多次了都不是他 到立法院也不來昨天有來啦 昨天公聽會有來啦昨天公聽會有來 今天有立委要質詢的就不來昨天沒有立委質詢他的就來啦 |
| transcript.whisperx[351].start |
10439.232 |
| transcript.whisperx[351].end |
10463.928 |
| transcript.whisperx[351].text |
哎呀 不要這樣子護航啦博電你能耐就好了你叫很多醫事團體都出來給你聲援繼續留任啊連建築師公會都出來聲援啦建築師公會都出來聲援啦叫一個署長來 叫不來喔好啦 我覺得現在事情又很多了 我跟你來 我跟你講 台北 台北廖姓郎一另外一個姓平案件喔 他 |
| transcript.whisperx[352].start |
10465.189 |
| transcript.whisperx[352].end |
10483.864 |
| transcript.whisperx[352].text |
我們主張不應該只有局限於對病人也應該包含職場教學之便的這個範圍台北廖姓郎醫在今年有一個廖姓郎醫對護理師性騷擾114年判刑定讞請問他會不會被揭露 |
| transcript.whisperx[353].start |
10485.775 |
| transcript.whisperx[353].end |
10503.034 |
| transcript.whisperx[353].text |
會不會 今年剛定宴不會對病 跟委員報告目前在資訊專區所揭露的不管是對病人對住院醫師還有對其他團隊的成員只要有犯這樣的罪都會把它做揭露 |
| transcript.whisperx[354].start |
10503.274 |
| transcript.whisperx[354].end |
10516.024 |
| transcript.whisperx[354].text |
你們的說明裡面沒有喔你們現在只有局限在對病人喔對於同事對於職場教學之便的範圍的沒有納入規範喔你不是在這裡生氣嗎你們的內容你們揭露的範圍不在裡面好我想鮑偉我想那個內容的充實以及那個掌握度我想我們會一直在加強 |
| transcript.whisperx[355].start |
10532.898 |
| transcript.whisperx[355].end |
10536.881 |
| transcript.whisperx[355].text |
柏中你現在在說什麼 我都聽不懂了 還有呢我再講幾個 再講四個不會被揭露的已經懲處決議或調查已經確認了 但沒有進入司法程序第一個 新北的陳姓郎一 109年利用植物之變在整間幼島變幻發生關係事後還改姓名 |
| transcript.whisperx[356].start |
10557.779 |
| transcript.whisperx[356].end |
10579.256 |
| transcript.whisperx[356].text |
111年遭懲戒 現在跨縣市職業還擔任醫院裡的主管職他不會被揭露啊因為沒有 當事人沒有告他啊沒有判 沒有刑事訴訟啊這會不會被揭露 跨縣市還擔任主管職你覺得這個要讓大家知道嗎 |
| transcript.whisperx[357].start |
10586.585 |
| transcript.whisperx[357].end |
10608.01 |
| transcript.whisperx[357].text |
下一階段就是有懲戒被懲戒處分的資料我們也會做好來下一階段是什麼時候我現在就是要聽你下一階段我現在不要聽你不要轉移焦點副司長說下一個階段你們連懲戒都要可以被查詢那下一個階段是多久以後你來告訴我 |
| transcript.whisperx[358].start |
10610.407 |
| transcript.whisperx[358].end |
10624.313 |
| transcript.whisperx[358].text |
不可以在這裡騙立委啊當初立委很好分立委都亂說很好騙下一階段是多久報告委員因為我們網路已經建立了那個的確是 |
| transcript.whisperx[359].start |
10625.501 |
| transcript.whisperx[359].end |
10645.294 |
| transcript.whisperx[359].text |
突破性啦 這個請委員要肯定一下什麼突破性 我給你1月2月在野黨提案我們一直諮詢我已經諮詢這個第4次了第4次啦我們也跟司法院有聯繫司法院也因為都一直沒有給我們回應所以我們只好用有一點用人工方式一直在蒐集你們 |
| transcript.whisperx[360].start |
10647.895 |
| transcript.whisperx[360].end |
10657.682 |
| transcript.whisperx[360].text |
我們懲戒紀錄是在地方政府就有的懲戒紀錄跟司法院無關這是行政調查 行政懲戒懲戒紀錄要在地方 它每個格式都不太一樣格式不一樣 那我問你 我要叫你立即馬上嗎已經諮詢了三個月 四個月 五個月了你到底要花多久的時間 你就告訴我我們不要一拖再拖又拖 |
| transcript.whisperx[361].start |
10673.792 |
| transcript.whisperx[361].end |
10688.884 |
| transcript.whisperx[361].text |
我跟大家報告 還是要報告一下現況嘛現況就是各個地方限制 今天這件事已經說不出來了他們要有一個標準的格式然後要 你不要用技術面來講我都不想聽 我今天問你 你認為要多久的時間你如果說要一年就一年 說半年就半年你告訴我一個答案 告訴全國的人民 |
| transcript.whisperx[362].start |
10698.035 |
| transcript.whisperx[362].end |
10714.682 |
| transcript.whisperx[362].text |
要多久我們醫事室認得他的在技術方面我要是能夠隨時公佈我明天會公佈也沒關係沒關係啦 我問你要多久我給你時間啊 |
| transcript.whisperx[363].start |
10716.441 |
| transcript.whisperx[363].end |
10740.291 |
| transcript.whisperx[363].text |
但是我要看那個實際上他們在沒有啦 你跟我說要多久啦意思是認為半年內可以來完成半年內你來告訴我有懲戒紀錄的也會被揭露也可以查詢出來那改了名字的還有跨縣市職業的那一些你們原來醫事系統查詢的會不會改善要多久時間改善我已經質詢到四本了 |
| transcript.whisperx[364].start |
10742.492 |
| transcript.whisperx[364].end |
10758.665 |
| transcript.whisperx[364].text |
因為他改名字以後是不是我們能夠找到這個我就不敢講但是不管他跨縣市他還是留有紀錄啊那些紀錄就會上去啦我不是在說留有紀錄你們的醫事查詢系統查不到啦我現在是在說你們的醫事查詢系統我講資訊在市面上你現在都聽不懂我再問你 高雄曾姓郎醫 |
| transcript.whisperx[365].start |
10764.79 |
| transcript.whisperx[365].end |
10768.192 |
| transcript.whisperx[365].text |
趁診療機會取得變換聯絡資訊進行性騷擾然後114年遭懲戒停業兩個月現在還在職業桃園高性狼醫110年診療時藉著甲狀腺問題影響性荷爾蒙為由對變換進行內診還趁機性侵強吻 |
| transcript.whisperx[366].start |
10784.162 |
| transcript.whisperx[366].end |
10789.911 |
| transcript.whisperx[366].text |
直到護理師進來才停止112年這麼嚴重當時沒有進行刑事訴訟但112年遭懲戒到目前沒有定業有訴訟但沒有定業還在職業當中 |
| transcript.whisperx[367].start |
10799.525 |
| transcript.whisperx[367].end |
10814.723 |
| transcript.whisperx[367].text |
第四個 台中陳姓郎一113到114年之間多次假借看診民意 習胸摸腿他們地方政府認定為性騷擾成立但是還沒有懲戒記錄 |
| transcript.whisperx[368].start |
10816.192 |
| transcript.whisperx[368].end |
10839.99 |
| transcript.whisperx[368].text |
我現在說的是什麼你們現行的揭露的機制的漏洞112年以前的目前還查不到只有懲處記錄的沒有辦法查得到調查台中市政府調查確認了也沒有公佈案件尚未定業的都可能因為系統限制而不被揭露而你們說還要再準備半年我很擔心你半年之後 |
| transcript.whisperx[369].start |
10841.113 |
| transcript.whisperx[369].end |
10862.548 |
| transcript.whisperx[369].text |
還是沒有辦法做好但是這些案子並不會沒有揭露而不存在這種案件通常會牽涉到權勢的壓力還有心理的創傷很多甚至我講了他沒有辦法進入訴訟程序因為很多不敢講嘛然後加上醫生換了名字的跨縣市職業的 |
| transcript.whisperx[370].start |
10864.042 |
| transcript.whisperx[370].end |
10876.796 |
| transcript.whisperx[370].text |
你的醫事查詢系統根本就查不出來你公告在你的人醫平台但人醫平台在改名字了他換的地方職業了在你的醫事查詢系統 |
| transcript.whisperx[371].start |
10877.895 |
| transcript.whisperx[371].end |
10898.115 |
| transcript.whisperx[371].text |
插不出來 你沒有整合所以你讓一般病患要辨識狼醫他的困難度很高反而變成了不良醫師的保護傘因為你公告狼醫叫陳某某你到醫師查詢系統 又改名字了 |
| transcript.whisperx[372].start |
10899.176 |
| transcript.whisperx[372].end |
10907.867 |
| transcript.whisperx[372].text |
所以我真的跟你說第四遍第五遍我不知道要說幾遍判決不是唯一認定違反醫療倫理的標準你們這樣子 |
| transcript.whisperx[373].start |
10912.079 |
| transcript.whisperx[373].end |
10936.391 |
| transcript.whisperx[373].text |
你們目前的做委員 其實是真的非常需要委員我們你對醫事專業團體 不是行政人員調查的是醫事專業團體他們所做的這個地方政府做的調查醫事團體做的決策和決議你調查跟他們的醫事團體專業你們信任度不足嗎 |
| transcript.whisperx[374].start |
10937.833 |
| transcript.whisperx[374].end |
10951.654 |
| transcript.whisperx[374].text |
違反醫療倫理的也不是只限於性平案件倒刷健保卡 僱用密醫使用非法的療法等等都嚴重的破壞醫病的信任這一些難道我們病患沒有知情權嗎 |
| transcript.whisperx[375].start |
10953.223 |
| transcript.whisperx[375].end |
10982.302 |
| transcript.whisperx[375].text |
所以我們在這裡再一次呼籲揭露所有的判決書和懲戒紀錄也不限於性平案件和時間範圍而且你在講剛剛講了六個月六個月要確保我們下次查詢資訊可追溯可查驗還有第三個你的醫師查詢平台跟你的狼醫公告平台改名了跨縣市人你不整合在一起 |
| transcript.whisperx[376].start |
10983.604 |
| transcript.whisperx[376].end |
10990.775 |
| transcript.whisperx[376].text |
現在又逍遙法外你的查詢系統又變成狼醫的護身符這樣要怎麼做 |
| transcript.whisperx[377].start |
10992.828 |
| transcript.whisperx[377].end |
11012.781 |
| transcript.whisperx[377].text |
委員所執行的我們一定都會去重視跟改善請放心那個我們剛剛所提的你的質疑我們一定都會去不是啦我不要聽到你重視跟改善那第二個就是說我們關於說是不是在調查期間能夠停止這個我們在8月下旬我有講到調查期間停職嗎會我有講到這句話嗎 |
| transcript.whisperx[378].start |
11013.621 |
| transcript.whisperx[378].end |
11019.726 |
| transcript.whisperx[378].text |
沒有就是說我是說我們在做一些可能過去大家我沒有講到這個我告訴你就舉了法務部的律師查詢系統那麼簡單你敢不敢跟整合你的醫師查詢系統跟你的人醫整個平台整合在一起像法務部的律師查詢系統 |
| transcript.whisperx[379].start |
11039.582 |
| transcript.whisperx[379].end |
11064.912 |
| transcript.whisperx[379].text |
查詢出來 他的懲戒記錄都有他現在職業狀態他的地址 你再加上一個改名他的職業縣市在桃園有職業 在新北有職業這樣子會很難嗎為什麼人家法務部做得到 你做不到法務院其實都查得到 但是有現在全部都查不到 你不要胡說八道我的意思就是說人眼都查得到 |
| transcript.whisperx[380].start |
11066.092 |
| transcript.whisperx[380].end |
11080.049 |
| transcript.whisperx[380].text |
你們衛福部查得到病患人民永遠查不到啦現在都還查不到啦是查得到現在比較多拒絕要暴露他身份的就是護理人員比較多啦我們有一個我不是跟你講了你的類別可以強度不用一樣嘛 |
| transcript.whisperx[381].start |
11084.986 |
| transcript.whisperx[381].end |
11101.941 |
| transcript.whisperx[381].text |
你對醫師所要揭露的資訊跟對一個護理師 復健師 驗光師所要揭露的 你去分等級嘛我知道 我知道這這麼簡單的事情 我就不知道你們到底是怎麼想這就沒辦法做了兩者都沒辦法做了我不知道你醫事師的領略是要做什麼我今天來的技術都還沒開始老實說 |
| transcript.whisperx[382].start |
11113.376 |
| transcript.whisperx[382].end |
11123.964 |
| transcript.whisperx[382].text |
我們針對進口藥品原料的課稅對我國產業造成的影響 老實說一個字都還沒諮詢這件事這麼簡單 我已經說第四遍了啦 第五遍了啦好 我們會繼續把它做得更好半年內 |
| transcript.whisperx[383].start |
11133.22 |
| transcript.whisperx[383].end |
11150.192 |
| transcript.whisperx[383].text |
我所質詢的全部都會得到答案嗎不過我還是跟委員報告一下醫師可以提供的資料跟律師其實是不太一樣因為他們的工作性質真的就不太一樣你不要去說這些啦那另外就是說現在要叫你揭露這個人有沒有懲戒紀錄有沒有判刑紀錄他的職業他是在哪個地方職業哪一個縣市職業 |
| transcript.whisperx[384].start |
11160.479 |
| transcript.whisperx[384].end |
11161.381 |
| transcript.whisperx[384].text |
這是在說什麼這什麼叫暗暗的 林醫生自己就看不過了你這種態度 嚴附人意 |
| transcript.whisperx[385].start |
11170.365 |
| transcript.whisperx[385].end |
11199.302 |
| transcript.whisperx[385].text |
但是我們要照規定來做啊稻域不合規定啊我問你啊 稻域不合規定啊我剛才說的稻域不合規定啊要我用個資保護法來說嗎那我已經七孫三輩啊你在上面就說沒問題啊現在又開始來了 再來灰啊 再來鹵 再來荒啊反反覆覆我們非常誠懇的一反一覆啊 小人心啊一漲一退啊 山西水俗語 俗語 |
| transcript.whisperx[386].start |
11202.839 |
| transcript.whisperx[386].end |
11225.448 |
| transcript.whisperx[386].text |
反反覆覆啦 不能這樣啦 這麼簡單的事情還是要多補充就做得出來 多輸充就做得出來補充 你是要輸充娃娃的 就有人會做出來了啦啊啦 沒辦法 沒了補充娃娃的 沒地方就做出來了啦我不知道你的困難是在哪裡 你的困難到底是在哪裡啊 |
| transcript.whisperx[387].start |
11227.935 |
| transcript.whisperx[387].end |
11251.529 |
| transcript.whisperx[387].text |
法律工具有限法律有局限那律師的工具為什麼沒有受限我想這個部分那個你要多用一點心啦我告訴你喔已經第四遍第五遍 再說也不好好啦今天的主題下一次再諮詢因為我再說下去我想我要避免他也要避免啦好啦 |
| transcript.whisperx[388].start |
11252.878 |
| transcript.whisperx[388].end |
11270.135 |
| transcript.whisperx[388].text |
我們會繼續努力好 謝謝林書恩委員 感謝黃秀芳委員執行謝謝主席 我們請部長好 部長請委員好 |
| transcript.whisperx[389].start |
11277.864 |
| transcript.whisperx[389].end |
11297.592 |
| transcript.whisperx[389].text |
部長我想請教就是說我們從四月份就針對這個美國的這個對等關稅從四月初然後到我記得在七月份的時候七月中的時候我們也有針對這個討論就是有關美國關稅然後可能會影響到我們國內的這個 |
| transcript.whisperx[390].start |
11299.733 |
| transcript.whisperx[390].end |
11314.61 |
| transcript.whisperx[390].text |
這個藥品或者是藥價的這個議題我們有討論過那我今天也想請教就是說8月初的這個這個對等關稅就是目前是20%那在7月份的時候我們已經有希望就是說這個 |
| transcript.whisperx[391].start |
11316.472 |
| transcript.whisperx[391].end |
11338.638 |
| transcript.whisperx[391].text |
可能會影響到這個藥價或者是醫材也許會出現一些波動那我想請教部長就是說這個將近幾個月的時間我們衛福部針對這部分你們有沒有跟這個產業界有做一些討論那是不是你們有一些因應的方式我想再確定再具體一點 |
| transcript.whisperx[392].start |
11340.233 |
| transcript.whisperx[392].end |
11366.781 |
| transcript.whisperx[392].text |
好 謝謝委員的吹醒我想我們從世界委員的關心跟大家的一個關心之下我們當然當時都會認為因為藥品的關稅是零關稅但是現在可能還是應應會有川普的做法有時候會變變化所以我們要更要準備好所以我們剛剛一直報告我們有強化供應疫情提升 |
| transcript.whisperx[393].start |
11367.661 |
| transcript.whisperx[393].end |
11381.178 |
| transcript.whisperx[393].text |
藥品的儲備確保藥價的合理鼓勵在地的製造這個部分我們都做好準備那至於跟產業的一個互動的話我想石耀石市長來報告一下 |
| transcript.whisperx[394].start |
11383.788 |
| transcript.whisperx[394].end |
11405.397 |
| transcript.whisperx[394].text |
這邊跟委員進一步做說明我們從四月份其實更早三月份在針對台灣的學名藥製劑廠以及原料藥的原料廠那以及在這種情形下做了溝通如何去建立韌性因為在韌性的前提之下我們剛才提到有育海市四家製劑總共一千億的產值所以相對的 |
| transcript.whisperx[395].start |
11406.297 |
| transcript.whisperx[395].end |
11429.003 |
| transcript.whisperx[395].text |
每一家的規模是小我們特別跟學民藥的工會的理事長等等的會員超外去討論說必須要做所謂區域的聯防去因為他們評估起來都會有相同的標的要去做所謂的製劑可是這樣之下競爭反而是讓他們自己的價格非常困難所以我們提到的是說如何去對於我們的必要藥品的清單 |
| transcript.whisperx[396].start |
11430.163 |
| transcript.whisperx[396].end |
11447.333 |
| transcript.whisperx[396].text |
在專利藥過期進入製劑的過程當中能夠確確的去做分工那這分工其實是要從內部協調所以我們在特別提到在公司協力自主規制的方面他們自己的對產業裡面的互相的協調那我們對於我們現在的必要藥品有 |
| transcript.whisperx[397].start |
11447.853 |
| transcript.whisperx[397].end |
11477.473 |
| transcript.whisperx[397].text |
特別的藥事法二十七條之二那進一步擴展到全體所謂的藥品只要短缺的情形之下再進入修法希望在未來能夠達到的是只要有短缺的疑慮之下在政府的政策能夠介入做更好的一些所謂的管控跟調控以及分派所以我們用智慧性的導入所謂的這些管銷的一個系統我們過去是從大盤中盤到所謂的醫療院所 |
| transcript.whisperx[398].start |
11478.153 |
| transcript.whisperx[398].end |
11493.159 |
| transcript.whisperx[398].text |
有一部分我們最近特別去借起來也跟醫院的部分做了一些討論希望能夠達到醫院直接從藥廠面供的部分能夠達到整體的藥品的供應上面是一個有限的產能之下 |
| transcript.whisperx[399].start |
11493.999 |
| transcript.whisperx[399].end |
11519.37 |
| transcript.whisperx[399].text |
供需平衡我們可以再應用這些調控的機制而得到分配能夠均衡也讓我們的藥品的韌性達到不遺匱乏的狀況我是希望就是說剛剛署長也講得很清楚然後我們不希望就是說因為這個狀況然後可能會產生缺藥的這個問題那另外我想請教就是說其實各國的藥廠可能有的是因應川普的這個關稅議題那有的是這個藥品庫存可能就是會 |
| transcript.whisperx[400].start |
11523.192 |
| transcript.whisperx[400].end |
11537.453 |
| transcript.whisperx[400].text |
會有一些庫存我想請教部長或者是署長針對這一部分我們可能也要有一些因應的措施就是說某些藥也許我們也需要有一些庫存量 |
| transcript.whisperx[401].start |
11538.934 |
| transcript.whisperx[401].end |
11565.744 |
| transcript.whisperx[401].text |
剛剛署長有特別提到就是說我們要有在地化 任性化像這樣子的話庫存的部分不要說到時候會造成可能缺藥的問題我是不是可以再請教一下署長針對這一部分你們有沒有就是說國人最常用的這些藥品我們是不是有一些庫存量它的庫存的時間到底是有多久 |
| transcript.whisperx[402].start |
11567.518 |
| transcript.whisperx[402].end |
11584.777 |
| transcript.whisperx[402].text |
那這邊跟委員進一步報告我們針對現在的製劑的部分我們在所謂的西藥及醫療器材供應的平台上面如果在藥事法I27條之二裡面針對有所謂的短缺的疑慮之下在半年內他必須做通報 |
| transcript.whisperx[403].start |
11585.778 |
| transcript.whisperx[403].end |
11611.719 |
| transcript.whisperx[403].text |
那对于通报的药品其实我们做后续的在所谓的临床药学会里面的做进入评估之后对这些药品它如何有时候是国外因为产能上面或者国内这个产制的上面的供给上面如果是短期供应是无余的但是需要做调配的我们就会做一些控药所以在半年内如果说会有就是在半年的时间是的 |
| transcript.whisperx[404].start |
11612.679 |
| transcript.whisperx[404].end |
11628.828 |
| transcript.whisperx[404].text |
會有一些短缺的疑慮我們就會分析如果在供應上面真的是有疑慮的時候我們會公告專案的製造或專案的輸入能夠讓這些可能潛在的不能平衡的部分能夠及時的補足 |
| transcript.whisperx[405].start |
11630.129 |
| transcript.whisperx[405].end |
11645.428 |
| transcript.whisperx[405].text |
那另外還有一個部分其實很殘酷的就是國際大藥廠在面對特定的藥物他們在全世界佔比就是單一藥廠有將近80%他在產能上面我們是不是會有前後上面供給上面的優先順序的 |
| transcript.whisperx[406].start |
11646.249 |
| transcript.whisperx[406].end |
11664.097 |
| transcript.whisperx[406].text |
那我們面對這議題我們針對國內的製劑廠生物理事的藥廠的部分我們積極的溝通國內產業呢他們覺得他也是可以做得到所以這部分總我們就是跟這些國內的一些製劑的廠生物理事的藥廠裡面積極的去研擬這個部分因為那個 |
| transcript.whisperx[407].start |
11665.377 |
| transcript.whisperx[407].end |
11694.15 |
| transcript.whisperx[407].text |
牽一髮動千鈞的單一個藥廠的那其實是全世界的議題這個議題呢也是在國際亞洲區裡面發酵我們在國內也有研擬我們目前也有幾次的跟生物理事要藥廠裡面在做這件研擬的工作那目前看起來是我們有看到一些曙光因為特定的藥廠他對於這些談判跟可能的一個做法我們在這邊也比較不方便一下子做揭露但是他們是很努力我們也持續的進行 |
| transcript.whisperx[408].start |
11694.77 |
| transcript.whisperx[408].end |
11719.01 |
| transcript.whisperx[408].text |
那另外我想請教就是說立法院在前些日子就是有三讀通過就是因應國際情勢強化經濟社會及民眾消費韌性的特別條例那這個特別條例當中有提到這個法案的附帶決議有兩項附帶決議一個是健保基金獲得這個撥補預算中要優先用於增進我國產品供應韌性 |
| transcript.whisperx[409].start |
11720.191 |
| transcript.whisperx[409].end |
11742.233 |
| transcript.whisperx[409].text |
那第二個附帶決議就是說益住健保基金的預算數不得低於個期預算總數的12%那我想請教衛福部針對這兩個附帶決議那你們有什麼就是說是不是照著這樣子去執行或者是未來會有什麼樣的變化或者是會有什麼樣的困難 |
| transcript.whisperx[410].start |
11743.234 |
| transcript.whisperx[410].end |
11755.447 |
| transcript.whisperx[410].text |
那是不是可以請部長這邊做一下我想我們大宴已經通過的三途包括條文以及決議我想我們會尊重大宴來努力來進行而且在這樣的一個 |
| transcript.whisperx[411].start |
11759.591 |
| transcript.whisperx[411].end |
11774.247 |
| transcript.whisperx[411].text |
支援之下我們會把它該做的一個專業方面的事情我們會把它做好來保護我們當時變這個預算的一個用心讓我們的健保能夠運轉得更好讓我們的藥品能夠更加的穩定 |
| transcript.whisperx[412].start |
11774.747 |
| transcript.whisperx[412].end |
11800.143 |
| transcript.whisperx[412].text |
那部長我再請教就是說健保署在推動一個使用生物相似性藥品及學名藥的鼓勵事辦計畫那這個事辦計畫你們也希望就是說可以達到這個一定的這個比例可能也許達到70%左右那我想請教就是說我們提出這樣學名藥的鼓勵政策那可能目前是以那個化療 |
| transcript.whisperx[413].start |
11802.024 |
| transcript.whisperx[413].end |
11818.618 |
| transcript.whisperx[413].text |
藥的這個部分先開始做那我想請教就是說目前做的這個情況是怎樣那會不會有一些影響通常病人或者是病人家屬都會希望說是用原廠的藥品 |
| transcript.whisperx[414].start |
11820.459 |
| transcript.whisperx[414].end |
11849.899 |
| transcript.whisperx[414].text |
那如果說健保署這樣子鼓勵的話當然就是大家都是信任醫師醫師開什麼藥當然就是都信任醫師那我也想請教就是說以病人為優先的話那當然是推動這個也是推動我們這個藥品的在地這個韌性韌性化然後在地化那我想請教部長或者是署長針對你們這樣的一個推動那未來這個你們目標目前是已經快達標了嗎或者是說 |
| transcript.whisperx[415].start |
11851.46 |
| transcript.whisperx[415].end |
11868.239 |
| transcript.whisperx[415].text |
或者是說你們還有努力的空間那當然就是說你們如果是朝這個方向在執行的話我覺得還是要以病人的這個權益為優先是不是可以請部長或署長回應一下我先補充一下 |
| transcript.whisperx[416].start |
11869.6 |
| transcript.whisperx[416].end |
11892.406 |
| transcript.whisperx[416].text |
我想我們台灣的醫療醫療跟藥品的一個品質都是受到肯定的那只要攜手合作我相信我們會用達到用我們在我們的目標之下來給民眾做最完整的一個照顧埃及現在這個計畫到底進行的情況請時事長報告一下 |
| transcript.whisperx[417].start |
11894.219 |
| transcript.whisperx[417].end |
11909.596 |
| transcript.whisperx[417].text |
跟委員報告我們現在所推動的去年是這個生物相似藥那裡面有部分是癌藥多數是一些風濕免疫的藥那今年我們推動的是那個癌症的化學用藥我們叫化療的藥 |
| transcript.whisperx[418].start |
11911.178 |
| transcript.whisperx[418].end |
11935.977 |
| transcript.whisperx[418].text |
那這個化學治療的藥其實它不是全部都是國產它有進口的 它也有國產的但是這個下去之後各國都是這樣它可以分散這個用藥的多元性不會寡占 避免斷藥的危機啦所以我們現在來鼓勵這個那麼鼓勵的同時當然就要確保這個療效的相等性所以我們還有這個療效不相等通報系統 |
| transcript.whisperx[419].start |
11936.557 |
| transcript.whisperx[419].end |
11953.992 |
| transcript.whisperx[419].text |
所以如果在臨床上用了有任何一個藥物感覺它有不等效的情形就可以通報那食藥署就會接著去介入去驗證這個藥品的效果我們還是希望就是說以病人的權益為優先如果說這個做起來就 |
| transcript.whisperx[420].start |
11954.753 |
| transcript.whisperx[420].end |
11974.942 |
| transcript.whisperx[420].text |
效果就沒有那麼好那我覺得說也不要去硬要推這樣子一個計畫另外我最後再問一個問題就是說我們一直在研擬就是藥品的供應韌性相對的這個對策那當然就是說國內的這個剛剛部長也有特別提到就是說國內的我們的那個 |
| transcript.whisperx[421].start |
11978.224 |
| transcript.whisperx[421].end |
11991.74 |
| transcript.whisperx[421].text |
這個醫藥的那個產業鏈其實也算是非常的完整那當然就是說我們也希望就是說我們的這個醫藥的這個產業鏈未來也是可以成為我們的護國神山那我想請教部長就是說 |
| transcript.whisperx[422].start |
11993.802 |
| transcript.whisperx[422].end |
12010.878 |
| transcript.whisperx[422].text |
其實我們還有很多需要去去做的那我也想希望就是說健保每一年附在這個醫療 醫藥 醫材方面其實我們都會覺得說一年的這個預算已經 |
| transcript.whisperx[423].start |
12013.741 |
| transcript.whisperx[423].end |
12016.465 |
| transcript.whisperx[423].text |
8000多億今年9286億9286那其實我覺得說有一些可能也配合國內的這個這個產業鏈好如果說因為我們我都覺得說這個 |
| transcript.whisperx[424].start |
12030.204 |
| transcript.whisperx[424].end |
12050.877 |
| transcript.whisperx[424].text |
這個健保的這個費用其實應該是已經很多了那應該也要扶植國內的這樣子醫療的或者是醫材醫藥的這個產業鏈能夠更完整的話其實未來把這樣的一個這個政策這樣的一個完整性然後推動到其他國家我覺得這個也是成為我們國內或者跟國外一個非常好的一個 |
| transcript.whisperx[425].start |
12052.418 |
| transcript.whisperx[425].end |
12065.173 |
| transcript.whisperx[425].text |
讓我們國內的這些產業醫療界醫藥界的這個產業鏈能夠推廣到其他國家去我覺得這個也是我們國家未來的一個也是一個非常重要的一個韌性 |
| transcript.whisperx[426].start |
12066.434 |
| transcript.whisperx[426].end |
12091.167 |
| transcript.whisperx[426].text |
那我希望就是說衛福部這邊也要針對這一部分應該要好好去思考好讓這樣子的一些一個產業鏈能夠複製到其他國家去讓這些醫藥界醫療醫材能夠在其他國家能夠發光發熱非常謝謝委員這麼重要的一個提點跟指示我們朝這個方向來努力好謝謝辛苦了謝謝 |
| transcript.whisperx[427].start |
12095.267 |
| transcript.whisperx[427].end |
12100.109 |
| transcript.whisperx[427].text |
謝謝黃委員 謝謝署長 部長來 接下來我們請王振旭委員質詢好 非常感謝主席我們還是請邱部長 |
| transcript.whisperx[428].start |
12116.71 |
| transcript.whisperx[428].end |
12136.995 |
| transcript.whisperx[428].text |
委員好 菅部長好今天的這個主題我想經過這麼多委員的槌尋剛剛也做了非常完整的說明不過還是有三個問題再跟部長還有跟其他同仁就教一下第一個就是川普藥價最惠國政策對我國藥品價格及供應的衝擊 |
| transcript.whisperx[429].start |
12138.235 |
| transcript.whisperx[429].end |
12152.372 |
| transcript.whisperx[429].text |
因應的對策第二個部分就是要如何提升我國學民藥的自給率第三個就是美國藥品關稅對我國原料藥進出口的影響基本上就是這三個問題 |
| transcript.whisperx[430].start |
12153.613 |
| transcript.whisperx[430].end |
12172.346 |
| transcript.whisperx[430].text |
那有關於這個川普要加最惠國政策的衝擊我想大家都非常清楚差不多兩百多萬這個川普總統就公開的發函他希望全球17家國際的大藥廠不是只有美國的藥廠而已 |
| transcript.whisperx[431].start |
12176.229 |
| transcript.whisperx[431].end |
12203.378 |
| transcript.whisperx[431].text |
要大幅降低美國處方藥的價格因為我們都了解很多新藥產出的時候都是從美國開始美國FDA就會通過相關的私營證然後開始做一些藥物的給付在抗癌藥這部分其他的一些新的不管是新機制或者是一些創新的藥品很多是從美國這邊研發出來的 |
| transcript.whisperx[432].start |
12204.998 |
| transcript.whisperx[432].end |
12229.247 |
| transcript.whisperx[432].text |
所以他就針對於這個藥價的部分依照經驗還有實際的狀況其實美國的藥價普遍都會比其他國家相對高一點所以他當然川普就覺得這樣很不爽以外為什麼美國人用藥的價錢會比其他國家的人還要高所以他就特別希望能夠有好的方式有適當的機制來做這樣的處理 |
| transcript.whisperx[433].start |
12231.428 |
| transcript.whisperx[433].end |
12255.12 |
| transcript.whisperx[433].text |
所以他要求要17個大藥廠敦促這些大藥廠要降價並且將適當的機制以超額收入能夠回饋給美國的政府當然還有包括美國的人民所以他要求在9月29號之前他必須要有相關的這個做出承諾要求這個17家的大藥廠 |
| transcript.whisperx[434].start |
12258.041 |
| transcript.whisperx[434].end |
12286.595 |
| transcript.whisperx[434].text |
能夠配合他的要求如果不配合的話那就看著辦這個就是我們為什麼今天要花很多的時間精神來討論一下如果這些大藥廠真的針對於我們看到下一張的內容有施大要求他們如果都真的配合這樣的要求的話對台灣用藥的權益或者是在費用上會造成什麼樣的衝擊跟影響 |
| transcript.whisperx[435].start |
12287.595 |
| transcript.whisperx[435].end |
12308.163 |
| transcript.whisperx[435].text |
第一個就是它的世代要求之一要拓展最惠國定價到這個醫療補助裡面第二個是要保證新上市的藥品的最惠國定價就是說反正不管怎麼樣我們美國的藥品不可能要比其他國家的這些用藥還要來得高 |
| transcript.whisperx[436].start |
12308.943 |
| transcript.whisperx[436].end |
12326.049 |
| transcript.whisperx[436].text |
就是他做標準就對了他如果比較低 別人不能比他高就是說他要拿到的是最低的藥價讓他那個民眾在用藥上的權益是可以同步的去使用到藥物然後又是全球最低價 |
| transcript.whisperx[437].start |
12327.309 |
| transcript.whisperx[437].end |
12349.83 |
| transcript.whisperx[437].text |
第三個就是海外增加的收入要還給美國的患者跟納稅人第四個就是要提供中國的價格的直接採購這個是他具體的要求我們往下看就知道說那為什麼美國要把油供給我們台灣為什麼會影響到譬如說我們的油要變多貴這到底是什麼邏輯或是什麼理由 |
| transcript.whisperx[438].start |
12350.49 |
| transcript.whisperx[438].end |
12372.967 |
| transcript.whisperx[438].text |
那這邊我們看得出來剛剛所提到的因為台灣長期以來是以相對的低價來不管是從美國或者是從其他的地方購入的這個藥品都會比原地可能還要低一點那如果美國政府要求要這個藥廠要壓低價格的話那台灣我們本來是相對於其他 |
| transcript.whisperx[439].start |
12373.968 |
| transcript.whisperx[439].end |
12396.029 |
| transcript.whisperx[439].text |
國際的這個用藥價格相對比較低的時候那我們變成是會被要求要漲價的對象就其他17家或其他的藥廠可能就會要求台灣的這個藥價不能夠這麼低這個是我們可以理解的地方所以莊皇仁老師就指出說因為台灣長期以來用低價進入購入這個美國藥品 |
| transcript.whisperx[440].start |
12397.811 |
| transcript.whisperx[440].end |
12412.505 |
| transcript.whisperx[440].text |
所以從川普的立場來看這個也很自然那吃幾吃那麼久所以感覺他這次身為美國總統他要勇敢的或者是要有魄力的站出來要把這個事情能夠做一個徹底的解決 |
| transcript.whisperx[441].start |
12413.366 |
| transcript.whisperx[441].end |
12436.016 |
| transcript.whisperx[441].text |
所以當他發現說美國藥廠在海外市場賣得比較便宜回到國內就是說他美國自己發明的藥下去其他的國家電動鼻涕美國國家給所以他一定要把這個筆賬要討回來所以張文老師就表示說如果藥廠重新來訂 |
| transcript.whisperx[442].start |
12437.496 |
| transcript.whisperx[442].end |
12450.508 |
| transcript.whisperx[442].text |
調整全球的價格的時候台灣有給柯林要面臨兩到三倍的漲幅這個是張老師他所擔心的部分這個媒體也都有相關的報導 |
| transcript.whisperx[443].start |
12451.383 |
| transcript.whisperx[443].end |
12473.925 |
| transcript.whisperx[443].text |
那另外就是有關於那個台大醫學院的沈麗堅副院長他長期也都很在關心這個藥物的定價還有他本身是一個很傑出的這個藥學教授他長期也都在幫助健保署這邊主持各項的會議 |
| transcript.whisperx[444].start |
12475.246 |
| transcript.whisperx[444].end |
12504.228 |
| transcript.whisperx[444].text |
他說目前在台灣的健保制度下為了要有效的控管支出所以要定價的方式是以十個已開發中國家的中位數甚至是最低價做目標意思就是說我們的健保制度之下為了要照顧全民眾的健康還有用藥所以盡量的希望用比較大的這些額度去爭取到全球或者是相對是比較低價的 |
| transcript.whisperx[445].start |
12505.149 |
| transcript.whisperx[445].end |
12520.2 |
| transcript.whisperx[445].text |
那為了要避免這個價格的定毛效應所以很多這些大藥廠其實是很擔心一旦不管是新藥或者是其他用藥在台灣透過健保上市的時候呢其實會有一些定毛效應 |
| transcript.whisperx[446].start |
12521.721 |
| transcript.whisperx[446].end |
12547.608 |
| transcript.whisperx[446].text |
其他國家就說你們可以賣到台灣那為什麼要賣到我不管是哪一個國家東南亞或者是歐盟等等國家包括美國他們就會擔心說能夠賣台灣這麼低那為什麼就不能夠賣到其他國家有一樣的價錢所以為什麼我們的用藥有時候沒有辦法很及時的在台灣上市這個可能也是一個原因 |
| transcript.whisperx[447].start |
12548.468 |
| transcript.whisperx[447].end |
12573.784 |
| transcript.whisperx[447].text |
尤其是針對癌藥 寒藥跟重大疾病不管是新藥或原廠藥的取得跟價格我們根據這一次的關稅的變化我們有什麼樣的衝擊我們如何來因應未來在討論健保制度之下的藥價定位的時候我們目前有沒有什麼方案要來處理這部分不知道部長的意見是如何 |
| transcript.whisperx[448].start |
12574.355 |
| transcript.whisperx[448].end |
12590.268 |
| transcript.whisperx[448].text |
好 非常謝謝委員 也敬佩委員收集了真的關心這個主題而且收集了這麼專家的一些意見而且專家 這些專家他提供的一些建議我們都覺得有考慮 |
| transcript.whisperx[449].start |
12591.309 |
| transcript.whisperx[449].end |
12618.781 |
| transcript.whisperx[449].text |
考量的必要以及做準備的必要那當然在策略上最重要就是我們不管什麼藥我們都民眾都用得到特別是相關的剛剛尤其是委員最關心的癌症用藥喊病重大的疾病的一個訓療所以那個當然川普以剛剛委員所描述的川普他是用 |
| transcript.whisperx[450].start |
12620.001 |
| transcript.whisperx[450].end |
12638.231 |
| transcript.whisperx[450].text |
想要用比較低的這個部分當然我們也敬佩我們過去台灣政府的努力都能夠把一些藥品盡量壓到比較低但是時勢所變化必須要讓可能會 |
| transcript.whisperx[451].start |
12640.879 |
| transcript.whisperx[451].end |
12666.054 |
| transcript.whisperx[451].text |
會漲價但是我們又必須要給民眾能夠用得到藥當然我們就要有多元化的一個政策那當然第一個我們要準備更多的一個譬如說健保的一個預算來準備它的一個應用它的一個變化第二個我們當然也要那個來促進我們的本土的 |
| transcript.whisperx[452].start |
12667.089 |
| transcript.whisperx[452].end |
12680.64 |
| transcript.whisperx[452].text |
國產的協名藥譬如說輔導國內國產協名藥廠來產製必要的藥品先穩固我們大部分的一個可以做的藥品的供需 |
| transcript.whisperx[453].start |
12682.503 |
| transcript.whisperx[453].end |
12701.657 |
| transcript.whisperx[453].text |
當然這一方面當然要建立民眾對學名藥的信賴度讓我們的學名藥能夠使用力能夠提升我想這個衝擊就會比較少我們從這幾個方面來努力這樣子當然這是一個方向 |
| transcript.whisperx[454].start |
12702.578 |
| transcript.whisperx[454].end |
12727.016 |
| transcript.whisperx[454].text |
那今年我們為了因應這個關稅訂的特別條例裡面也有增舉到200億希望做一個健保因應的措施不過我要提醒的就是說依照歐盟的這個統計如果是以癌藥為例的話可能就會對每一個民眾使用癌藥的時候會增加1萬個歐元的衝擊差不多30萬台幣 |
| transcript.whisperx[455].start |
12729.298 |
| transcript.whisperx[455].end |
12757.164 |
| transcript.whisperx[455].text |
所以我不曉得這個200億裡面到時候如果為了要因應以癌藥或者是剛剛所看到的重大傷病帶來的這些用藥還有患病的用藥這很多都是原廠藥那不是說我們自己可以做學名藥就可以處理因為都還在一些保障保護期所以這就不是我們所期待就是說我們自己可以做什麼包括說這些影響跟措施 |
| transcript.whisperx[456].start |
12758.244 |
| transcript.whisperx[456].end |
12784.201 |
| transcript.whisperx[456].text |
對 所以這樣的一個剛剛提的這個中間的空檔我們需要資金來處理這個14檔其實也一直都有報告過大概我們也有估算過它的一個數目大概這樣目前的一個狀況加上欠保險的一個裡面的一個空間加上這個基金的挹注 |
| transcript.whisperx[457].start |
12785.622 |
| transcript.whisperx[457].end |
12793.088 |
| transcript.whisperx[457].text |
我們在剛剛所談到的這些相關的藥品的提供應該是有相當穩定的作用 |
| transcript.whisperx[458].start |
12794.271 |
| transcript.whisperx[458].end |
12815.283 |
| transcript.whisperx[458].text |
所以這邊我們列了三個建議補充來參考一下就是美國藥價最惠國政策對我國的衝擊的影響評估這個評估可能還要更到位第一點就是研議配合調整新藥與原廠藥的健保給付機制剛才報告的我們現在都用中味價 要最低價這種機制 |
| transcript.whisperx[459].start |
12817.784 |
| transcript.whisperx[459].end |
12840.7 |
| transcript.whisperx[459].text |
這個目前我們已經也有建立有這個機制當然對我們是很好啦不過你如果考慮到這次關稅的影響或者是相對未來讓民眾在用藥能夠也及時的話這個政策如何去透過好的機制重新檢討當然不是說希望讓我們整體的 |
| transcript.whisperx[460].start |
12844.603 |
| transcript.whisperx[460].end |
12863.544 |
| transcript.whisperx[460].text |
負擔增加 而是說如何能夠在好的機制之下對 同時去保障我們這個用藥相關的這是一定要堅持的再來就是研議對健保財務增加或致富增加的因應措施這三點的建議就請部長來做一些是的 我們都有在進行 |
| transcript.whisperx[461].start |
12865.086 |
| transcript.whisperx[461].end |
12885.144 |
| transcript.whisperx[461].text |
好 再來比較快速的就是有關於這個學名藥自給濾的部分大家已經說很多了所以部長的書面報告裡面也談論了很多我想這部分我們就不再深入那最後有關於美國藥品關稅對我國原尿藥進出口衝擊的評估 |
| transcript.whisperx[462].start |
12886.845 |
| transcript.whisperx[462].end |
12913.78 |
| transcript.whisperx[462].text |
周副署長其實也有提到我們這些量那再請教一下周副署長就是說我們有沒有根據剛才有人說可能250%有人說100%有人說150%有沒有做差異性分析就是說當這個不同的稅制出現的時候當然現在還是有一點早因為我們也知道川普總統真的是一日三變 |
| transcript.whisperx[463].start |
12914.58 |
| transcript.whisperx[463].end |
12941.56 |
| transcript.whisperx[463].text |
不過如果我們能夠去做出差異性分析的話那不管是對於進口或出口衝擊會是如何可以讓大家有一個比較知道怎麼去掌握因應的措施這部分不知道副署長有沒有什麼意見可以提供給大家參考是在台美談判小組這邊應該有收集到充分的資訊包含不同的稅率之下對產業有什麼樣的衝擊應該都有做一些相關的準備是 |
| transcript.whisperx[464].start |
12942.065 |
| transcript.whisperx[464].end |
12963.907 |
| transcript.whisperx[464].text |
好 那我們也很期待就是除了不斷的去讓談判可以更順利好成果以外也希望這些差異性分析可以讓民眾可以更安心相關的企業界也可以有好的一個因應的對策好 謝謝我們實教室也一直在評估終極好啊OK 那是江署長要補充報告 |
| transcript.whisperx[465].start |
12966.706 |
| transcript.whisperx[465].end |
12982.399 |
| transcript.whisperx[465].text |
蘇美的原料要是0.17億就5億台幣那原來是0%的如果超過30到50%以上生意就不要做了所以我們必須要導引所以產業界他們自己其實要轉生其他非美供應的市場 |
| transcript.whisperx[466].start |
12983.28 |
| transcript.whisperx[466].end |
13001.189 |
| transcript.whisperx[466].text |
那也有考慮說是不是要去美國去設廠因為本來的不是量不那麼大那最重要的事情是最後他們必須要去做調控就是找到新的一個的目標才是他們最重要的 以上好謝謝王振旭委員 謝謝部長署長 |
| transcript.whisperx[467].start |
13009.07 |
| transcript.whisperx[467].end |
13015.397 |
| transcript.whisperx[467].text |
陳培宇陳培宇陳培宇委員不在葉元梓委員質詢馬安橋那個部長衛福部長謝謝 |
| transcript.whisperx[468].start |
13033.027 |
| transcript.whisperx[468].end |
13053.057 |
| transcript.whisperx[468].text |
委員好部長好我相信今天召委排這個專題報告應該就是大家很擔心缺藥的問題特別是美國關稅之後對缺藥問題會不會特別嚴重我看部長你回答媒體的訪問好像信心滿滿所以已經下令要求什麼製劑的存量要三個月然後提出四大策略 |
| transcript.whisperx[469].start |
13053.977 |
| transcript.whisperx[469].end |
13069.436 |
| transcript.whisperx[469].text |
譬如說什麼要強化供應的預警啊什麼要價合理等等四大策略感覺上好像胸有成竹可是其實部長我不知道到底有沒有掌握到實際狀況其實我應該上個月也有在委員會有跟你提有跟你提過在我們 |
| transcript.whisperx[470].start |
13070.277 |
| transcript.whisperx[470].end |
13094.423 |
| transcript.whisperx[470].text |
地方很多病患他們要拿廚房簽的藥實際上都要跑遍很多藥局那時候舉的是眼藥的例子最近短效胰島素也非常的缺很多病患他是在醫院看病然後拿著廚房簽跑遍藥局都買不到短效胰島素最後還是要跑到大醫院 |
| transcript.whisperx[471].start |
13095.043 |
| transcript.whisperx[471].end |
13121.408 |
| transcript.whisperx[471].text |
我覺得這你就失去當時讓大家可以就近到社區藥局領藥的這種便利性現在很多藥已經沒有辦法達到這樣的效果那所以您的您很有信心我當然是我們也是希望您的信心是真的可以化為實際但是實際上狀況就不是這樣而且我不曉得部長你有沒有掌握現在有非常多的大的藥廠都發出缺藥通知你知道這個事嗎 |
| transcript.whisperx[472].start |
13122.268 |
| transcript.whisperx[472].end |
13139.128 |
| transcript.whisperx[472].text |
我這邊手上就有一堆資料譬如說我們紓壓痰點演藝公司就說因廠商停止供應預計115年停止供應然後一大堆很多人都是說因為原物料短缺造成的結果 |
| transcript.whisperx[473].start |
13139.608 |
| transcript.whisperx[473].end |
13154.345 |
| transcript.whisperx[473].text |
那這個部分到底部長您有沒有真的去了解問題提出一個比較明確的解決的問題因為這沒有什麼政治性議題這就是一般民生大家要用藥我覺得不要粉飾台針對問題解決問題部長您的這個解決方式到底是什麼 |
| transcript.whisperx[474].start |
13158.37 |
| transcript.whisperx[474].end |
13179.582 |
| transcript.whisperx[474].text |
好 謝謝委員我想謝謝委員關心我們特別是新北市的一個醫藥方面的一個提供新北市的醫藥方面的團體我們都很熟所以大概也都知道他們運作的狀況這是長久的問題在有些藥部長我相信這應該不會只是新北市的狀況 |
| transcript.whisperx[475].start |
13180.362 |
| transcript.whisperx[475].end |
13202.711 |
| transcript.whisperx[475].text |
因為它的藥來源都是藥商那藥商不可能說北部藥商有這樣的問題然後南部沒這樣的問題我不相信我覺得應該就是全國的問題是的 所以我兩個部分一個是說一直這幾年來一直發生我們一直在解決讓醫醫譬如說處方先拿的能夠順暢的拿這個部分怎麼去這也是有些應該問題應該是這樣藥變少這是事實 |
| transcript.whisperx[476].start |
13206.132 |
| transcript.whisperx[476].end |
13220.858 |
| transcript.whisperx[476].text |
就是藥商供應的量變小這是事實嘛不管他是原物料缺少還是說因為藥價關係他不願意投入太多在台灣這個是事實但現在出現還有一個分配的問題就是說最後他到醫院都拿得到但他藥局就是沒有 |
| transcript.whisperx[477].start |
13221.718 |
| transcript.whisperx[477].end |
13247.299 |
| transcript.whisperx[477].text |
所以我覺得分配問題你應該也可以去針對這個部分去思考一下你醫院有時候一大堆也不見得大家集資去領可是藥局就沒有那怎麼去調配那個量讓醫院也不要沒有但是讓它有充足的情況之下有比較多餘的可以進入到社區藥局便利我們民眾去領這個不是不能解決第二個是缺藥平台因為上次我也有跟你提過 |
| transcript.whisperx[478].start |
13248.12 |
| transcript.whisperx[478].end |
13274.69 |
| transcript.whisperx[478].text |
你們都會講說只要有缺藥就可以到缺藥平台去反映可是藥局的心聲就是反映的沒用反映的沒用所以到最後當他覺得這東西反映沒用之後就不會再去反映了就是這樣就覺得反正也沒有意義所以最後你們這邊的得到訊息就會誤解成說都沒有人來反映都沒人來反映所以一定沒缺藥可是實際上人家是因為反映的沒用所以沒去反映 |
| transcript.whisperx[479].start |
13275.45 |
| transcript.whisperx[479].end |
13301 |
| transcript.whisperx[479].text |
所以我真的覺得這個衛福部官員跟基層有很大的落差我真的強烈建議因為部長你也是醫師出身嘛您在其實我了解您在那個醫師團體聲望很高啦很多醫生對你很肯定你其實可以多多問看他們的意見不管是醫師團體或者是藥師團體一樣到底我講的是不是事實還是你了解的是事實 |
| transcript.whisperx[480].start |
13301.92 |
| transcript.whisperx[480].end |
13325.379 |
| transcript.whisperx[480].text |
因為我們兩個的了解有落差沒有 我委員所講的的確是有這種現象那我們一直在改善那要怎麼改善嘛因為這個問題拖很久了江組長來跟議員這邊進一步報告剛才提到的我非常非常肯定我也知道是現實那我要說明的事情台灣的 |
| transcript.whisperx[481].start |
13326.44 |
| transcript.whisperx[481].end |
13347.888 |
| transcript.whisperx[481].text |
整個的市場小所以我們在藥物 舉個例子就是胰島素這件事情那胰島素面臨的是全世界第一名智商占比的叫諾荷諾的一家它的短效的胰島素等等還有其他的那因為短效胰島素 人類胰島素特殊性上面它必須用在關鍵的一般民眾的胰島素 |
| transcript.whisperx[482].start |
13349.449 |
| transcript.whisperx[482].end |
13371.319 |
| transcript.whisperx[482].text |
糖平遲的狀況之下其實是可以替代的可是有些關鍵的地方就需求特別嚴重要進入交互病房裡面昏迷的糖尿病的病患跟酮酸中毒他就必須要用這種的所以我們在做的這樣的情形之下我們要讓最關鍵的人能夠用得到所以我們做的必須要做控制跟控藥 |
| transcript.whisperx[483].start |
13372.527 |
| transcript.whisperx[483].end |
13377.994 |
| transcript.whisperx[483].text |
那這個東西在社區一般民眾我今天你會講很長我知道啦其實我的問題很簡單就是我的問題非常簡單你讓需要的人能夠在社區拿到藥 |
| transcript.whisperx[484].start |
13386.434 |
| transcript.whisperx[484].end |
13405.854 |
| transcript.whisperx[484].text |
那就是這樣那該不該做 該嘛那該嘛 那問題出在哪裡你要把問題找到嘛而不是講一大堆這個藥是怎麼樣要控制說那問題是你就沒有讓人家拿到藥啊謝謝委員這邊委員報告的地方是我們在處方的行為上會決定他拿得到拿不到 |
| transcript.whisperx[485].start |
13406.573 |
| transcript.whisperx[485].end |
13427.111 |
| transcript.whisperx[485].text |
所以我們跟醫學會上面我反應的是說處方的行為希望他拿得到的部分他還是拿不到比如說眼藥水嘛應該他不是什麼你剛剛講的他要控制要讓特殊的人才能拿到應該不是這個情況但是現在很多病患他跑藥局要去拿眼藥水也拿不到啊 |
| transcript.whisperx[486].start |
13427.811 |
| transcript.whisperx[486].end |
13446.636 |
| transcript.whisperx[486].text |
就是你要普遍性的去解決這個缺藥的問題嘛了解我們這個部分一個是真的是缺嘛一個是所謂的平衡的部分能夠讓它的供應鏈能夠穩定這兩部分我們持續在努力如果說我們在這邊一直反映基層的心聲然後你一直講一堆理由我相信這問題沒有辦法解決你應該是說 |
| transcript.whisperx[487].start |
13449.257 |
| transcript.whisperx[487].end |
13477.654 |
| transcript.whisperx[487].text |
確實我們應該要讓民眾如果他這個藥是應該在藥局拿得到他就應該要拿得到不過不要因為缺藥的問題讓他拿不到你們是要去解決這件事情然後去跟藥局做一個加強聯繫譬如說你現在的聯繫方式是缺藥平台但缺藥平台現在已經失靈了那怎麼樣再重新讓這些藥局對缺藥平台產生信心用什麼方式讓他覺得說我今天跟政府反映事情是有用的 |
| transcript.whisperx[488].start |
13478.424 |
| transcript.whisperx[488].end |
13500.435 |
| transcript.whisperx[488].text |
你現在要建立起政府對於民眾或者是藥局的信心我們現在反映的是這個事情而不是針對署長剛剛提到特定一個藥到底它是為什麼我們要平衡什麼不是我講當然那個也是其中之一但是大的方向是你要解決我剛剛講的那兩件事這個我們深刻了解我們會記得因為這個同樣的問題一直在反映 |
| transcript.whisperx[489].start |
13501.485 |
| transcript.whisperx[489].end |
13509.898 |
| transcript.whisperx[489].text |
我上次好像有請部長這邊說是不是你說會檢討嘛然後說會給我們一個檢討的一個說明嘛我不知道你有做嗎 |
| transcript.whisperx[490].start |
13513.348 |
| transcript.whisperx[490].end |
13536.317 |
| transcript.whisperx[490].text |
不然的話同樣的問題就是每次一直在問然後每次我講的我都覺得部長你很認同但是認同都沒有行動總是要行動我們有認同也一直在想要解決所以這個必須要跟這有急迫性部長這不是等你想到政黨輪替了來不及了藥界有它的文化有大的藥局有連鎖藥局有小藥局 |
| transcript.whisperx[491].start |
13538.638 |
| transcript.whisperx[491].end |
13563.129 |
| transcript.whisperx[491].text |
這個強度有時候他們拿到的貨的確可能的確這個不管是醫的這個專業配合藥的一個分布我們的確要做下來來溝通看看那要多久國際間我們當然爭取藥進來讓他不要缺藥這也是很重要不要缺藥裡面再來就分配分配的讓他社區的民眾藥能夠順暢 |
| transcript.whisperx[492].start |
13565.49 |
| transcript.whisperx[492].end |
13586.463 |
| transcript.whisperx[492].text |
這是一定要做的事情但是這個就是可能又有點變成一種比較business的一個因素在裡面但是為了社區民眾的一個拿藥的方便我想我們會出來來介入來協調 |
| transcript.whisperx[493].start |
13592.226 |
| transcript.whisperx[493].end |
13607.553 |
| transcript.whisperx[493].text |
我們就這個部分我們積極辦理跟委員這邊做報告那到什麼時候再來問你嘛什麼時候會有一個初步的一個構想出來或者是一個做法因為今天的戰略都比較比較高大上很崇高啦但那個戰略 |
| transcript.whisperx[494].start |
13608.934 |
| transcript.whisperx[494].end |
13617.448 |
| transcript.whisperx[494].text |
跟實際落差很大跟委員報告一下其實我們想的我們組長整組其實都已經因為我剛剛的問題都已經講完了我現在只要一個期程就是什麼時候 |
| transcript.whisperx[495].start |
13624.339 |
| transcript.whisperx[495].end |
13652.838 |
| transcript.whisperx[495].text |
大概什麼時候再來問你你可以有一個比較具體的解決的方案跟委員報告他牽涉後續的後面那一段是講很實情的問題都很了解不要再拖時間了要以數個月到半年以上來計才有辦法數個月調控的有點需要有一些時間因為他牽涉到全球不是 做法啦什麼時候會有一個做法出來做法應該回去就可以拿出來了我們已經都已經有做法跟想法 |
| transcript.whisperx[496].start |
13653.098 |
| transcript.whisperx[496].end |
13669.235 |
| transcript.whisperx[496].text |
沒有問題 這個我們跟委員們做進一步我們的規劃的報告我想我們一個月內把做法跟委員報告那三個月會提出一個更積極的一個一個進行的程度這樣OK 好 謝謝謝謝好 謝謝葉委員 謝謝部長來 接著我們請陳盈委員質詢 |
| transcript.whisperx[497].start |
13688.665 |
| transcript.whisperx[497].end |
13697.805 |
| transcript.whisperx[497].text |
那個請部長委員好 |
| transcript.whisperx[498].start |
13698.61 |
| transcript.whisperx[498].end |
13721.049 |
| transcript.whisperx[498].text |
部長好我想先首先我們先花一點時間我要追蹤一下這個台東花蓮全線實施這個長者智慧手環的事情那我在去年底質詢而且在預算審查的時候也提到要求今年要公告實施那這個今年我持續追蹤現在已經八月份了 |
| transcript.whisperx[499].start |
13723.07 |
| transcript.whisperx[499].end |
13738.095 |
| transcript.whisperx[499].text |
衛福部到底什麼時候呢可以把這個計畫書提出來那部長每次都跟我說一個月所以我現在想請問說到底是哪個單位來主辦什麼時候可以提計畫 |
| transcript.whisperx[500].start |
13739.48 |
| transcript.whisperx[500].end |
13761.996 |
| transcript.whisperx[500].text |
好 是的 謝謝委員那這個是我們請衣服會在進行是不是衣服會王副總統報告一下是 委員好這個關於智慧這個手環的部分我們這個衣服會也經過委員這個多次的這個指導那目前這個計畫辦的這個在進行中那後續委員有指導我們說要把它擴到擴大到這個 |
| transcript.whisperx[501].start |
13763.337 |
| transcript.whisperx[501].end |
13791.736 |
| transcript.whisperx[501].text |
獨老花東兩線的這個至少要獨居老人的這個部分優先來辦理對對對那這個因為衣服會的業務還是督導我們這個部署的醫院來進行這個醫院那個醫療保健等等業務那所以我們在那個跟兩位次長我們林次跟呂次這個請示過報告也有呈上來請示他們那關於獨老業務呂次還是覺得說這個由社家署 |
| transcript.whisperx[502].start |
13792.156 |
| transcript.whisperx[502].end |
13819.194 |
| transcript.whisperx[502].text |
因為一般讀老都是由社家署來主政會好一點所以後續可能會依這個方向來照委員的指導來辦理好所以就是主責的部分是由社家署來主責這個業務好那你們什麼時候就是提計劃的部分是已經都提出來了嗎 |
| transcript.whisperx[503].start |
13821.209 |
| transcript.whisperx[503].end |
13844.754 |
| transcript.whisperx[503].text |
就是如果後續由社家署來處理的話那計劃可能由社家署來寫不方便我們幫他代寫這樣子社家署有沒有問題你們要靠麥克風一點很小聲社家署這邊說明一下就是獨居老人的部分本來服務的業務就在社家署沒有錯但是 |
| transcript.whisperx[504].start |
13845.219 |
| transcript.whisperx[504].end |
13873.866 |
| transcript.whisperx[504].text |
主要我們還是在安全的部分就是緊急救援裝置的部分本來目前就是在規劃就是已經在縣市的部分已經都有在提供那這個部分我想我們獨居老人的緊急救援裝置居家的部分我們都還是會繼續進行那智慧手環的部分可能還是要看衣服會這邊目前後續進行的一個執行的一個狀況那看是不是要再做一些後續的一些精進或者是其他的一些作為 |
| transcript.whisperx[505].start |
13874.448 |
| transcript.whisperx[505].end |
13896.136 |
| transcript.whisperx[505].text |
那這個部分我們就尊重衣服會的部分那獨居老人的部分我們還是會持續進行我們既有的一個原有的服務我想綜合起來回答我回答好了那個因為這個我們非常重視所以兩位次長像昨天就開會開到可能七八點那個針對我們很重視 |
| transcript.whisperx[506].start |
13897.176 |
| transcript.whisperx[506].end |
13912.812 |
| transcript.whisperx[506].text |
委員在偏鄉這樣的一個照顧老人怎麼樣把這個美意的可行性這個是部裡面要負責的並不是只有一個單位所以我想由部來承擔這樣的一個計畫 |
| transcript.whisperx[507].start |
13914.794 |
| transcript.whisperx[507].end |
13936.854 |
| transcript.whisperx[507].text |
當然我們會請相關的部會去做業務上的規劃那這個部分以昨天討論的立場是希望能夠用社會安全業務這個觀念來處理我們會把這一步一步的規劃把它列出來然後再跟委員報告 |
| transcript.whisperx[508].start |
13937.682 |
| transcript.whisperx[508].end |
13945.973 |
| transcript.whisperx[508].text |
所以今年有可以因為這牽涉到經費的來源所以我們計畫一出來我們也要去爭取經費 |
| transcript.whisperx[509].start |
13947.478 |
| transcript.whisperx[509].end |
13970.648 |
| transcript.whisperx[509].text |
是 那個部長 所以您這邊計畫提出來可不可以有一個期程因為每一次的一個月當然計畫就要有期程大概也要經費的一個預估所以現在沒有辦法提出一個期程嗎因為這個事情也講滿久然後部長也承諾幾次的一個月了對 |
| transcript.whisperx[510].start |
13978.584 |
| transcript.whisperx[510].end |
14001.24 |
| transcript.whisperx[510].text |
因為委員所提的是智慧手環它的功能是比較多啦那現在的比較衛福部在做的都是比較屬於那個安全的監測跟救援服務那這樣的一個擴展到底它需要的經費是多少以及它的可行性會做到什麼程度 |
| transcript.whisperx[511].start |
14002.667 |
| transcript.whisperx[511].end |
14026.906 |
| transcript.whisperx[511].text |
這個我想我們會很努力來規劃我先這樣確認好了因為我覺得這樣問其實在期程上是模糊的啦我現在確認就是說基本上在我去年預算審查的主決議基本上這件事情我們是要做的是 |
| transcript.whisperx[512].start |
14030.594 |
| transcript.whisperx[512].end |
14038.422 |
| transcript.whisperx[512].text |
我們提計畫沒問題提基層也沒問題提預算也沒問題但是就是要想辦法來從哪一個地方來爭取 |
| transcript.whisperx[513].start |
14039.994 |
| transcript.whisperx[513].end |
14064.656 |
| transcript.whisperx[513].text |
好了解現在就是說那個你們就是經費來源的部分徵取經費是沒有問題就是那個來源是要看是我們規劃沒有問題啊那當然當然但是就是說我在經費的徵取方面我們會看大家一起來努力一步一步把它往前走這樣子 |
| transcript.whisperx[514].start |
14065.296 |
| transcript.whisperx[514].end |
14093.727 |
| transcript.whisperx[514].text |
所以這個我們就是因為起碼我們應該要有一個時間點啦比如說像我們之前去蘭嶼上禮拜到蘭嶼你們很清楚把那個騎乘列出來雖然需要好幾年三到三四年甚至到七年的時間但我覺得你們那個表格就規劃得很清楚那你如果沒有給自己設立目標的話 |
| transcript.whisperx[515].start |
14094.947 |
| transcript.whisperx[515].end |
14106.102 |
| transcript.whisperx[515].text |
永遠回答本席都是一個月然後我每次來追蹤都會沒有就是看不到那個時間點我們什麼時候會達成這樣子 |
| transcript.whisperx[516].start |
14111.772 |
| transcript.whisperx[516].end |
14131.978 |
| transcript.whisperx[516].text |
部長是不是可以就是說你們在你們的評估規劃內有一個期程什麼時候應該到達到什麼樣的進度我覺得這樣子會比較好啦是好我想委員很關心我們花東的 |
| transcript.whisperx[517].start |
14133.823 |
| transcript.whisperx[517].end |
14156.681 |
| transcript.whisperx[517].text |
老人的一個照顧我想我們本來就是應該政府的立場就是要這樣做所以我們就請那個我們本部會來提出相關的規劃好不好那看那個騎乘規劃的部分其實應該下一週可以給我們辦公室因為這個是給大家一個比較 |
| transcript.whisperx[518].start |
14157.702 |
| transcript.whisperx[518].end |
14163.146 |
| transcript.whisperx[518].text |
我們提出一個規劃然後到先到委員辦公室那邊跟委員報告好不好那很快的談一下這個蘭嶼的問題蘭嶼醫院的問題部長上個禮拜我們未還委員會有到蘭嶼考察那我知道其實部長很重視這個議題那畢竟這個總統都有去看過 |
| transcript.whisperx[519].start |
14186.545 |
| transcript.whisperx[519].end |
14213.946 |
| transcript.whisperx[519].text |
那原先規劃是部長要一起去那我們也理解說行政院會那裡那時候臨時要開這個預算的這個會議所以每一位部長都需要出席所以就由這個呂次來代表部長到蘭嶼去那他在蘭嶼發言的時候有提到也代表部長表達衛福部的立場那他說蘭嶼醫院 |
| transcript.whisperx[520].start |
14215.707 |
| transcript.whisperx[520].end |
14229.654 |
| transcript.whisperx[520].text |
舊式要蓋那我想在立法院這邊我們再度確認一下有個記錄就是說那天他代替部長在那駐座舊式要蓋這件事情沒有錯吧我們已經提出計畫會朝著蓋已經提出計畫了 |
| transcript.whisperx[521].start |
14241.994 |
| transcript.whisperx[521].end |
14259.199 |
| transcript.whisperx[521].text |
因為那天講10月嘛我不知道回來一個禮拜你們就提了這個計畫就是現在在我們衣服會已經如火如蝠在寫了就我目前看到大概完成的度大概完成一半左右OK那10月份因為你們規劃預計就是10月份會提出公建計畫這樣沒錯沒錯沒錯那我會來追蹤緊追這件事情好的 |
| transcript.whisperx[522].start |
14264.901 |
| transcript.whisperx[522].end |
14273.705 |
| transcript.whisperx[522].text |
如果順利10月提出公建計畫之後到這個醫院興建而且完成啟用起碼就至少還要三四年的時間 |
| transcript.whisperx[523].start |
14275.544 |
| transcript.whisperx[523].end |
14299.043 |
| transcript.whisperx[523].text |
我目前看到的版本是7年半7年半好那可能有那天看到是這樣但我們還是希望可以盡量的去縮短但我們同時也理解因為蘭嶼這個建造這個醫院不管是醫院或者任何的建築物他都有這個這些材料 |
| transcript.whisperx[524].start |
14300.644 |
| transcript.whisperx[524].end |
14328.171 |
| transcript.whisperx[524].text |
到材料的取得跟運送到本島還有這個人工其實不管是經費的這個耗費跟人力的這個尋找其實都相當比在台灣本島要困難很多這個我們可以理解但七年半我想也希望大家在盡可能的狀態下盡量去縮短那個期程那 |
| transcript.whisperx[525].start |
14330.311 |
| transcript.whisperx[525].end |
14356.737 |
| transcript.whisperx[525].text |
我想再跟部長討論一下就是說當然醫院蓋完了如果沒有人力醫療人員的進駐那就會變成一個蚊子館所以既然花了其實是三倍比在本島蓋醫院三倍的經費才能完成這個還比規模比我講的三倍基準那個規模還小一點的醫院 |
| transcript.whisperx[526].start |
14359.198 |
| transcript.whisperx[526].end |
14377.352 |
| transcript.whisperx[526].text |
我們看一下這是蘭嶼每萬人口的醫師比還有每萬人口的護理師比的統計目前蘭嶼人口數是5000多人島上有三位醫師護理師有八位試算目前每萬人口的醫師比 |
| transcript.whisperx[527].start |
14379.594 |
| transcript.whisperx[527].end |
14399.273 |
| transcript.whisperx[527].text |
與醫師比那每萬人口大約有5.8億位醫師那每萬人口呢約有19.39位的護理師這樣的比例我們看來不僅遠低於全國平均甚至跟這個離島地區的比率相比都還差了一大截 |
| transcript.whisperx[528].start |
14400.074 |
| transcript.whisperx[528].end |
14422.476 |
| transcript.whisperx[528].text |
那如果我們用這個離島的這個離島地區的比率來試算蘭嶼呢他應該是要有這個6位的醫師還有17位的這個護理師那請教部長我們這個差距你怎麼去縮小然後怎麼可以提高這個蘭嶼醫護的人力我們目前是不是有這個具體的方法可以來解決 |
| transcript.whisperx[529].start |
14423.274 |
| transcript.whisperx[529].end |
14428.723 |
| transcript.whisperx[529].text |
好 謝謝 醫護會有具體的方向報告委員 我們現在在做的計畫裡面你要對準麥克風 太小聲 |
| transcript.whisperx[530].start |
14431.499 |
| transcript.whisperx[530].end |
14455.568 |
| transcript.whisperx[530].text |
我們現在在提這個公建計畫就是有把這個醫師的數目提高到6名護理師目前我看到是15名那後續當然是需要再增加但是也順便跟委員報告 目前的計畫加上這些醫護人員 加上還有醫事人員藥師 檢驗師 放射師等等還有行政人員大概要有40幾位那這個一年營運下來的虧損會達到8000萬以上 |
| transcript.whisperx[531].start |
14459.69 |
| transcript.whisperx[531].end |
14483.312 |
| transcript.whisperx[531].text |
那這個部分也會以後會造成一些困擾那即便有虧損我想對於蘭嶼這樣子的一個我那天說我們去那裡是懷著贖罪的心情畢竟有這麼十幾萬桶的核廢料放在那邊搞不好如果重啟這個核三之後又有更多的核廢料要放到蘭嶼 |
| transcript.whisperx[532].start |
14484.193 |
| transcript.whisperx[532].end |
14496.617 |
| transcript.whisperx[532].text |
我想這個部分不能按照一般正常的這個比例去看它所以即便每年都有8000萬的虧損我覺得政府也應該認了這筆費用 |
| transcript.whisperx[533].start |
14499.378 |
| transcript.whisperx[533].end |
14522.218 |
| transcript.whisperx[533].text |
部長我想目前蘭嶼有這樣規劃很好那我們要想盡辦法達到這樣的目標不管是這個加錢也好加福利也好我們就是要想盡辦法達成那目前蘭嶼還有缺一位牙醫師7月16初缺到現在還沒有找到可以支援的人力這個部分部長怎麼解決醫護會不會報嗎 |
| transcript.whisperx[534].start |
14531.43 |
| transcript.whisperx[534].end |
14545.184 |
| transcript.whisperx[534].text |
照護師在找我們是照護師嗎還是口腔師照護師是在看偏鄉的一個偏鄉的衛生所那這個部分我們會趕快來瞭解 |
| transcript.whisperx[535].start |
14546.598 |
| transcript.whisperx[535].end |
14561.098 |
| transcript.whisperx[535].text |
好我想是這樣子啦就是我目前應該這樣說你們可能就是說在目前尋找中但是到底要多久不知道萬一 |
| transcript.whisperx[536].start |
14562.819 |
| transcript.whisperx[536].end |
14578.845 |
| transcript.whisperx[536].text |
這個時間是比較長的我想在這個空窗期你們應該要有相當的作為去彌補這樣子的一個醫師缺額的狀況好看是中間譬如說補助藍綠人的鄉親到台灣本島來 |
| transcript.whisperx[537].start |
14582.242 |
| transcript.whisperx[537].end |
14593.467 |
| transcript.whisperx[537].text |
來處理他們的牙齒那或者是有什麼其他的我們來協調人力我們來協調如果沒有固定的話我們來支援那就是說 |
| transcript.whisperx[538].start |
14595.836 |
| transcript.whisperx[538].end |
14617.094 |
| transcript.whisperx[538].text |
最後就是說這個單以這個醫師人力來講未來蘭嶼的醫院他會有這個內科外科家庭醫學科牙科但目前蘭嶼衛生所只有一位婦產科醫師還有兩位急診的醫師那我想我知道說現在有很多的這個公費醫師呢正在培訓當中 |
| transcript.whisperx[539].start |
14617.975 |
| transcript.whisperx[539].end |
14632.847 |
| transcript.whisperx[539].text |
但是這些公費生未來可以到蘭嶼而且科別又相符合的醫師你們有沒有去精算過我想我提出這樣子的一個提醒是很重要我不知道你們有沒有精算過 有嗎 |
| transcript.whisperx[540].start |
14635.594 |
| transcript.whisperx[540].end |
14646.582 |
| transcript.whisperx[540].text |
因為這牽涉到全國的一個分配我想站在醫療平衡的立場上面如果偏鄉尤其蘭嶼他所需要的科北我們應該優先會規劃 |
| transcript.whisperx[541].start |
14648.68 |
| transcript.whisperx[541].end |
14673.294 |
| transcript.whisperx[541].text |
好謝謝那所以你們還是回頭就趕緊去看一下畢竟醫院的這個期程已經有還有目前有缺的狀態那公費生養成需要大概12年左右那到時候不要說醫院蓋好就沒有醫生這個也是我們那天去他們也會擔心因為現在還有醫學生所以到他12年後才會出來 |
| transcript.whisperx[542].start |
14674.355 |
| transcript.whisperx[542].end |
14682.442 |
| transcript.whisperx[542].text |
好 那我們現在就是說目前公費生培訓的情形 科別的狀況我們會注意到這個提供 謝謝謝謝陳委員的用心 謝謝部長來 最後一個我們的劉建國召委 |
| transcript.whisperx[543].start |
14704.498 |
| transcript.whisperx[543].end |
14731.995 |
| transcript.whisperx[543].text |
好 召委辛苦請坐有請部長部長美國總統川普召委好8月5號我沒有問你認不認識不要誤會8月5號的時候在接受媒體採訪的時候有公開表示會先對藥品課一個小關稅但一年到一年半之間稅率將提高到150%然後會再提高到250% |
| transcript.whisperx[544].start |
14733.856 |
| transcript.whisperx[544].end |
14758.557 |
| transcript.whisperx[544].text |
因此他希望藥品要在他們美國國內生產這個川普大帝隨便講一句話即便還沒有發生都還沒有發生就會造成全球大混亂因為他這句話果不其然全球的這個藥廠開始緊張所以因此召委今天再排一次我4月7日已經排過一次了你看召委多用心然後也緊張這個事情所以再排這一次的專報 |
| transcript.whisperx[545].start |
14759.858 |
| transcript.whisperx[545].end |
14780.215 |
| transcript.whisperx[545].text |
邀请大家一起在这些讨论所以我针对这个议题我特别在关心因为在11本月11月的时候又有一篇报道部长请看一下是大家上去说药厂为了维持利润可能会把这个成本转嫁到其他国家全球药价都会飙涨涨幅恐怕超过两成那有癌症病友就透露 |
| transcript.whisperx[546].start |
14780.976 |
| transcript.whisperx[546].end |
14802.786 |
| transcript.whisperx[546].text |
大家現在很焦慮因為光是一年的智慧藥物就百萬起跳如果藥價再漲半年可能就要多花50萬恐怕難以負荷然後癌藥的三大優略裡面部長再看一下已經智慧用藥的癌藥如果藥價再持續上漲那癌藥恐怕就難以負擔那第二 如果癌藥漲價 |
| transcript.whisperx[547].start |
14804.747 |
| transcript.whisperx[547].end |
14818.508 |
| transcript.whisperx[547].text |
目前已經在健保擠入中的癌藥會不會有重新溢價或退出的問題那第三對可能準備納入健保的癌藥會不會因為這波的關稅衝擊最終變成無法納入部長有掌握嗎 |
| transcript.whisperx[548].start |
14821.651 |
| transcript.whisperx[548].end |
14844.209 |
| transcript.whisperx[548].text |
謝謝召委的關心這的確是我們政府應該努力的我們現在追求癌症的死亡率標準死亡率在2030年要降低三分之一怎麼樣給病人最好的一個早期的篩檢然後適當的精準的一個基因檢測然後精準的治療其實是很需要藥物的 |
| transcript.whisperx[549].start |
14846.23 |
| transcript.whisperx[549].end |
14868.879 |
| transcript.whisperx[549].text |
我們政府 衛福部這邊一定全力不管是在健保或智慧的支付方面一定不要去增加癌友的一個負擔這是一個最大的原則一定不要去增加癌友的負擔面對到關稅的衝擊哪怕調到150到250就是不能讓癌友增加這些藥物的費用的負擔 對不對 |
| transcript.whisperx[550].start |
14869.819 |
| transcript.whisperx[550].end |
14896.847 |
| transcript.whisperx[550].text |
我想我們一定要以這樣來做最大的原則OK 好 謝謝 署長要不要補充 署長很嚴肅這個衝擊真的是蠻大的那未來到底會走到什麼程度我們會密切的注意不過我們盤點那麼因應如果這個全球的這些藥價都一起漲的時候那麼我們最大的衝擊會是在於還在專利期內的藥就是我們 |
| transcript.whisperx[551].start |
14898.227 |
| transcript.whisperx[551].end |
14920.636 |
| transcript.whisperx[551].text |
其他都還有溢價空間可是專利期內的藥通常它的那個寡占性比較強所以我們首先先盤點這個在專利期內的藥還有多少項以健保來講還有214項左右是屬於專利期的藥專利期內的藥大概一年的現在健保的支出大概在390億左右 |
| transcript.whisperx[552].start |
14921.556 |
| transcript.whisperx[552].end |
14949.268 |
| transcript.whisperx[552].text |
這裡面如果又是把它屬於基本就是必要藥品的那大概是在75項左右那麼大概是200億所以我們在短期內當然會需要多一點這個費用來挹注因應這個萬一調漲的時候我們比較沒有那個溢價空間就只好要多付出一些第二個是這一些專利 |
| transcript.whisperx[553].start |
14950.248 |
| transcript.whisperx[553].end |
14977.991 |
| transcript.whisperx[553].text |
的藥呢在未來五六年內大概有76個品項他會過專利期所以我們要鼓勵這個趕快這個過專利期的趕快有這個學名藥或生物相似藥來遞汰他的藥價就會比較低所以我們也有一個鼓勵的措施就是如果你在這個專利期一過的五年內來提出的這個這個學名藥或者是生物相似藥前兩張 |
| transcript.whisperx[554].start |
14978.772 |
| transcript.whisperx[554].end |
15000.26 |
| transcript.whisperx[554].text |
我們價格讓它跟原廠樣一樣來分散這個用藥的風險這個是第二個那當然第三個就是學民藥的鼓勵這裡面還是有很多會是學民藥所以我們也鼓勵學民藥我們去年先從生物相似藥開始那今年我們就鼓勵癌症的化學藥 |
| transcript.whisperx[555].start |
15001.3 |
| transcript.whisperx[555].end |
15026.734 |
| transcript.whisperx[555].text |
那麼學名藥我們也鼓勵也有這個獎勵的措施明年我們開始會把所有的癌症的用藥的學名藥也都納入我們獎勵所以我們這樣一步一步來因應好 我時間很足夠讓署長一一做這樣的說明對不對所以你已經占了我的質詢一半的時間請主席要補回來給我但是言而總之總而言之就是我聽部長那一句話 |
| transcript.whisperx[556].start |
15027.875 |
| transcript.whisperx[556].end |
15043.043 |
| transcript.whisperx[556].text |
不管美國的關稅如何調整對藥價的關稅如何調整總而言之 言而總之就不能讓我們的癌友因為關稅的調整造成他更大的負擔我就是聽這句話但是這還是要有相關的一些因應作用跟配套簡單講 不管150還是250 |
| transcript.whisperx[557].start |
15047.945 |
| transcript.whisperx[557].end |
15068.84 |
| transcript.whisperx[557].text |
衛福部應該盡速針對癌症 寒病重症這三類別提出藥品別治療這個治療線別還有病類別可能受到這個衝擊評估及領域調查我想這個應該要做吧好 這個一直有在做但是因為川普一直變化我們也會隨之他來調整OK |
| transcript.whisperx[558].start |
15070.377 |
| transcript.whisperx[558].end |
15083.687 |
| transcript.whisperx[558].text |
這個如果有必要的話隨時可以做相關的報告好 因為川普一直在變化所以你們也是做相關的一些調查也是要跟著變動 這個我很清楚但是我這邊可以再跟部長建議一下主動監控這些 |
| transcript.whisperx[559].start |
15085.735 |
| transcript.whisperx[559].end |
15102.943 |
| transcript.whisperx[559].text |
這些藥品就是跟特別講的癌症含病重症的他的這個智慧藥品的價格波動緊密的追蹤國內藥品價格是我受到國際因素的提高並隨時提出相關的因素措施避免市長這個訊息不對稱造成恐慌性的加價就可以吧 |
| transcript.whisperx[560].start |
15105.206 |
| transcript.whisperx[560].end |
15116.228 |
| transcript.whisperx[560].text |
當然 這應該要這樣做你要這樣做 你沒有這樣做嗎你沒有隨著川普的變動做這樣一個市場執行的監控嗎應該沒有吧那個食藥署要不要回答一下 |
| transcript.whisperx[561].start |
15119.144 |
| transcript.whisperx[561].end |
15135.39 |
| transcript.whisperx[561].text |
不好意思 又要用你的時間好 已經超過三分之四了主席會補給我現在藥品的監控的話我們在於我們的製劑要兩個到三個月如果在半年前製劑已經有短缺的在通報系統上面通報我們啟動整個藥學會的評估 |
| transcript.whisperx[562].start |
15137.091 |
| transcript.whisperx[562].end |
15160.85 |
| transcript.whisperx[562].text |
必要之時我們可以做專案的進口跟專案的輸入以及做藥品的調控那接下來其實是更進一步在藥事法二十七之三條所有不見得是在必要藥品在所有藥品的短缺的情況之下需要有一個進入調配的機制政府能夠進一步的介入那這個部分是我們目前是希望能夠智慧導入的不是 我是 所長我請教部長的是針對價格的部分 |
| transcript.whisperx[563].start |
15163.952 |
| transcript.whisperx[563].end |
15191.843 |
| transcript.whisperx[563].text |
你是在回應我是針對到時候我缺這些藥品的時候可以從怎樣來輸入嘛對不對我是針對這個價格的部分啦我想因為自費藥品的價格部分在食藥署其實我們這邊沒有特別的定價的這個的一個的一個權責在裡面我們這些其實是針對所以你意思是部長找你上來打呼我就不對了嘛對自費的部分他找錯人了自費其實是好 |
| transcript.whisperx[564].start |
15192.903 |
| transcript.whisperx[564].end |
15210.801 |
| transcript.whisperx[564].text |
我想智慧的藥品也是對這些集中重症和寒病的病人很大的負擔所以這個一定要我們站在政府的立場一定要監測而且不能讓他隨意負擔增加我想這個部分所以請大家不要也請藥廠不能 |
| transcript.whisperx[565].start |
15212.443 |
| transcript.whisperx[565].end |
15228.537 |
| transcript.whisperx[565].text |
不能隨便加價也不要有恐慌的加價的現象好 那就請部長跟委員會做一個說明你們的監測機制應該就是在因應這個美國關稅過程裡面馬上就啟動嘛然後適時的再去公布這些相關的訊息嘛好 我們馬上啟動OK 好 謝謝價格的一個波動 |
| transcript.whisperx[566].start |
15231.299 |
| transcript.whisperx[566].end |
15252.318 |
| transcript.whisperx[566].text |
謝謝 好 第二個題目剛剛前部長有答覆我嘛我們要追求到2031年把這個癌症支持率降到這個三分之一嘛 對不對降至三分之一嘛但是從長遠來看我覺得台灣必定要盡速扶持國家的生技產業啦這個部分絕對不是衛福部這是跨部會包含經濟部等等等包含國華會嘛 |
| transcript.whisperx[567].start |
15253.659 |
| transcript.whisperx[567].end |
15270.924 |
| transcript.whisperx[567].text |
我想現在要去鼓勵外國的大型的藥廠來台灣投資設廠我看也困難了啦因為美國是希望到他們的國家去設嘛才會免除這個關稅的問題嘛但是相對的我們不用去鼓勵國外的來設廠那國內的可能你要大勢的來做 |
| transcript.whisperx[568].start |
15272.484 |
| transcript.whisperx[568].end |
15287.843 |
| transcript.whisperx[568].text |
相關的一些獎勵或是鼓勵的措施讓我們降低對國外的這些藥廠的依賴我為什麼這麼講其實衛福部應該不只是可以扶持民間的藥廠我們還有相關的一些能力可以做整合 |
| transcript.whisperx[569].start |
15289.123 |
| transcript.whisperx[569].end |
15311.618 |
| transcript.whisperx[569].text |
對不對 投入開發 都可以做我要以韓國為例 韓國在2000年成立國家癌症中心不僅整合國內的癌症各項業務也包含臨床的治療研究等項目最重要最重要的是他本身也有研發癌症藥物的能力他們已經自主研發多項抗癌新藥涵蓋免疫療法標靶藥以及能量代謝抑制劑 |
| transcript.whisperx[570].start |
15313.287 |
| transcript.whisperx[570].end |
15329.596 |
| transcript.whisperx[570].text |
然後從南海的媒體數據資料也看出南海癌症的整體死亡率2002年到2013年年年均下降到2.8%然後2013到2021是最近的已經下降到3.2%同時同時我再一個資料 |
| transcript.whisperx[571].start |
15331.963 |
| transcript.whisperx[571].end |
15358.131 |
| transcript.whisperx[571].text |
那個資料沒有把我顯示出來嗎你生病了嗎同時對比台灣年齡標準化的這個癌症的死亡率2024年台灣每10萬人就有大約113人死於癌症好 南韓大約是61人他不到我們一半喔差不多一半啦 差不多一半如果按照南韓的人口數對比起來少之又少 |
| transcript.whisperx[572].start |
15359.366 |
| transcript.whisperx[572].end |
15380.075 |
| transcript.whisperx[572].text |
少之又少那天下雜誌在2022年又有一個專題報告就是韓國做了什麼20年前做了一個決定如今罹癌率死亡率都比台灣低開頭就講韓國的癌症發生率死亡率都低於台日五年存活率更高達78背後關鍵就是在2000年成立國家癌症中心 |
| transcript.whisperx[573].start |
15381.562 |
| transcript.whisperx[573].end |
15406.579 |
| transcript.whisperx[573].text |
這是天下大事的一個報導給部長做參考也就是說有資源有預算還有整個政策的這個支持人家的成果就是如此他們的國營也不用在那邊擔心藥價會不會漲太過擔憂那如果對照台灣我們現在只有行政院的中央癌症防治匯報還有國衛院的癌症研究所 |
| transcript.whisperx[574].start |
15407.659 |
| transcript.whisperx[574].end |
15429.116 |
| transcript.whisperx[574].text |
對不對是好部長你知道你有參與這個行政院的中央癌症紅字會報嗎有啊有嗎那一年開幾次會應該至少每半年開一次會有嗎有有有我們都有去參加應該是沒有吧我的資料裡面是113年到10011年到113年這這三年就只有在12月開一次會 |
| transcript.whisperx[575].start |
15437.292 |
| transcript.whisperx[575].end |
15459.68 |
| transcript.whisperx[575].text |
這最近一兩年有開了兩次組織當然應該是國健署跟健保署嘛再加上國衛院轄下的癌症研究所因為在場應該有國健跟健保署嘛可以問一下這三年是不是都12月才開一次會我要跟部長提醒的啦不是開會幾次的重要性與否啦是這個功能性嘛對照韓國 |
| transcript.whisperx[576].start |
15461.089 |
| transcript.whisperx[576].end |
15475.568 |
| transcript.whisperx[576].text |
人家一個國家級的一個癌症這個中心可以創造出這麼大的一個成績的效果出來降低他們癌症的死亡率降低他們致癌的這樣的比例然後包含開發了這麼多的一個新藥 |
| transcript.whisperx[577].start |
15477.162 |
| transcript.whisperx[577].end |
15495.738 |
| transcript.whisperx[577].text |
它幾乎是一個國家級的一個癌症中心它給予所有的功能於一切啦所以才有辦法去打造那個降低死亡率的目標我們要配合賴總統的健康台灣我們到2023年要降低癌症死亡率三分之一我們不能沒有積極的作為啊 |
| transcript.whisperx[578].start |
15496.653 |
| transcript.whisperx[578].end |
15518.872 |
| transcript.whisperx[578].text |
一定要更多一些機器的作為嘛那我是拿韓國的例子可以做參考部長當然還是可以其他參照其他國家嘛那如果韓國的案子可以參考是不是趕快來做一些相關研究然後一個月內給委員會做一個報告那我們知道說我們要如何在2031年可以降低癌症的死亡率達到三分之一 |
| transcript.whisperx[579].start |
15519.352 |
| transcript.whisperx[579].end |
15536.399 |
| transcript.whisperx[579].text |
好的 可以吧我們大概三支箭嘛第一個是癌症早期篩檢請大家民眾篩檢這個我知道 而且現在的篩檢也擴大了也增加了40億第二個就是癌症的基因檢測以做精準的一個治療然後我看我們 |
| transcript.whisperx[580].start |
15537.659 |
| transcript.whisperx[580].end |
15564.101 |
| transcript.whisperx[580].text |
健保室每天都在公布又有什麼癌藥進來所以其實今年進了很多很多的癌藥對於醫師來講在治療上面真的多了很多的力氣這個大概都會都一定可以降低我們的一個五年的提升五年的存活力那這個部分是不是說現在台灣是這樣各個醫院都已經這麼大間去那裡因為白龍有中壢酯 |
| transcript.whisperx[581].start |
15565.442 |
| transcript.whisperx[581].end |
15588.038 |
| transcript.whisperx[581].text |
台大他現在有資質運作 電機也是資質運作所以在台灣也許要用我們這樣的一個情況我們怎麼樣集合大家的力量是用什麼方式 這的確是可以正如委員所講的來思考但是協調整合這個是一定 |
| transcript.whisperx[582].start |
15588.999 |
| transcript.whisperx[582].end |
15616.195 |
| transcript.whisperx[582].text |
都有 其實也一直這幾十年來也一直有在做我知道你們都有在做但是我只是用韓國例子來講 它是2000年就要比我們在講長照日本的健康保險也是2000年開始台灣在2000年跟2025年之間我們對防癌降低癌症的使用率都有在做這個署長也都是很記在做但是我只是講說用一個韓國例子來跟你做參考其他有其他國家的例子也都可以讓部長參考 |
| transcript.whisperx[583].start |
15617.236 |
| transcript.whisperx[583].end |
15634.401 |
| transcript.whisperx[583].text |
我們要如何在這三事件已經發動的時候短短短的時間2030年現在經濟恐慌出沒四檔位不是出五檔位出沒四檔位我們要去降到三分之一我們會有很大很大的挑戰還有川普大帝為什麼這樣為什麼這樣 |
| transcript.whisperx[584].start |
15637.402 |
| transcript.whisperx[584].end |
15662.433 |
| transcript.whisperx[584].text |
那個藥給我們要去因應嘛那剛剛聽部長講的那些話我當然替這些癌友感到窩心嘛感到溫暖嘛最起碼不能再造成他們增加這些癌症新藥的癌症藥物的一些負擔嘛不管關稅如何去做調整嘛其實部長講這些話坦白講就足夠了啦但是我們還是期待說可以達到2030年這樣的一個目標所以我才會擔憂才會用韓國的歷史來給部長做參考我們來瞭解韓國他的做法 |
| transcript.whisperx[585].start |
15665.754 |
| transcript.whisperx[585].end |
15691.992 |
| transcript.whisperx[585].text |
想說跟我們現在台灣怎麼做也許是有我們來做一個比較來再跟委員報告分析好 最後啦最後這個是召委多給我的時間我再講一下因為跟屏東有關係所以要講一下昨天樣子台灣再度少過這個我們受災嚴重中南部嘛在風災之後登革熱就是疫發的時間點我想這個大家知道那中國現在又爆發這個屈公病那屈公病又跟這一個登革熱一樣 |
| transcript.whisperx[586].start |
15692.512 |
| transcript.whisperx[586].end |
15721.226 |
| transcript.whisperx[586].text |
都是透過埃及斑蚊還有白腺斑蚊的傳染的疾病這民眾會恐慌那部長應該還記得2023年那時候是薛部長他為了這事情還到雲林應該有兩趟因為那個時候是從2015年來爆發最嚴重的一次將近本土確診病例登革熱的這樣的一個對象高達兩萬人左右當時嚴重到必須要封閉農民的果園消毒 |
| transcript.whisperx[587].start |
15721.986 |
| transcript.whisperx[587].end |
15739.523 |
| transcript.whisperx[587].text |
也造成農民在整個嚴重的經濟損失所以那一年我才跟這個當地的林鄉長還有在地的一些民代跑到行政院來跟行政院做一些緩令最後行政院核定了一千八百多萬的登革熱傳染病農損補助 |
| transcript.whisperx[588].start |
15741.329 |
| transcript.whisperx[588].end |
15765.845 |
| transcript.whisperx[588].text |
這也算是破紀錄啦因為整個都封起來了農民沒有辦法沒有辦法去收納嘛沒有辦法去採收嘛對不對沒有辦法去補肥嘛沒有辦法去噴農藥嘛因為將農藥回到野外就比農藥還便宜啊所以那組成農民的經濟損失嘛不才會去啟動來做這個步驟嘛我覺得是說因為虹苔 丹納斯 零米零七二八現在還洋流 |
| transcript.whisperx[589].start |
15766.845 |
| transcript.whisperx[589].end |
15792.46 |
| transcript.whisperx[589].text |
這個事後可能在很快的很短的時間內會不會造成這個登革熱還有這個區公併的區公併當然也是境外的一個防堵嘛那登革熱是有可能本土的又再起所以可能要未雨綢繆如果不積極的趕快去做相關的一些因應那到時候政府又要投入很大的人力物力甚至預算所以請部長一個星期內啦可能一個星期還太久我覺得因為洋流已經過了嘛 |
| transcript.whisperx[590].start |
15793.511 |
| transcript.whisperx[590].end |
15817.668 |
| transcript.whisperx[590].text |
所以我們從風災來之前都一直在做宣導同時也督導地方的衛生局在環境的清潔上面特別要注意到登革熱的相關的疫苗的一個預防那也氣功病其實也是沒有人傳播他也不會人傳人所以是一樣的啦也是要清 |
| transcript.whisperx[591].start |
15818.488 |
| transcript.whisperx[591].end |
15829.514 |
| transcript.whisperx[591].text |
到尋到清刷一樣去把它落實希望就不要避免到對人民更進一步的傷害好 謝謝 謝謝部長 謝謝署長主席請站起來 謝謝好 謝謝 |
| transcript.whisperx[592].start |
15839.356 |
| transcript.whisperx[592].end |
15866.985 |
| transcript.whisperx[592].text |
謝謝 謝謝部長本日會議詢答全部結束委員楊耀圖前及所提書面資料列入記錄刊登公報現在做以下決定第一 報告及詢答完畢第二 委員諮詢未及答覆或請補充資料者相關機關以兩週內書面答覆委員另要求者期限者從即鎖定本日會議到此結束 現在上會 |
| transcript.whisperx[593].start |
15868.062 |
| transcript.whisperx[593].end |
15868.224 |
| transcript.whisperx[593].text |
謝謝大家 |