| IVOD_ID |
17240 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Full/1M/17240 |
| 日期 |
2026-01-29 |
| 會議資料.會議代碼 |
委員會-11-4-26-22 |
| 會議資料.會議代碼:str |
第11屆第4會期社會福利及衛生環境委員會第22次全體委員會議 |
| 會議資料.屆 |
11 |
| 會議資料.會期 |
4 |
| 會議資料.會次 |
22 |
| 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4會期社會福利及衛生環境委員會第22次全體委員會議 |
| 影片種類 |
Full |
| 開始時間 |
2026-01-29T08:37:57+08:00 |
| 結束時間 |
2026-01-29T13:23:00+08:00 |
| 影片長度 |
04:45:03 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://h264media01.ly.gov.tw:443/vod_1/_definst_/mp4:1M/bfaf9b39ac01a685d600d02e1221ac87a3b6de55729bb299e692bdb9a1e47977a6aa1f5072119fcb5ea18f28b6918d91.mp4/playlist.m3u8 |
| 會議時間 |
2026-01-29T09:00:00+08:00 |
| 會議名稱 |
立法院第11屆第4會期社會福利及衛生環境委員會第22次全體委員會議（事由：邀請衛生福利部就「春節急診醫療人力調度與跨院協調機制之現況與精進作為」暨「假日及連續假期急重症分級醫療政策之執行成效與改進方向」進行專題報告，並備質詢。
討論事項
審查
一、 委員何欣純等17人擬具「國民年金法第五十四條之一及第五十五條條文修正草案」案。
二、 委員邱鎮軍等17人擬具「國民年金法第十五條及第五十四條之一條文修正草案」案。
三、 委員王美惠等18人擬具「國民年金法第五十四條之一條文修正草案」案。
四、 委員劉建國等16人擬具「國民年金法第五十四條之一條文修正草案」案。
五、 委員馬文君等20人擬具「國民年金法第五十四條之一條文修正草案」案。
六、 委員徐巧芯等18人擬具「國民年金法第五十四條之一條文修正草案」案。
七、 台灣民眾黨黨團擬具「國民年金法第五十四條之一條文修正草案」案。
八、 委員邱鎮軍等21人擬具「國民年金法第十五條及第五十條條文修正草案」案。
九、 委員陳俊宇等29人擬具「國民年金法第五十四條之一條文修正草案」案。
十、 台灣民眾黨黨團擬具「國民年金法第十五條及第五十條條文修正草案」案。
十一、 委員黃秀芳等21人擬具「國民年金法第五十四條之一條文修正草案」案。
十二、 委員羅廷瑋等16人擬具「國民年金法第五十四條之一條文修正草案」案。
十三、 民進黨黨團擬具「國民年金法部分條文修正草案」案。
十四、 委員蔡易餘等17人擬具「國民年金法部分條文修正草案」案。
十五、 委員吳思瑤等18人擬具「國民年金法部分條文修正草案」案。
十六、 委員郭國文等17人擬具「國民年金法第五十四條之一條文修正草案」案。
十七、 委員王美惠等22人擬具「國民年金法部分條文修正草案」案。
十八、 委員徐富癸等18人擬具「國民年金法第五十四條之一條文修正草案」案。
十九、 委員陳亭妃等16人擬具「國民年金法部分條文修正草案」案。
【專題報告與討論事項綜合詢答，討論事項僅詢答】） |
| 委員名稱 |
完整會議 |
| 委員發言時間 |
08:37:57 - 13:23:00 |
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報告委員會出席委員人數11人已足法定人數請主席宣布開會好現在開會請議事人員宣讀上次會議議事錄 |
| transcript.whisperx[1].start |
1412.543 |
| transcript.whisperx[1].end |
1437.585 |
| transcript.whisperx[1].text |
立法院第11屆第4會期社會福利及衛生環境委員會第21次全體委員會議議事錄時間115年1月21日星期三9時1分至17時38分1月22日星期四9時1分至18時58分地點請顯露801會議室出席委員陳委員昭之等15人列席委員羅委員美玲等6人列席官員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 |
| transcript.whisperx[2].start |
1438.466 |
| transcript.whisperx[2].end |
1452.671 |
| transcript.whisperx[2].text |
報告事項宣讀上次會議議事錄決定確定討論事項審查及繼續審查身心障礙者權益保障法部分條文修正草案等37案修正動議22案決議一身心障礙者權益保障法 |
| transcript.whisperx[3].start |
1453.371 |
| transcript.whisperx[3].end |
1478.24 |
| transcript.whisperx[3].text |
部分條文修正草案等37案審查完均內容如審查結果並按你據審查報告提報院會討論院會討論時由劉兆吉委員建國補充說明須交黨團協商二本法案條次條文中援引條次及法制用語調整授權議事人員整理相關立法說明授權行政單位提供審查結果照行政院提案通過第15條第38條第40條第42條第43條第46條第51條 |
| transcript.whisperx[4].start |
1482.822 |
| transcript.whisperx[4].end |
1485.424 |
| transcript.whisperx[4].text |
第52條之二第54條第57條第58條第58條之一第61條第63條第63條之二至第63條之六第74條第76條至第80條第86條第88條第89條第89條之一第89條之二第90條第94條及第98條條文 |
| transcript.whisperx[5].start |
1503.32 |
| transcript.whisperx[5].end |
1521.765 |
| transcript.whisperx[5].text |
第二條照行政院提案修正通過第三條及第四條照委員林月晴等十八人提案修正通過第十條照行政院提案修正通過第十條之一照委員林月晴等三人所提修正動議修正通過第十條之二照委員林月晴黃秀芳陳盈范雲賴慧媛等五人所提修正動議修正通過 |
| transcript.whisperx[6].start |
1522.685 |
| transcript.whisperx[6].end |
1547.017 |
| transcript.whisperx[6].text |
第11條縱採各委員提案及所提修正動議修正通過第18條照台灣民眾黨黨團及委員林月琴等18人提案修正通過第20條照委員林月琴等3人所提修正動議修正通過第21條照行政院提案修正通過第22條照委員林月琴等3人所提修正動議修正通過第26條照行政院提案修正通過第27條照委員范雲等19人提案修正通過 |
| transcript.whisperx[7].start |
1547.637 |
| transcript.whisperx[7].end |
1573.519 |
| transcript.whisperx[7].text |
第28條照台灣民眾黨黨團委員郭玉琴等18人及委員范雲等19人提案修正通過第30條之一照台灣民眾黨黨團提案通過第30條之二照台灣民眾黨黨團及委員郭玉琴等18人提案修正通過第31條照委員郭玉琴等18人提案通過第32條照委員劉建國等3人所提修正動議通過第39條之一照委員郭玉琴等18人提案修正通過 |
| transcript.whisperx[8].start |
1574.139 |
| transcript.whisperx[8].end |
1582.98 |
| transcript.whisperx[8].text |
第44條 照委員林月琴等18人提案修正通過第50條 照委員林月琴等18人提案及委員劉建國等3人所提修正動議修正通過 |
| transcript.whisperx[9].start |
1585.557 |
| transcript.whisperx[9].end |
1612.366 |
| transcript.whisperx[9].text |
第50條之一 照委員林月琴等三人所提修正動議及委員劉建國等三人所提修正動議通過第52條 照委員劉建國等三人所提修正動議修正通過第52條之一 照行政院提案修正通過第59條 照委員林月琴等18人提案修正通過第63條之一 照行政院提案及委員林月琴等18人提案修正通過第63條之七 照行政院提案及委員王玉敏等17人提案修正通過第84條 照委員劉建國 |
| transcript.whisperx[10].start |
1614.787 |
| transcript.whisperx[10].end |
1615.027 |
| transcript.whisperx[10].text |
不予增訂 |
| transcript.whisperx[11].start |
1638.827 |
| transcript.whisperx[11].end |
1660.785 |
| transcript.whisperx[11].text |
委員王衛明等17人及委員萬美玲等17人提案第38條之二條文委員王宏威等20人委員柯志恩等18人委員洪孟凱等18人及委員林倩琦等19人提案第40條之一條文委員林月琴等18人提案第60條之二及第71條之二條文委員羅廷輝等16人及委員廖偉翔等19人提案第7章之一章名第83條之一至第83條之九條文 |
| transcript.whisperx[12].start |
1663.727 |
| transcript.whisperx[12].end |
1674.31 |
| transcript.whisperx[12].text |
委員羅廷輝等16年提案第7章之2章名第84條之1至第84條之13第85條之1第7章之3章名第85條之2第7章之5章名第85條之9至第85條之17第7章之6章名第85條之18至第85條之23第7章之7章名第85條之24至第85條之37第7章之8章名及第85條之38 |
| transcript.whisperx[13].start |
1691.374 |
| transcript.whisperx[13].end |
1719.271 |
| transcript.whisperx[13].text |
至第八十五條之四十四條文台灣民眾黨黨團委員郭玉琴等十八人及委員范雲等十九人提案第八十四條之一條文委員羅廷瑞等十六人提案第七章之四章名及委員廖偉祥等十九人提案第七章之二章名委員羅廷瑞等十六人提案第八十五條之三及委員廖偉祥等十九人提案第八十五條之十條文委員羅廷瑞等十六人提案第八十五條之四及委員廖偉祥等十九人提案第八十五條之十一條文 |
| transcript.whisperx[14].start |
1720.071 |
| transcript.whisperx[14].end |
1727.977 |
| transcript.whisperx[14].text |
委員羅廷惠等16人提案第85條之5及委員廖偉祥等19人提案第85條之12條文委員羅廷惠等16人提案第85條之6及委員廖偉祥等19人提案第85條之13條文委員羅廷惠等16人提案第85條之7及委員廖偉祥等19人提案第85條之14條文委員羅廷惠等16人提案第85條之8及委員廖偉祥等19人提案第85條之15條文保留條文 |
| transcript.whisperx[15].start |
1747.692 |
| transcript.whisperx[15].end |
1771.055 |
| transcript.whisperx[15].text |
行政院提案第七條第十六條第七十一條第一百條之一第一百條第一百零七條及其對應條文台灣民眾黨黨團委員郭玉琴等十八人委員范雲等十九人及委員吳立華等十八人提案第五條條文委員范雲等十七人委員羅廷輝等十六人委員廖偉祥等十九人委員王玉明等十七人及委員萬美玲等十七人提案第四章之一章名 |
| transcript.whisperx[16].start |
1772.616 |
| transcript.whisperx[16].end |
1786.929 |
| transcript.whisperx[16].text |
委員范雲等17人委員羅廷輝等16人委員廖偉祥等19人委員王玉敏等17人及委員萬美玲等17人提案第47條之1條文委員范雲等17人委員羅廷輝等16人及委員廖偉祥等19人提案第47條之2條文 |
| transcript.whisperx[17].start |
1788.971 |
| transcript.whisperx[17].end |
1804.718 |
| transcript.whisperx[17].text |
委員范瑩等17人委員羅廷威等16人及委員廖偉祥等19人提案第47條之3委員王玉明等17人及委員萬美玲等17人提案第47條之2條文委員羅廷威等16人及委員廖偉祥等19人提案第47條之4委員王玉明等17人與委員萬美玲等17人提案第47條之3條文委員羅廷威等16人及委員廖偉祥等19人提案第47條之5條文 |
| transcript.whisperx[18].start |
1816.664 |
| transcript.whisperx[18].end |
1824.546 |
| transcript.whisperx[18].text |
委員羅廷威等16人及委員廖偉祥等19人提案第47條之6委員王一鳴等17人及委員萬美玲等17人提案第47條之4條文委員范雲等17人提案第47條之4委員羅廷威等16人及委員廖偉祥等19人提案第47條之7台灣民眾黨黨團提案第50條之2委員王一鳴等17人與委員萬美玲等17人提案第47條之5條文 |
| transcript.whisperx[19].start |
1843.052 |
| transcript.whisperx[19].end |
1859.784 |
| transcript.whisperx[19].text |
委員范雲等17人委員羅廷威等16人委員廖偉翔等19人委員王玉明等17人及委員萬美玲等17人提案第4章之2章明委員范雲等17人提案第47條之5委員羅廷威等16人與委員廖偉翔等19人提案第47條之8台灣民眾黨黨團提案第50條之3委員郭玉琴等18人及委員范雲等19人提案第50條之2 |
| transcript.whisperx[20].start |
1868.47 |
| transcript.whisperx[20].end |
1892.884 |
| transcript.whisperx[20].text |
委員王玉明等17人及委員萬美玲等17人提案第47條之6條文委員范雲等17人提案第47條之6委員羅廷慧等16人與委員廖偉翔等19人提案第47條之9委員王玉明等17人與委員萬美玲等17人提案第47條之7條文委員陳冠廷等20人委員劉建國等17人委員蔡奕宇等16人委員郭玉琴等18人 |
| transcript.whisperx[21].start |
1893.844 |
| transcript.whisperx[21].end |
1905.233 |
| transcript.whisperx[21].text |
委員何欣淳等17人委員廖偉祥等19人委員林月琴等18人委員范雲等19人委員吳立華等18人委員盧聖怡等16人及委員張雅玲等23人提案第53條條文委員劉建國等17人提案第100條條文 |
| transcript.whisperx[22].start |
1910.117 |
| transcript.whisperx[22].end |
1932.079 |
| transcript.whisperx[22].text |
保留之修正動議委員盧憲義等三人所提之第七條第五十三條及第七十一條條文委員林月琴王振旭劉建國武立華等四人所提之第五條及第七條條文委員林月琴等三人所提之第十六條條文委員劉建國等三人所提之部分條文委員王振旭劉建國黃秀芳張雅玲等四人所提之第十六條條文 |
| transcript.whisperx[23].start |
1933.16 |
| transcript.whisperx[23].end |
1946.682 |
| transcript.whisperx[23].text |
委員林月琴黃秀芳陳盈范雲賴會員等5人所提之第16條條文委員盧聖義等3人所提之第16條及第16條之一條文委員林月琴等3人所提之第71條第4項條文通過附帶決議38項宣讀完畢請問委員會上次議事錄有無錯誤或遺漏之處 |
| transcript.whisperx[24].start |
1962.06 |
| transcript.whisperx[24].end |
1986.34 |
| transcript.whisperx[24].text |
好那議事錄確定本日的會議成為第一邀請衛福衛生福利部就春節急診的醫療人力調度與跨院協調機制之現況與精進作為即假日及連續假日急重症分級醫療政策之執行成效與改進方向進行專題報告並被質詢那第二 |
| transcript.whisperx[25].start |
1989.822 |
| transcript.whisperx[25].end |
2017.252 |
| transcript.whisperx[25].text |
審查委員黨團分別擬據國民年金法部分條文的修正草案等19案以上專案報告及討論事項採綜合詢答討論事項僅詢答那現在介紹在場委員及列席官員由我們陳昭資委員林月琴委員王振旭委員 |
| transcript.whisperx[26].start |
2019.383 |
| transcript.whisperx[26].end |
2046.046 |
| transcript.whisperx[26].text |
還有鍾嘉斌委員那在場官員有衛生福利部部長石崇良 石部長還有醫事司司長劉月平司長社會保險司參事代理社會保險司司長張玉璇 張司長還有中央健康保險署署長陳亮瑜 |
| transcript.whisperx[27].start |
2049.491 |
| transcript.whisperx[27].end |
2078.441 |
| transcript.whisperx[27].text |
行政院主計總處基金預算處專門委員吳婉玉公務預算處專門委員陳淑萍財政部國庫署專門委員羅瑞宏賦稅署專門委員蔡孟淑還有這個稽查洪正義 |
| transcript.whisperx[28].start |
2082.283 |
| transcript.whisperx[28].end |
2097.196 |
| transcript.whisperx[28].text |
勞動部勞工保險局副局長李靖韻勞工保險局國民年金組組長烏偉陽農業部農民輔導司檢任繼政王東良法務部參事汪南鈞 |
| transcript.whisperx[29].start |
2110.103 |
| transcript.whisperx[29].end |
2127.814 |
| transcript.whisperx[29].text |
援助民族委員會社會福利處副處長洪玲接著請提案委員說明提案要旨每位委員兩分鐘那請陳昭資委員代表台灣民眾黨黨團說明 |
| transcript.whisperx[30].start |
2133.47 |
| transcript.whisperx[30].end |
2142.976 |
| transcript.whisperx[30].text |
主席各位同仁本案這個台灣民眾黨黨團針對國民年金法的第15條跟第50條有關配偶連帶繳納保險費及裁罰規定提出制度上是必要的檢討跟修正憲法法令在釋字第696號已經很明確的指出如果僅僅因為有沒有婚姻關係就讓人民承受較重的這個經濟負擔甚至加諸額外的這個不利益這樣的差別在於等同是對婚姻的懲罰是違反憲法保障婚姻家庭制度的本 |
| transcript.whisperx[31].start |
2161.028 |
| transcript.whisperx[31].end |
2165.632 |
| transcript.whisperx[31].text |
這個本意故婚姻關係之有無所形成之差別待遇是否違反憲法第7條的原則應該受到比較嚴格的一個審查但是我們看到國民年金法裡面在第15條的規定只有婚姻關係夫妻之間就互付連帶繳納這個責任進一步在第50條還有裁罰的規定反過來說如果沒有婚姻關係就不會承擔同樣的這個法律後果 |
| transcript.whisperx[32].start |
2183.248 |
| transcript.whisperx[32].end |
2187.912 |
| transcript.whisperx[32].text |
那這樣的差別並不是基於他的所得或實際能力而是單純因為設計上已經引發懲罰婚姻的這個爭議換句話說這個制度在無意之間讓進入婚姻關係的人反而負擔更高的法律風險跟經濟壓力那臺灣民眾黨認為這是值得公部門重新再檢討的問題所以也在附屬預算跟年度預算上有多次提出檢討必要那整個從社會發展來看現在家庭的型態跟角色的分工也都不一樣了近十年的女性的勞參率大概也維持在五成以上 |
| transcript.whisperx[33].start |
2213.152 |
| transcript.whisperx[33].end |
2219.574 |
| transcript.whisperx[33].text |
社會對於經濟責任跟保險義務也在越來越強調個人的責任跟個人的保障在這樣背景上繼續以配偶的身份作為連帶責任的裁罰依據已經逐漸跟當前強調的性平跟個人自主的政策產生落差因此本黨團在這屆立法院的第二會議就率先提出國民年金法修法草案希望能夠讓保險責任回歸到個人的本身避免國家制度在沒有正當理由的情況下對婚姻關係 |
| transcript.whisperx[34].start |
2241.021 |
| transcript.whisperx[34].end |
2247.388 |
| transcript.whisperx[34].text |
加諸額外的不利益也讓整體制度更符合憲法平等原則跟社會的現實好 以上說明 謝謝好 謝謝陳昭之委員說明接下來請鍾嘉斌委員代表民進黨黨團說明 |
| transcript.whisperx[35].start |
2264.807 |
| transcript.whisperx[35].end |
2282.414 |
| transcript.whisperx[35].text |
民主聯盟黨團有鑒於財政收支分法修改後我們國民年金法當中的第36條就應該予以調整根據憲法第10章中央與地方制分權第107條明定財政是由中央來主導 |
| transcript.whisperx[36].start |
2283.374 |
| transcript.whisperx[36].end |
2301.049 |
| transcript.whisperx[36].text |
然而108條規定有關於社會福利等各種的社會救助是由中央立法或交由地方來執行因此我們很清楚財化法本應該是由中央來立法做分配然而在去年財化法接連遭到 |
| transcript.whisperx[37].start |
2302.165 |
| transcript.whisperx[37].end |
2326.034 |
| transcript.whisperx[37].text |
一個亂財政的修法那麼造成中央跟地方的財政失衡然而這是國會多數通過的那麼基於權責一致當國家的收入已經大幅的交給地方了那麼根據憲法中央跟地方分權的精神地方就應該來負擔原本由中央在國民年金法舉例來說 |
| transcript.whisperx[38].start |
2327.955 |
| transcript.whisperx[38].end |
2346.891 |
| transcript.whisperx[38].text |
36條他就是由中央來負擔但是呢在經過這樣的修法之後我們認為有必要針對第36條將地方的財政分為五級其中第一級的部分對於國民年金的負擔應該各付一半第二三級的部分至少地方要負擔30%財力相對較弱的第四級跟第五級負擔15%這樣子才能夠落實錢權一致 |
| transcript.whisperx[39].start |
2354.477 |
| transcript.whisperx[39].end |
2382.833 |
| transcript.whisperx[39].text |
避免肥地方受中央而國民年金法照顧的都是我們的人民最弱勢的人民需要由中央跟地方共同協力來照顧因此我們提出的修法以36條為核心將原本由中央負擔全部國民年金負擔的這樣的一個條文轉化為中央跟地方共同來承擔我們還是要再強調一次中央民國憲法當中第十章中央跟地方之分權是牢不可破 |
| transcript.whisperx[40].start |
2383.453 |
| transcript.whisperx[40].end |
2393.2 |
| transcript.whisperx[40].text |
然而在財化法經過修改之後我們認為有必要進一步的去規範地方跟中央在國民福利社會安全制度上應有之責任以上好謝謝鍾嘉賓委員說明接下來請衛福部石部長就本日會議議程專案專題報告及討論事項並案報告及說明時間10分鐘 |
| transcript.whisperx[41].start |
2415.681 |
| transcript.whisperx[41].end |
2435.127 |
| transcript.whisperx[41].text |
主席還有各位委員那麼今天本部呢呈邀列席來報告有關於春節急診醫療人力調度與跨院協調機制的現況進行作為還有假日跟連續假日期間的急重症分級醫療政策的執行成效改進方向那麼以及有 |
| transcript.whisperx[42].start |
2436.847 |
| transcript.whisperx[42].end |
2465.053 |
| transcript.whisperx[42].text |
何新存委員等19案有關國民年金部分條文修正草案來提出這個書面報告那麼我請口頭的部分來就補充那首先的是有關於這個春節的急診的醫療人力的調度與協調機制那麼有介於今年的春節的長假那麼高達9天那同時也接近了在去年 |
| transcript.whisperx[43].start |
2466.274 |
| transcript.whisperx[43].end |
2487.686 |
| transcript.whisperx[43].text |
這個過年期間農曆過年期間的急診用色的問題所以我們本部呢在今年就提早這個啟動因應的相關措施那麼你訂了自1月31號到3月1號期間那麼有所謂的春節整備專案那麼這個方案裡頭主要有四個重點 |
| transcript.whisperx[44].start |
2488.366 |
| transcript.whisperx[44].end |
2497.295 |
| transcript.whisperx[44].text |
第一個就是提早因應我們已經協調各個衛生局以及地方政府建設的急診的監測指標強化持續性的監測及時的因應 |
| transcript.whisperx[45].start |
2504.902 |
| transcript.whisperx[45].end |
2533.461 |
| transcript.whisperx[45].text |
調度那麼同時呢也請藥商提高了有關於季節性傳染病藥品的安全庫存跟供應量那第二點呢是在患者分流的部分那麼我們在1月20號開始那麼就放寬了這個流感抗病毒藥物的使用規定來降低呢這個可能性可能的這個季節流感的高峰那麼另外也已經宣布在 |
| transcript.whisperx[46].start |
2535.342 |
| transcript.whisperx[46].end |
2544.347 |
| transcript.whisperx[46].text |
農曆春節初一、初二、初三強化所有的急救責任醫院來開設傳染病特別門診第三點是有關擴充春節的醫療量能 |
| transcript.whisperx[47].start |
2549.89 |
| transcript.whisperx[47].end |
2564.643 |
| transcript.whisperx[47].text |
那麼我們健保署也已經在1月23號公告在今年的農曆春節期間的加成獎勵方案那麼包含從這9日當中那麼提供 |
| transcript.whisperx[48].start |
2565.843 |
| transcript.whisperx[48].end |
2583.109 |
| transcript.whisperx[48].text |
開診服務的這個門診那麼他的診察費跟他的藥事服務費還有包含這個藥局的服務呢那麼都加成從30%到100%不等那麼另外在醫院的部分的 |
| transcript.whisperx[49].start |
2583.809 |
| transcript.whisperx[49].end |
2601.977 |
| transcript.whisperx[49].text |
住院診查或者是急診的診查還有護理跟藥事費用都加成百分之百那麼目前正在調查各醫院的還有各急診診所的藥局的開診情形那麼預計會在下週 |
| transcript.whisperx[50].start |
2605.958 |
| transcript.whisperx[50].end |
2632.967 |
| transcript.whisperx[50].text |
公布所有的開診訊息未來民眾就可以在全民健保的行動快意通裡面會有一個春節院所的服務查詢專區就可以查詢到在過年期間的各醫療院所的開診時段這個是有關於擴大醫療量能的部分總共會投入到16億來 |
| transcript.whisperx[51].start |
2634.528 |
| transcript.whisperx[51].end |
2653.457 |
| transcript.whisperx[51].text |
作為這個獎勵的費用那麼讓民眾可以得到必要的醫療服務那最後呢就是強化這個區域的聯防那麼也透過我們中央地方政府跟醫療院所都這個建立的這個聯繫的平台那麼對於在整個過年期間來確保這個醫療網的運作可以這個及時發揮這個調度的作用 |
| transcript.whisperx[52].start |
2660 |
| transcript.whisperx[52].end |
2673.732 |
| transcript.whisperx[52].text |
那麼此外呢在尋常的假日或者是連續假期期間的急重症分流的情形那有鑑於呢在這個假日的期間特別是在這個週日那麼 |
| transcript.whisperx[53].start |
2676.341 |
| transcript.whisperx[53].end |
2688.308 |
| transcript.whisperx[53].text |
這個基層的開診率呢那麼比較低大概在15%左右那但是民眾呢仍然有一些就醫的需要那因此我們在去年的這個11月2號那麼開辦了 |
| transcript.whisperx[54].start |
2691.85 |
| transcript.whisperx[54].end |
2709.841 |
| transcript.whisperx[54].text |
這UCC也就是假日的輕急症中心主要的服務對象就是以急但是不重的病人為主那從開辦至今呢那麼已經服務量也有明顯的提升到53%的增加那又以這個台南地區 |
| transcript.whisperx[55].start |
2710.762 |
| transcript.whisperx[55].end |
2728.748 |
| transcript.whisperx[55].text |
那麼幾乎在每一個假日有近200人的就診那其中也有近一半是骨外科的病人表示卻有這樣的需求所以我們會持續的來精進那麼此外對於有一些需要住院治療靜脈抗生素 |
| transcript.whisperx[56].start |
2731.229 |
| transcript.whisperx[56].end |
2753.144 |
| transcript.whisperx[56].text |
的部分我們也在去年8月開始推動了所謂OPAT門診靜脈抗生素治療方案那麼讓這民眾可以選擇那麼以到每日到門診注射的方式來減少這個住院的需求提升病人的可靜性跟方便性那麼 |
| transcript.whisperx[57].start |
2755.225 |
| transcript.whisperx[57].end |
2766.83 |
| transcript.whisperx[57].text |
執行迄今已經有182家的醫療院所包含醫院跟診所協助加入這個方案執行的成效目前已經也超過3600人我們會持續的來推動 |
| transcript.whisperx[58].start |
2770.711 |
| transcript.whisperx[58].end |
2792.502 |
| transcript.whisperx[58].text |
按照這樣的這個輕急症分流的方式落實分級醫療至於各位委員所關心的國保的給付調整的部分那麼國民年金那麼自97年開辦那麼今年已經邁入第18年那麼中間呢那麼涵蓋了五項的保險給付跟三項的津貼給付 |
| transcript.whisperx[59].start |
2793.522 |
| transcript.whisperx[59].end |
2807.879 |
| transcript.whisperx[59].text |
那麼據統計到去年值納保人數是286萬餘人各項幾戶的勤領人數大概有超過200萬餘人那但是有鑑於近年的這個 |
| transcript.whisperx[60].start |
2809.401 |
| transcript.whisperx[60].end |
2823.74 |
| transcript.whisperx[60].text |
物價還有生活水平的這個變動那麼我們在相關的這個給付的基本數額的部分那麼也多年未經調整那因此呢行政院也擬定了相關的 |
| transcript.whisperx[61].start |
2824.941 |
| transcript.whisperx[61].end |
2848.545 |
| transcript.whisperx[61].text |
調整方案那麼送請大院審查那因為這個可能是時間的關係因為上個禮拜我們才送到大院所以不及排入於今天的議程希望未來能夠併案審查那本次行政院版本的國民年金部分條文的修正草案有幾個重點那麼第一個呢就是調高國保給付的 |
| transcript.whisperx[62].start |
2849.105 |
| transcript.whisperx[62].end |
2878.303 |
| transcript.whisperx[62].text |
基本數額每人每月至少調升至五千元那麼身心障礙民眾可以調高到六千七百一十五元那麼第二呢是放寬排富的標準那麼比照這個這個老農津貼的方式那麼同時刪除了民眾唯一自住房屋的扣除額的上限那麼第三呢我們也在行政院版本裡面也新增了 |
| transcript.whisperx[63].start |
2878.843 |
| transcript.whisperx[63].end |
2906.438 |
| transcript.whisperx[63].text |
那麼每兩年那麼依據這個CPI的變動如果達3%以上就進行調整基本數額中的檢討機制來及時反映物價至於呢剛剛有委員關心的強制配偶代繳保險費的相關罰款規定在行政院版本當中也予以刪除以彰顯平等原則那我想這個行政院的版本也大概含納了 |
| transcript.whisperx[64].start |
2908.179 |
| transcript.whisperx[64].end |
2929.632 |
| transcript.whisperx[64].text |
委員所提的版本的修正條文特別是在放寬排附規定的部分我們目前看到其他委員的版本所無但是我們認為這個是很重要的一個條文所以希望能夠在未來審查的時候 |
| transcript.whisperx[65].start |
2931.052 |
| transcript.whisperx[65].end |
2950.196 |
| transcript.whisperx[65].text |
一併同行政院的版本共同修訂那麼討論那麼建立起國民年金與時俱進的彈性制度提升國保民眾的基本經濟安全的保障那以上報告再請各位委員指教 謝謝好 謝謝石部長報告 |
| transcript.whisperx[66].start |
2958.14 |
| transcript.whisperx[66].end |
2974.172 |
| transcript.whisperx[66].text |
那有關本次會議各項書面資料均列入記錄刊登公報那現在開始詢答做以下宣告第一本會委員詢答時間6加2分鐘列席委員4分鐘那10點半截止發言登記 |
| transcript.whisperx[67].start |
2975.416 |
| transcript.whisperx[67].end |
2990.705 |
| transcript.whisperx[67].text |
三 委員如有書面質詢 請於散會前提出 預期不受理四 暫定10點半 休息10分鐘五 本日不處理臨時提案現在請登記第一位委員陳昭智委員發言謝謝主席 有請部長請時部長 |
| transcript.whisperx[68].start |
3002.146 |
| transcript.whisperx[68].end |
3020.019 |
| transcript.whisperx[68].text |
陳委員早好 副長謝謝你們這個國民連改的那個接受民眾黨團建議的第15跟50項的修改 謝謝那最近澄清醫院也發生了急診暴力那有酒醉的這個民眾他把護理師打到腦震盪所以造成很多民眾跟這個醫療人員他們都非常的憤怒 |
| transcript.whisperx[69].start |
3020.439 |
| transcript.whisperx[69].end |
3042.988 |
| transcript.whisperx[69].text |
那有人提出這樣的主張說在醫院施暴或毆打醫護人員應該要停用健保卡一年全額自費但是部長我知道就是說在全面停卡會涉及憲法上的一個健康權跟比例原則但是我還是要請教衛福部在不能停卡的一個前提下有沒有辦法讓施暴者付出實質代價的一個制度上的設計呢 |
| transcript.whisperx[70].start |
3044.742 |
| transcript.whisperx[70].end |
3071.042 |
| transcript.whisperx[70].text |
跟委員報告我想對於不管在任何場域任何的情境之下那麼我們對於這個暴力行為一定是嚴厲的譴責啦那特別是在醫療這種救人的場域更不應該那麼過去呢這個在103年你有在做一些制度上的設計嗎制度上我們有很多的措施啦那麼剛剛提到的這個 |
| transcript.whisperx[71].start |
3073.104 |
| transcript.whisperx[71].end |
3082.415 |
| transcript.whisperx[71].text |
這個用健保的方式因為健保畢竟它是以這個保障這個生命的安全做最重要的基本再請問下面幾個問題就是您一併考慮就是說醫護人員是否有據診 |
| transcript.whisperx[72].start |
3087.641 |
| transcript.whisperx[72].end |
3107.776 |
| transcript.whisperx[72].text |
就是說拒絕這個診療或終止就暫停這個醫療的空間施暴者除了刑責他本身就要負刑責那是否有健保給付上的一個譬如說加重負擔是否研議對特定惡意的行為人設計部分負擔的加成或指定就醫流程等等這個配套有沒有往這個方向去思考 |
| transcript.whisperx[73].start |
3109.117 |
| transcript.whisperx[73].end |
3138.18 |
| transcript.whisperx[73].text |
我想我們有在這個擬定一些相關的指引那麼所有在醫療過程當中還是以安全最重要所以這個剛剛說到的據診那麼不是很恰當但是呢保護自身醫護人員自身的安全還是應該優先考慮如果有這種這個暴力甚至危害到安全的情況應該先處理安全的情形那麼自身的保護還是最重要的 |
| transcript.whisperx[74].start |
3138.56 |
| transcript.whisperx[74].end |
3166.517 |
| transcript.whisperx[74].text |
當然我這張投屏的標題說能不能註記當然我也覺得註記是當然這個也要考慮然後指定就醫流程其實有點像開黃燈就是說我們知道他就是有可能有暴力傾向但是你在醫學倫理上又不能不照顧部長這個健保署統計去年11月到今天全國UCC每天看診的人數大概只有350人還不及一間急救責任醫院他一日的看診人數 |
| transcript.whisperx[75].start |
3168.078 |
| transcript.whisperx[75].end |
3195.3 |
| transcript.whisperx[75].text |
甚至有好多天是不到300人那其中台北市很嚴重每個月只有40個人次那台北有三個點那其中兩個點還蠻靠近的那陳署長您也說過說UCC是由健保署來進行方案的規劃那提供經費支持那但是選點是由地方衛生局來做的那當地的衛生局也許是更清楚醫療的量能那但是目前的健保署的資料統計還是顯示整個量能是很不一的 |
| transcript.whisperx[76].start |
3196.061 |
| transcript.whisperx[76].end |
3222.311 |
| transcript.whisperx[76].text |
那陳署長你也說過說開始有設計說4月初預計要針對這些選點再重新做個盤點因為設立之初的時候是尊重各地衛生局他來選擇這個地點但並沒有預設說要多少人數就醫人數所以我下面就請教部長跟署長以目前累積的大概我的所編資料4800的人次的累積使用量請問UCC是否已經達到避免民眾都往急診衝的這個政策目標呢 |
| transcript.whisperx[77].start |
3224.412 |
| transcript.whisperx[77].end |
3249.803 |
| transcript.whisperx[77].text |
我想這個階段是剛剛如同委員所提的我們初始的階段是搭配這個跟衛生局討論那麼由衛生局去指定這個點那麼一共有六都開始試辦未來可能還會擴大到其他縣市有這個需要的話那六都共選定了13個處所我們可以看到有些處所很成功譬如說在台南的點它的這個 |
| transcript.whisperx[78].start |
3250.943 |
| transcript.whisperx[78].end |
3278.894 |
| transcript.whisperx[78].text |
這個一天的這個就診量將近200人那也可以看到他他鄰近的像成大醫院集美醫院的急診輕症的人數也有下降像這樣的點還有服務的方式就很成功那但是像台北市像您指教的台北市看起來三個點那麼他相對於台北市的整個就醫的量是大的那麼以這三個點提供到的這個分流的機制確實有限 |
| transcript.whisperx[79].start |
3279.514 |
| transcript.whisperx[79].end |
3299.866 |
| transcript.whisperx[79].text |
所以我們未來會去檢討我想再提醒一點說雖然說選點是尊重這個地方面具但這個是一個全國性的健保政策那如果說完全沒有中央的最低標準沒有使用量的門檻來看的話也沒有退場機制那這樣有點像地方自治有點像中方政府就放手不管了有點就是說請 |
| transcript.whisperx[80].start |
3301.327 |
| transcript.whisperx[80].end |
3325.208 |
| transcript.whisperx[80].text |
我們會跟地方衛生局討論醫療改革基金會也非常重視他們提出一個很關鍵的提醒他不說制度本身沒有錯而是改變的順序錯了醫改會要指出很多國家UCC的成功是因為比急診快比急診便宜但是在台灣民眾之所以加熱還是跑大醫院的急診近六成這是他們的數字近六成是因為不知道哪裡有診所可看病 |
| transcript.whisperx[81].start |
3326.589 |
| transcript.whisperx[81].end |
3344.484 |
| transcript.whisperx[81].text |
26%是無法判斷病情的這個嚴重度那健保署常說台灣有推動了20多年的這個嘉義群計畫應該能夠在基層為民眾的健康把關但是醫改會也曾經用神秘客的方式抽樣六都嘉義群整種的電話諮詢發現這是他們的調查數字96%的人無法回答哪邊可以看門診在假日的時候 |
| transcript.whisperx[82].start |
3351.269 |
| transcript.whisperx[82].end |
3364.525 |
| transcript.whisperx[82].text |
不到25%可以提供任何衛教指導一聽到發燒大概有一半以上都直接接你去大醫院急診那這樣的家喻群真的有能力來承接輕的急症分流的角色嗎這是他們的統計數字 |
| transcript.whisperx[83].start |
3367.088 |
| transcript.whisperx[83].end |
3382.502 |
| transcript.whisperx[83].text |
所以部長您是第一次聽還是就是讓您參考畢竟他們也做了一些方法學去了解那一改會有指出UCC成功的關鍵不是只有設點而是事前能不能有人幫民眾做判斷那一改會執行長林執行長也說 |
| transcript.whisperx[84].start |
3383.963 |
| transcript.whisperx[84].end |
3409.31 |
| transcript.whisperx[84].text |
世界各國都知道一般人是很難一般人很難為自己做這個疾病的嚴重度判斷所以正在民眾立場來看設計配套提供各式各樣的諮詢的一個引導是很重要我們台灣的UCC其實是仿效日本可是部長您知道這件事嗎日本的UCC有它明確的收治條件而且很重要的它非常重視事前的諮詢所以它有不同年齡群都各有諮詢專線這樣可以免跑一趟就是說 |
| transcript.whisperx[85].start |
3413.111 |
| transcript.whisperx[85].end |
3427.379 |
| transcript.whisperx[85].text |
就避免白跑一趟嘛會不會到將來有打算要規劃類似的一個諮詢系統嗎跟文說明第一個對那個加一計畫裡面確實我們有call center的設計這個我們都有一些這個經費的支持那 |
| transcript.whisperx[86].start |
3430.12 |
| transcript.whisperx[86].end |
3457.886 |
| transcript.whisperx[86].text |
能不能夠提高他的這個功能讓他因為這個都是老病人我們現在納入加一計畫大概已經超過600萬人600萬人如果能夠把這個機制強化我覺得這個是有幫忙這個我們會來檢討那第二個呢就是對民眾的就醫的指引的建立我們也會去建立起來未來會上線那至於說這個看診的資訊像我們今年的春節期間我們就會有一個專區 |
| transcript.whisperx[87].start |
3459.106 |
| transcript.whisperx[87].end |
3475.3 |
| transcript.whisperx[87].text |
看診的資訊這九天哪裡可以看那讓他很好搜尋那麼未來我們也會去強化在假日期間他可以看診所以我們會去鼓勵這個基層開診那哪裡可以看我們會再多多監討那我們現在就回到UCC的 |
| transcript.whisperx[88].start |
3476.741 |
| transcript.whisperx[88].end |
3493.13 |
| transcript.whisperx[88].text |
定位究竟是在民眾自行判斷後前往的一個選項呢還是應該建立在專業判斷跟轉介系統之後的服務這是看你覺得如果沒有前端的判斷跟指引那UCC再多設幾個點都不會改變民眾直接跑急診這種行為所以這個台北市醫師職業工會有提出幾項建議那請部長跟署理這邊參考 |
| transcript.whisperx[89].start |
3500.034 |
| transcript.whisperx[89].end |
3502.856 |
| transcript.whisperx[89].text |
對於現存UCC的應該設置的預期達成目標值如果你經過嘗試還是沒有辦法達成的話應該及時退場止損或是另外尋求其他的這個長指這是他們第一點的建議第二個政府應該考慮設置這個院前的諮詢管道讓民眾可以透過線上或是說電話諮詢剛剛部長有提到是在平台上嗎 |
| transcript.whisperx[90].start |
3523.227 |
| transcript.whisperx[90].end |
3539.444 |
| transcript.whisperx[90].text |
至少他的問題可能適合你可能適合在UCC獲得結束因此不必直接往這個急診去你要讓他知道嘛讓他放心那第三個如果UCC是政府這個應變災難及重大傷患的一個韌性醫療的一環假設你把他列在這樣的一環那應該考慮將來是不是把他列入這個人員都要接受定期的訓練 |
| transcript.whisperx[91].start |
3544.409 |
| transcript.whisperx[91].end |
3560.931 |
| transcript.whisperx[91].text |
之列並且以社區急救站這樣的概念的標準來打造就是涉及你對UCC的這個定位那我們必須再談一件事就是說那個希望政府能夠正視UCC跟醫院急診之間的巨大資源的鴻溝部長您知道我這句話的意思嗎 |
| transcript.whisperx[92].start |
3562.172 |
| transcript.whisperx[92].end |
3587.972 |
| transcript.whisperx[92].text |
現在我看署長在點頭這三倍以上的經費差異可以看作說是醫院醫護醫療人員 醫護人員勞動力受到高度的壓榨為什麼是說三倍你在UCC所規範的薪資一天光是人事費大概是12萬元那全國13座你講的是大概156萬元那我們扣掉民眾有部分負擔的部分大概也要支出150萬可是這些人如果一天350人他都往急診去的時候醫學中心急診室 |
| transcript.whisperx[93].start |
3588.912 |
| transcript.whisperx[93].end |
3593.497 |
| transcript.whisperx[93].text |
健保只支出30到50萬就是這一塊是150萬但是如果他們都往急診區他是50萬所以這個醫院的醫療人員他們就覺得他們事實上是在過去勞動力的受到壓榨的程度就從你做參考 |
| transcript.whisperx[94].start |
3604.587 |
| transcript.whisperx[94].end |
3629.486 |
| transcript.whisperx[94].text |
所以部長就是涉及您對UCC的定位還有目前能夠做改進那定位之後當然你就有目標還有這個大家提供的意見怎麼樣讓UCC如果你要繼續讓它存在然後也有清楚的定位目標是應該讓民眾有能夠有一個指引讓它不然大家還是繼續往那邊衝啊因為現在現在平均的量比一家一家醫院的一天的量都還不足 |
| transcript.whisperx[95].start |
3630.767 |
| transcript.whisperx[95].end |
3652.542 |
| transcript.whisperx[95].text |
跟委員報告剛剛提到的有一個UCC的點一次假日可以進200人次這個已經高過有一些地區醫院的量所以他看你怎麼去宣導跟設計至於剛剛你一直在強調的這個院前諮詢管道這我們會去思考這個我們會有一些就醫指引 |
| transcript.whisperx[96].start |
3652.742 |
| transcript.whisperx[96].end |
3668.502 |
| transcript.whisperx[96].text |
那甚至未來搭配AI的方式我們像現在健保也開始克服第一線是AI克服然後後線才是真人克服那這樣的設計也許搭配我們的指引未來的這個就醫指引再搭配AI的協助 |
| transcript.whisperx[97].start |
3670.224 |
| transcript.whisperx[97].end |
3689.333 |
| transcript.whisperx[97].text |
可以一起來思考那麼這個所謂的院前這個諮詢的管道那至於UCC的定位那麼我剛剛提到我們一直在強調這個分級醫療可是在假日的時候或連續假日的時候很明顯的因為這個基層的醫師要休息這個是 |
| transcript.whisperx[98].start |
3691.054 |
| transcript.whisperx[98].end |
3712.685 |
| transcript.whisperx[98].text |
這個有必要的所以呢讓假日的時候不會說我們平常分級醫療假日不分級醫療通通到醫院去所以UCC是要扮演這樣的角色至於到目前的績效來講確實有需要再提升的地方我們會滾動式的來修正謝謝部長跟署長因為這是美意啦我們就是要繼續進步然後這個進行盤整了解民眾的需要好謝謝謝謝主席好謝謝委員謝謝 |
| transcript.whisperx[99].start |
3718.23 |
| transcript.whisperx[99].end |
3733.18 |
| transcript.whisperx[99].text |
謝謝陳昭芝委員發言接下來請林月琴委員發言主席麻煩我們的石部長請石部長 |
| transcript.whisperx[100].start |
3739.144 |
| transcript.whisperx[100].end |
3762.502 |
| transcript.whisperx[100].text |
今天事實上是本會期的最後一次質詢部長那我總共有三個問題要請教首先是關於我們的那個春節的醫療的一個問題也就是部長應該知道過去我一直在強調急診要解決擁塞就必須要分流首先要感謝你願意去做採納設置了我們的假日及國定假日 |
| transcript.whisperx[101].start |
3763.082 |
| transcript.whisperx[101].end |
3787.182 |
| transcript.whisperx[101].text |
清急症中心我肯認這個政策方向也因為分流能降低急診跟第一線的負擔不過上週也跟你一起有到桃園的UCC視察的時候你有提到春節會有醫護人員的加成補助方案那我必須替第一線的我們的醫護人員來問清楚一件事情春節加成補助方案有幾成會給第一線的醫護人員 |
| transcript.whisperx[102].start |
3788.17 |
| transcript.whisperx[102].end |
3808.579 |
| transcript.whisperx[102].text |
這次我們在公告我們1月23號已經正式公告這個這個獎勵方案那上面已經明訂這個八成要發給出勤的相關人員好那部長你就是在想問那這筆錢實際上會怎麼發放還是直接進到第一線的醫護人員的口袋裡還是先撥給醫院再由醫院自行處理 |
| transcript.whisperx[103].start |
3809.49 |
| transcript.whisperx[103].end |
3829.072 |
| transcript.whisperx[103].text |
還是由醫院去分配啦但是八成一定是給相關的出勤人員為什麼我要問這個問題因為我最近接獲非常多醫護人員的反應跟陳情發現衛福部過去推很多獎勵計畫要獎勵我們的醫護人員可是加班還是不管是加班還是上夜班後 |
| transcript.whisperx[104].start |
3830.435 |
| transcript.whisperx[104].end |
3850.047 |
| transcript.whisperx[104].text |
卻發現那個錢 遲遲事實上是沒有下來的這是醫院內部他們給我的一個資料也就很明確跟部長講你一定知道夜班護理人員直接獎勵計畫這個計畫就是衛福部先把錢給醫院然後再由醫院分配結果醫護人員遲遲拿不到錢現在是幾月了 |
| transcript.whisperx[105].start |
3851.633 |
| transcript.whisperx[105].end |
3868.731 |
| transcript.whisperx[105].text |
現在1月底那去年的 再來講 去年的錢是不是去年有護理師跟我講說 去年6月上夜班按你們的規定8月就要發啦可是到現在他都還沒有領到那部長你知道這個狀況嗎 其他醫院有沒有一樣的狀況 你如何去解決 |
| transcript.whisperx[106].start |
3871.435 |
| transcript.whisperx[106].end |
3894.025 |
| transcript.whisperx[106].text |
因為我們有一些作業跟審查的落差所以大概是兩個月的落差兩個月的落差現在是幾月 現在是幾月因為我們有一個叫做通報平台如果有這個狀況是可以通報的那麼到目前我問了一下我們同仁好像沒有說到6月到現在還沒有發的信息你是不是再把 |
| transcript.whisperx[107].start |
3894.685 |
| transcript.whisperx[107].end |
3921.649 |
| transcript.whisperx[107].text |
再把這個資料給我們再來細查一下所以我要向部長確定這次春節補助和過去的防疫津貼的執行問題高度相似從第一線人員照冊院內合張到必須等健保署撥款後才能發放再加上牽扯到健保點數的轉換這部分院方都未必能清楚對外說明要如何確保這些春節願意上班的護理師能夠領到春節補助我覺得這非常重要 |
| transcript.whisperx[108].start |
3922.059 |
| transcript.whisperx[108].end |
3936.474 |
| transcript.whisperx[108].text |
我上次才質詢社工一樣一月到現在沒有去領到他們該有的錢那一樣如果醫護人員也是這樣那我覺得中央真的在督促地方或是都督促你們要執行的方案裡面真的要確保他們 |
| transcript.whisperx[109].start |
3937.611 |
| transcript.whisperx[109].end |
3955.622 |
| transcript.whisperx[109].text |
要給的要給這個跟委員報告這一個款項我們是用專款特別去自印所以它沒有點值的問題它就是1.1塊錢而且這個是健保的給付規定如果沒有按照這樣那麼會有健保特管法的 |
| transcript.whisperx[110].start |
3956.342 |
| transcript.whisperx[110].end |
3973.807 |
| transcript.whisperx[110].text |
罰款規定那同時也可能會如果該給而沒有給那醫院也有可能會涉及到侵占公款的形式問題所以這個問題很嚴重的所以這個我想多數的醫院都清楚啦那麼如果有少數的情形我們一定會嚴查 |
| transcript.whisperx[111].start |
3975.287 |
| transcript.whisperx[111].end |
3999.998 |
| transcript.whisperx[111].text |
所以再請委員放心如果有相關的訊息就給我們我覺得機制要做好來如果有醫護人員他畢竟還在那邊上班他們是不是有壓力那如果他今天出來告訴你這件事情可是這本來就不是正常的程序上因為兩個月你要給我錢加班費再怎麼樣當個月就要給了結果你兩個月沒給以外讓你們有些核算時間結果你事實上是五個月六個月都還沒有給 |
| transcript.whisperx[112].start |
4000.838 |
| transcript.whisperx[112].end |
4016.268 |
| transcript.whisperx[112].text |
所以我在這邊有提出三個比較具體務實的建議請部長也正面回憶一個月可不可以交也就是說清查各縣市醫院是否能有津貼持未發的狀況所以你們要主動清查不是叫醫護人員來跟你講然後最後呢他就是會有他的困難為什麼因為他如果一旦涉入到 |
| transcript.whisperx[113].start |
4021.513 |
| transcript.whisperx[113].end |
4042.153 |
| transcript.whisperx[113].text |
很容易大家知道是誰嘛那第二個就是評估是不是能改成看看能不能直接匯到第一線的醫治人員的帳戶這個你們評估看看第三個醫院在收到補助的時候一定要在第一線期限內發給第一線的醫治人員然後有沒有可以建置一個查核跟我覺得處罰機制 |
| transcript.whisperx[114].start |
4043.792 |
| transcript.whisperx[114].end |
4072.224 |
| transcript.whisperx[114].text |
跟我們報告這清查我們可以來清查啦那因為這個補助款我們來要求一定的時間因為我們進去的時間大概會有兩個月的落差然後醫院呢他也有發放這個薪資入帳的時間的落差那過去呢我們這個通報平台也有收過幾件那我們就會去了解那有些是他的行政作業上的務司或承辦人員的那個情有可原的都是都是OK但是 |
| transcript.whisperx[115].start |
4073.004 |
| transcript.whisperx[115].end |
4094.12 |
| transcript.whisperx[115].text |
如果因為我們那個通報平台不一定要具名的所以只要告訴我們可能是在哪些醫院我們就會去查那全面性的清查我想這個這個我們會來麻煩部長先因為為什麼當初這政策良善美意要做一些獎勵可是不要讓第一線的人工作人員 |
| transcript.whisperx[116].start |
4094.761 |
| transcript.whisperx[116].end |
4109.487 |
| transcript.whisperx[116].text |
辛苦之後他得到的是口號而不是準時可以拿到你確實該拿的補助因為我覺得春節也快到了我相信補職長的心情跟我們一樣就是會希望在以來願意付出的人能夠獲得該有的照顧 |
| transcript.whisperx[117].start |
4110.327 |
| transcript.whisperx[117].end |
4135.426 |
| transcript.whisperx[117].text |
那另外一個就是部長我覺得我們說要打造友善的生養環境可是現在很多家長面臨的是有錢卻找不到保姆為什麼根據最新的統計近三年全全國的保姆平均離職率大概是7%但加入率只有6所以差了1%所以等於每一年的人力流失是1%的部長你知道這個代表什麼嗎如果流失的速度不變的話五年後全國在宅的 |
| transcript.whisperx[118].start |
4135.99 |
| transcript.whisperx[118].end |
4156.148 |
| transcript.whisperx[118].text |
保姆將跌破2萬人而且在六都的狀況更嚴重台北市大概流失率是11%那台南呢高達14%部長照這個速度的話台北台南的居家托育服務10年內可能就是瓶頂消失了那衛福部到底有沒有規劃具體的政策來解決我們居家人員人數流失的問題 |
| transcript.whisperx[119].start |
4157.629 |
| transcript.whisperx[119].end |
4185.494 |
| transcript.whisperx[119].text |
跟委員說明一下我們目前的數字上來看去年的這個托育人力居家托育人力大概兩萬八那前一年大概是兩萬七千九所以大概是為此平盤但是您這邊提出的是縣市的差別我們整個數字看起來並沒有減少但是可能有縣市的差異所以我們會再進一步的進行比較細部的分析你一定相對應的對政策 |
| transcript.whisperx[120].start |
4185.854 |
| transcript.whisperx[120].end |
4213.768 |
| transcript.whisperx[120].text |
部長為什麼這樣提我們已經設定了政策目標要在2029年家外送托率要提升到36.9%部長目前托育供給的缺口還缺53916名的幼兒的那個托育名額換句話說如果要打標至少需要13500名的一個保姆部長要問你就是說再人力持續如果是流失甚至有所謂的都市跟像 |
| transcript.whisperx[121].start |
4214.648 |
| transcript.whisperx[121].end |
4234.157 |
| transcript.whisperx[121].text |
不均等的狀況底下這一萬三千五百名的那個保姆到底要從哪裡來因為我們的托育托法已經草案已經訂定了政府也要嚴定政策充實托育人力部長如果沒有穩定的人力的供給的話你這個政策大概是沒辦法來做一個落實所以 |
| transcript.whisperx[122].start |
4235.698 |
| transcript.whisperx[122].end |
4262.416 |
| transcript.whisperx[122].text |
我就直接問一個比較關鍵的問題照顧是不分老幼的為什麼政策不應該分那目前勞動部就有個缺工就業獎勵計畫已經納入長照服務員但同樣嚴重缺工同樣也攸關國內的居家托育人員的卻被排除在外那你現在聽會說那是勞動部啊那我因為我問過勞動部這個還是要衛福部因為保姆人員事實上是掌握在衛福部所以如果要 |
| transcript.whisperx[123].start |
4263.16 |
| transcript.whisperx[123].end |
4287.819 |
| transcript.whisperx[123].text |
只住這種人力缺失的話每年只需要吸引額外2380名的新進保姆在預算上大概以每人10萬8千的獎勵金的計劃的話一年約2.5億元就能做到部長你認為這個金額真的不可行嗎衛福部願不願意來會同勞動部將居家托育人員納入缺工就業獎勵計劃以前是民間在做彭阿盧基金會他們在做 |
| transcript.whisperx[124].start |
4288.519 |
| transcript.whisperx[124].end |
4295.812 |
| transcript.whisperx[124].text |
那可是現在我覺得這應該事實上如果長照有做勞動部也有那是不是政府這邊也要自己來做這件事情好 |
| transcript.whisperx[125].start |
4296.631 |
| transcript.whisperx[125].end |
4319.001 |
| transcript.whisperx[125].text |
有關於這個外託我們在這個新年的預算本來也有在要持續的增加這個公托的點我們還是會持續去增加人力的部分我們謝謝委員給我們這個這個建議的方向我們來找勞動部研究一下因為你剛剛講的是當然托嬰中心是一個方向可是畢竟機構式的和 |
| transcript.whisperx[126].start |
4320.582 |
| transcript.whisperx[126].end |
4348.12 |
| transcript.whisperx[126].text |
希望家庭式的不太一樣那最後就要問身障朋友有沒有有權有看醫生的權利我們上週剛把身權法送出委員會今天就要來請教部長關於身障朋友醫療可進行的問題首先本來身權法24條就有規定了主管機關一定規模的醫院應該要設立特別門診給予身障者那衛福部醫師司也因為因此而被授權訂定說身心障礙者特別門診管理辦法要求 |
| transcript.whisperx[127].start |
4348.78 |
| transcript.whisperx[127].end |
4371.556 |
| transcript.whisperx[127].text |
要設立特別門診這是給予身障朋友醫療禁用權的一個很好的管道身障朋友也認為這個幫助非常的大那我們就來看這個辦法來看特別門診有什麼科就關於辦法第三條指出說應設置獨立的牙科跟發展磁碗特別門診那上週上上週就有我們身心障的夥伴來拜會我們這邊他問的問題就是說 |
| transcript.whisperx[128].start |
4375.083 |
| transcript.whisperx[128].end |
4390.774 |
| transcript.whisperx[128].text |
我也想生育小孩可是我看婦產科就已經相對好麻煩所以我第二個問題說為什麼這麼多科別裡面只有牙科跟發展此外特別門診其他科沒有考量的是什麼你們有沒有真對身心障礙的需求進行過調查他們需要的醫療是什麼 |
| transcript.whisperx[129].start |
4393.077 |
| transcript.whisperx[129].end |
4405.894 |
| transcript.whisperx[129].text |
這個這個辦法這個特別門診的這個設置辦法多年前我在處長的時候訂的 是真的很多年沒有修啦當時候因為沒有提出來那現在有這個需求我們來修把這個這個這個 |
| transcript.whisperx[130].start |
4409.358 |
| transcript.whisperx[130].end |
4434.728 |
| transcript.whisperx[130].text |
孕產婦的門診把它納入那另外呢像剛剛提到我們有身心障礙的牙科的門診因為當時候的這個需求有提出來我們就把它設進去後來也搭配了那個健保會有這個診察費的加成所以它會有一些先設置的條件然後後端會搭配這個己婦上的加成 |
| transcript.whisperx[131].start |
4435.228 |
| transcript.whisperx[131].end |
4449.337 |
| transcript.whisperx[131].text |
那這個部分我想我們所以可不可以先調查看看因為這個法規的部分是1410那麼給付的部分健保會來一起一併的考量因為我自己身為女性非常深知生育的艱難 |
| transcript.whisperx[132].start |
4450.638 |
| transcript.whisperx[132].end |
4469.462 |
| transcript.whisperx[132].text |
如果躺在生殘手術台上連翻身都困難那公說一陣比一陣痛的時候生完還沒有力氣做起來就忍著傷口的疼痛每一天都要這樣撐過去我們尚且如此那身障朋友呢他們告訴我說他們光是從量體重的地方到驗超音波的診間就十分困難跑殘檢就像在打掛一樣所以衛福部110年做的全國的身障調查 |
| transcript.whisperx[133].start |
4476.063 |
| transcript.whisperx[133].end |
4499.075 |
| transcript.whisperx[133].text |
18歲以上的障礙者就已經超過七成都有生養子女那這代表生長者也非常渴望有家庭可是卻沒有友善無障礙的婦產科環境所以這些都是會讓想生育的生長朋友呢最後呢就是卻步所以更何況婦產科不是只有管生小孩其他的有關泌尿科這些疾病都需要婦產科所以部長可不可以再特別門診裡加婦產科讓生長婦女有基本的 |
| transcript.whisperx[134].start |
4503.444 |
| transcript.whisperx[134].end |
4530.103 |
| transcript.whisperx[134].text |
婦產科看診的一個權益 而且一個月內可不可以提出評估報告我們來修這個指定辦法好 謝謝部長 謝謝謝謝委員的指見好 謝謝林月請委員發言 接下來請陳金輝委員發言謝謝主席 謝謝各位官員還有委員 喔 部長請石部長 |
| transcript.whisperx[135].start |
4534.403 |
| transcript.whisperx[135].end |
4550.676 |
| transcript.whisperx[135].text |
今天我們會拍這個專報就是因為我們怕去年經歷的春節擁捨急診擁捨這樣子的現象今年重蹈覆轍其實很多醫務人員也在也在擔憂啦那這個是去年我不知道印象很深刻去年呢發生了急診擁捨之後賴總統當 |
| transcript.whisperx[136].start |
4552.997 |
| transcript.whisperx[136].end |
4578.891 |
| transcript.whisperx[136].text |
當時有親自主持健康臺灣推動委員會那他就說他非常關切這件事情那我們看衛福部自己發的文他寫得很清楚總統當時下令要落實分級並且呢總統指示說要建立一個民眾版的就醫指引那賴總統的支票已經開一年了這個傳說中可以解決擁捨的民眾版就醫指引你們弄好了嗎 |
| transcript.whisperx[137].start |
4579.952 |
| transcript.whisperx[137].end |
4594.091 |
| transcript.whisperx[137].text |
跟委員說明這個指引的部分那個144現在已經到了最後因為他要跟很多醫學會討論那差不多了那麼應該看看能不能在下個月初我們就會先上網下個月初 |
| transcript.whisperx[138].start |
4595.137 |
| transcript.whisperx[138].end |
4613.719 |
| transcript.whisperx[138].text |
春節已經 春節前我們就會讓他先上我給你看一下這個是我查到的因為你們蠻重視這件事嘛那我就上你們的網站去查你們的就醫指引到底在哪裡結果這個就醫指引是10年前的檔案這個你自己也知道啦 |
| transcript.whisperx[139].start |
4615.161 |
| transcript.whisperx[139].end |
4631.199 |
| transcript.whisperx[139].text |
他是105年上傳的並且他上傳的檔案裡面還有提到行政院衛生署行政院衛生署是2013年改制的表示他上傳這個檔案有可能這個檔案還更早比2015年還更早那我把這邊全部都讀完了52頁 |
| transcript.whisperx[140].start |
4633.702 |
| transcript.whisperx[140].end |
4661.805 |
| transcript.whisperx[140].text |
總統說到的分級醫療隻字未提裡面有講到說你去看醫生的時候你要自己怎麼樣整理自己的病情然後你應該跟醫生講什麼他有講到這些可是對於這個分級他是沒有講到那現在很開心聽到你說你要修改請問你修改的重點可以簡單一兩分鐘跟我們講一下就好了嗎當然他的這個重點上最重要是讓民眾清楚什麼時候到急診什麼時候其實在這個就近的 |
| transcript.whisperx[141].start |
4662.61 |
| transcript.whisperx[141].end |
4684.327 |
| transcript.whisperx[141].text |
這個基層診所看就可以重點在這個地方判斷這個需要去緊急就醫的那個要件是哪一些那我們也會搭配這個開診的資訊好像春節期間的我們都目前持續在調查當中那麼在1月28號我們健保已經在這個我們的那個就就醫 |
| transcript.whisperx[142].start |
4686.355 |
| transcript.whisperx[142].end |
4701.442 |
| transcript.whisperx[142].text |
資訊上面有個專區春節的就醫資訊專區裡面會列出所有每一天有開診的診所在哪一個區就可以查詢你會提供一個PDF檔會有一個APP就可以查 |
| transcript.whisperx[143].start |
4702.502 |
| transcript.whisperx[143].end |
4717.132 |
| transcript.whisperx[143].text |
剛講了這麼多我們來看一下這個表這個是我剛上任的時候做過的總質詢當時的行政院長還是陳建仁我說蔡英文總統執政8年分級醫療是不動如山並且花了總共530億元所以她 |
| transcript.whisperx[144].start |
4720.114 |
| transcript.whisperx[144].end |
4737.785 |
| transcript.whisperx[144].text |
民眾到醫學中心就醫的比例從106年到112年都是10點多%你們是把106年設定成一個基期那我們就從賴總統上任以來 我們來分析112到113又上漲了1% 10到11.8113到114又變成11.8到12.19 |
| transcript.whisperx[145].start |
4744.91 |
| transcript.whisperx[145].end |
4773.954 |
| transcript.whisperx[145].text |
我也想問因為當時我在做這個質詢的時候您是署長不知道有沒有印象那這個這三年這兩三年的投入看起來是出了什麼問題因為你的預算跟政策看起來是無效甚至是更加惡化到底問題在哪裡之前還是持平現在是一年上升一趴跟委員報告因為這樣的數字太過於RAF我們有更細緻的去分析我們的做法上是把 |
| transcript.whisperx[146].start |
4774.654 |
| transcript.whisperx[146].end |
4778.961 |
| transcript.whisperx[146].text |
醫院裡面把門診扣除掉重大傷病 |
| transcript.whisperx[147].start |
4779.437 |
| transcript.whisperx[147].end |
4802.021 |
| transcript.whisperx[147].text |
扣除掉門診手術扣除掉急診因為我們在申報的時候會急門診是一起的把它扣除之後去看它的占比在醫學中心的平均占比這樣所謂的輕症占比是38%整個醫院收入的38%那麼到區醫院的等級的話呢它是大概50到55%到地區醫院是65% |
| transcript.whisperx[148].start |
4806.002 |
| transcript.whisperx[148].end |
4824.344 |
| transcript.whisperx[148].text |
所以以这样来看我们的分级医疗是成功的你是用它的点值你是用它的点值全部加起来它看的病人就是比较重就是说它很高的比例是重大伤病者那些癌症的病人这些你是需要到医学中心就应该到医学中心这个是OK的 |
| transcript.whisperx[149].start |
4824.784 |
| transcript.whisperx[149].end |
4852.431 |
| transcript.whisperx[149].text |
所以按照這樣來看這個數字的占比醫學中心是在下降那你什麼時候會提出你的新的評估表因為你應該要提出一個新的評估表嘛你要怎麼樣看哪些指標分析料可以落實有那因為我們就搭配了個別醫院總合在看這個事情我想委員也聽我講過需要降到50%以下因為有的醫學中心我剛剛講的是平均是38%可是有的醫院是高的所以要 |
| transcript.whisperx[150].start |
4853.251 |
| transcript.whisperx[150].end |
4867.802 |
| transcript.whisperx[150].text |
超過50%的一定要降到50%以下我們會透過這個健保的機制醫院個別總和來調整所以來導引讓這個各層級的醫院扮演他的角色好 這個是你講的 |
| transcript.whisperx[151].start |
4868.502 |
| transcript.whisperx[151].end |
4886.136 |
| transcript.whisperx[151].text |
你說你會先觀察你去年10月的時候說先進入一個觀察期然後再來醫院聯盟再來是漲部分負擔但是我們從過去這段時間來看你有漲過但似乎沒有什麼太大的效果目前我們面臨的困難是對基層信任嘛 |
| transcript.whisperx[152].start |
4886.536 |
| transcript.whisperx[152].end |
4908.416 |
| transcript.whisperx[152].text |
因為大家可能覺得他平常非常習慣於到這邊看慢性病到醫學中心等等的他現在沒有辦法對基層信任我想知道你從10月到現在你說是觀察期你目前觀察到什麼跟委員說明我們另外再看基層剛剛我提到的是各層級醫院的分級醫療的角色我們認為他是有達到了 |
| transcript.whisperx[153].start |
4908.996 |
| transcript.whisperx[153].end |
4932.644 |
| transcript.whisperx[153].text |
那麼部分的醫院沒有達到我們會透過個別醫院總額的調整機制那麼來要求至於在基層的部分我們看到在慢性處方間的領取率在基層的部分是提高了所以這個基層我們看到的這個趨勢是有增加的所以我們覺得這個分級效還是它的成效但是可以繼續再往前走 |
| transcript.whisperx[154].start |
4932.984 |
| transcript.whisperx[154].end |
4958.319 |
| transcript.whisperx[154].text |
那我可以一個月跟你要你說你想設定新的評估數據嗎因為剛剛那個表也是你們自己做的然後做出來的表問你你又說不是這樣子算的可是這表是你做的我們不斷的在精進那一個月可以跟你說那一個月可以要你那新的指標嗎你新的指標那這邊再給你一些具體的建議因為你剛剛自己也講到說你要運用AI |
| transcript.whisperx[155].start |
4959.5 |
| transcript.whisperx[155].end |
4983.592 |
| transcript.whisperx[155].text |
好那其實我們現在就有一個APP健保快遇通的APP你為什麼你剛講了你說你現在在調查春節會開的診所基層診所然後你可能會給他誘因對嗎你現在已經在調查了嗎對誘因已經發布了然後到時候呢到時候你會做一個檔案然後讓全國的民眾去不是說檔案他是很優化的查詢他可以根據你的所在地去查 |
| transcript.whisperx[156].start |
4984.953 |
| transcript.whisperx[156].end |
5005.33 |
| transcript.whisperx[156].text |
我是建議你乾脆把它融入一個看診的地圖有有有 這已經有了我的意思是說你平常可以落實的話你春節就更可以落實更何況春節的時候很多人是在移動中所以他換到另外一個城市可能已經不是他在工作的地方所習慣的基層醫療診所他必須要重新去尋找 |
| transcript.whisperx[157].start |
5009.173 |
| transcript.whisperx[157].end |
5023.395 |
| transcript.whisperx[157].text |
其實委員你可能沒有下載我們的這個健保的快易通啦我們的健保快易通有啦那個打開打開喔我的意思是說我的意思是說你要把它融入節日的時候有開的 |
| transcript.whisperx[158].start |
5025.738 |
| transcript.whisperx[158].end |
5029.922 |
| transcript.whisperx[158].text |
你知道我的意思嗎因為我們現在就是在談論春節擁捨的問題那你平常平常當然一到五我自己打開我去查我去急診所很ok因為這邊是習慣你居住或是工作的地方可是你春節的時候就在移動了那你剛剛很辛苦收集到這麼多的資訊你不是應該要把它融入嗎 |
| transcript.whisperx[159].start |
5048.659 |
| transcript.whisperx[159].end |
5073.164 |
| transcript.whisperx[159].text |
那包括當然如果可以的話比如說清明連假或者是228連假你可以從這三四天五天的這些連假去做測試因為春節就是一個一整年的壓力測試你如果等到一整年才測試一次我覺得這個就有點久所以平常有些連假的時候你就可以測試我們春節的部分這一次會先 |
| transcript.whisperx[160].start |
5074.244 |
| transcript.whisperx[160].end |
5102.703 |
| transcript.whisperx[160].text |
拉出專區啦剛剛跟委員說明那個是選舉的拉出那個專區未來我們把假日也用一個專區啦您的意思是我的意思就是說其實他什麼時候很需要是因為他可能連假的時候有移動他更不熟悉那附近的基層診所在哪裡或者是誰有開嘛那你也可以鼓勵這些你給他誘因你鼓勵他上傳然後你把他結合進去你的地圖以後那這些他就更有誘因他可以被查詢到 |
| transcript.whisperx[161].start |
5105.165 |
| transcript.whisperx[161].end |
5121.256 |
| transcript.whisperx[161].text |
好那第二個就是這個UCC但是我剛有聽其他委員質詢所以我可能再等待一段時間聽起來你現在還沒有辦法給我們一個UCC你有沒有要擴大還是沒有要擴大是嗎對我們當時候就提到說十四六個月之後會檢討那來決定調整或擴大好 |
| transcript.whisperx[162].start |
5124.418 |
| transcript.whisperx[162].end |
5151.323 |
| transcript.whisperx[162].text |
那十六個月之後我們再來跟你查詢這個那第二個問題因為這個也是急診室擁捨最近就是剛好是近期靠近春節的前後都會發生的因為我們現在有很多的尾牙春酒然後還有春節這個過年大家去餐廳吃飯等等的那2024年醫療暴力高達444件是五年來的新高近六成都在急診室 |
| transcript.whisperx[163].start |
5153.004 |
| transcript.whisperx[163].end |
5171.301 |
| transcript.whisperx[163].text |
因為這樣子私人的活動所引起的醫療需求也就是說喝太多通常送到急診他就打點滴這個你都很清楚因為你也是急診科醫生睡覺可是他其實消耗掉非常多醫護的量能對這個你都懂那包括我們的警察救護車等等 |
| transcript.whisperx[164].start |
5172.122 |
| transcript.whisperx[164].end |
5187.41 |
| transcript.whisperx[164].text |
那這個是你們次長自己講的你們次長說他開始想到一些研議的方法比如說參考其他國家瑞士啊美國啊會有一個禁制隔離式類似讓他行久的這種觀察式他不一定是醫療機構裡面或者是醫療人員來成立的那他講的這個話後來又有新聞請問你們內部有開過會嗎 |
| transcript.whisperx[165].start |
5196.799 |
| transcript.whisperx[165].end |
5215.402 |
| transcript.whisperx[165].text |
這個跟委員說明過去在急診經常會處理這種病那麼一般來講有兩種狀況一種是因為他的混亂讓我們無法判斷他有沒有醫療問題他可能同時有外傷或什麼可是又有酒精的效果那一種才需要在醫院裡面留 |
| transcript.whisperx[166].start |
5216.022 |
| transcript.whisperx[166].end |
5223.048 |
| transcript.whisperx[166].text |
但是我純粹是要睡覺的不准在醫院睡覺這個我等一下會跟你討論我的意思是說你們次長講了這個然後這個也上了新聞你們到底我們要演你我不是在問你急診處理的guideline |
| transcript.whisperx[167].start |
5230.983 |
| transcript.whisperx[167].end |
5249.186 |
| transcript.whisperx[167].text |
這個所謂的靜置區這個靜置區就是觀察區啦就是觀察啦只是讓他不要去干擾到醫護人員或者是其他他就是個觀察區不是睡覺區啦就是說他有醫療的需要那需要留觀的時候讓他有一個isolate的地方我們會來研議因為過去在有一些醫院的急診有這種這個譬如說AQ Psychotic的病人他就會 |
| transcript.whisperx[168].start |
5259.915 |
| transcript.whisperx[168].end |
5284.003 |
| transcript.whisperx[168].text |
就會在這一個房間裡面去靜置不見得是酗酒所以聽起來你是想把它放在醫院裡面有時候是需要的聽起來你是希望把它放在醫療院所裡面不是不是不是不是我剛剛提到的是有一些急性精神病人他會有混亂的情形也會在急診裡面有一個獨立的空間對啊那就是醫療院所裡面就一樣啊就是跟這個概念是一樣 |
| transcript.whisperx[169].start |
5284.363 |
| transcript.whisperx[169].end |
5313.422 |
| transcript.whisperx[169].text |
我剛剛提到的是喝酒醉的喝酒醉的要睡覺就回家睡覺不是在醫院裡面擺一個空間給他酒醒沒有這回事情但是他如果有醫療的需要需要觀察看看他有沒有其他的問題因為有時候酒精的會影響到在病人病情診斷跟處事上的影響需要觀察那就留在這裡我先幫你整理我先幫你整理一下就是其實最近也有一個新聞 |
| transcript.whisperx[170].start |
5314.302 |
| transcript.whisperx[170].end |
5337.911 |
| transcript.whisperx[170].text |
這個新聞是他其實常常是想要回家但是他在回家的路上因為交通事故發生問題所以也不是這麼簡單但你們次長所講出來的整理了世界各國比如說瑞士美國加拿大澳洲他們都有做類似這樣子的行酒中心他們可能是地方政府或者是非營利機構主要就是做幾個事情當然他會去判斷他需不需要去醫院就像你剛剛講的他現在沒有 |
| transcript.whisperx[171].start |
5338.211 |
| transcript.whisperx[171].end |
5348.915 |
| transcript.whisperx[171].text |
急症嘛呼吸抑制嚴重的嘔吐或是意識喪失這個是他要判斷的如果沒有不需要醫療介入的可以自然等待清醒的會放在這邊安全的去安置監測離開的時候是要付費的那離開之後他可能還會被 |
| transcript.whisperx[172].start |
5354.897 |
| transcript.whisperx[172].end |
5366.602 |
| transcript.whisperx[172].text |
記錄如果他很常來他可能要過濾出有酒飲的人需要去戒斷的人還要去上課的人等等的但是他在其他國家很多並不一定是由醫療機構來做因為他很多處置並不需要醫療人員 |
| transcript.whisperx[173].start |
5372.225 |
| transcript.whisperx[173].end |
5388.515 |
| transcript.whisperx[173].text |
所以這個就是一個月內希望可以要到你研擬之後評估之後你到底多久要達成因為這個也是解決我們春節擁捨的其中一個小的項目或是平常跟委員報告這個一個月沒有辦法 |
| transcript.whisperx[174].start |
5388.975 |
| transcript.whisperx[174].end |
5409.546 |
| transcript.whisperx[174].text |
這個要跨部會不可能把它放在醫院裡面那我們多久可以再跟你討論三個月啦我們來研究看看好三個月那裡面就這幾個重點就請您稍微看一下就主觀的去判斷就這個到底機構法源基礎在哪裡它是醫療的還是警政還是民政然後它的 |
| transcript.whisperx[175].start |
5410.166 |
| transcript.whisperx[175].end |
5425.373 |
| transcript.whisperx[175].text |
比如說你們要不要收費那他是不是會跟一些介營來做串聯那主觀的判斷是要送醫院還是留在這邊等等然後各國遇到預算問題社區的接受度等等好那我們就三個月可以再跟您討論好好謝謝謝謝好謝謝陳勤輝委員發言接下來請王育明委員發言 |
| transcript.whisperx[176].start |
5440.535 |
| transcript.whisperx[176].end |
5442.48 |
| transcript.whisperx[176].text |
謝謝主席 我們有請部長請時部長王媛媛好 |
| transcript.whisperx[177].start |
5448.359 |
| transcript.whisperx[177].end |
5471.179 |
| transcript.whisperx[177].text |
部長好 部長今天大家都非常關注今年長達九天的春節期間到底我們的醫療量能夠不夠會不會很多民眾生病的時候又往大醫院跑造成急診的用色然後去排擠了一些需要重大醫療的病人就診的權利那我覺得第一件事情我們要確立的就是說 |
| transcript.whisperx[178].start |
5472.02 |
| transcript.whisperx[178].end |
5493.141 |
| transcript.whisperx[178].text |
我们的基层诊所的开诊率够不够因为你这样子才能分流那过去是一成的比例那你们今年寄出了16亿的奖金就希望大家可以提高那到目前为止我上次问过林经理次长他没有办法说出现在到底基层诊所开诊率达到多少那今天部长你知道了吗 |
| transcript.whisperx[179].start |
5493.741 |
| transcript.whisperx[179].end |
5511.71 |
| transcript.whisperx[179].text |
跟委員報告確實您的觀察完全正確在去年我們調查初一初二初三開診率2到4%左右沒有到一成2到4%非常的低所以我們今年才有這個獎勵措施這幾天開診是double的給付 |
| transcript.whisperx[180].start |
5512.35 |
| transcript.whisperx[180].end |
5527.158 |
| transcript.whisperx[180].text |
那到目前的話已經有在上升有的已經到10了那有些縣市大概在7左右已經比去年大概有兩倍的成長但是目前還在一直在調查當中透過衛生局跟醫師公會的push大家在調查所以這個 |
| transcript.whisperx[181].start |
5529.921 |
| transcript.whisperx[181].end |
5544.621 |
| transcript.whisperx[181].text |
這個門診就基層診所的開診率一定是比去年高那另外我們的UCC也準備好在這些六都人比較多的地方我們也去強化那醫院的部分的開診率也提高了現在調查回來大概醫院在這幾天 |
| transcript.whisperx[182].start |
5546.303 |
| transcript.whisperx[182].end |
5561.816 |
| transcript.whisperx[182].text |
初二 初三 開診率都會達到七成以上所以也都會有開診體驗對 醫院向來是比較高所以民眾的慣性就會覺得跑大醫院怎麼沒錯不過我們也知道醫院的開診是開在門診所以它也可以去分流掉那個急診不會直接跑到急診區 |
| transcript.whisperx[183].start |
5562.516 |
| transcript.whisperx[183].end |
5585.567 |
| transcript.whisperx[183].text |
對 但是基層的診所其實對民眾就醫來講是相對比較方便的那所以你現在有沒有把握就是說經過你們這樣的激勵之後你剛剛說有部分已經到10%那整體22個縣市 你有把握平均數可以拉到10到15%嗎我們朝這個10%來努力10%嗎 對所以寄出16億也只能到10% |
| transcript.whisperx[184].start |
5587.308 |
| transcript.whisperx[184].end |
5606.308 |
| transcript.whisperx[184].text |
你知不知道大家診所不開不開的原因不過也要考慮到的是說民眾的那個就醫需要啦是因為這個傳統上這個大年初一看病這個我知道但是我們的醫療讓大家都很累但是沒有病人也不好所以我們在在拿捏在拿捏 |
| transcript.whisperx[185].start |
5607.589 |
| transcript.whisperx[185].end |
5619.078 |
| transcript.whisperx[185].text |
是我覺得這個部分的確你們要好好去研議我今天看到了這個基隆市政府他們做一件事情我覺得蠻不錯的我認為衛福部應該去督導各縣市是不是可以比照辦理他們其實在26號他就找了這個區域裡面包括醫師公會然後醫院診所就是大家來開會然後仔細去盤點然後很慎重的來看待這件事情 |
| transcript.whisperx[186].start |
5635.211 |
| transcript.whisperx[186].end |
5659.73 |
| transcript.whisperx[186].text |
去整合這樣的一個醫療量能那另外一個呢他還特別在2月14號呢他要開始去安排人力每天去監控就是他的急診的就醫人數還有病床數還有他跟醫院的高層他其實是會及時有一個及時的調度機制的然後呢他就是透過這個及時調度機制要去確保醫療量能是足夠的 |
| transcript.whisperx[187].start |
5660.51 |
| transcript.whisperx[187].end |
5665.895 |
| transcript.whisperx[187].text |
我看到金融市政府衛生局這樣的做法我個人覺得蠻欣賞的因為這個就是很確實去掌握在地的所有的醫療量而且透過溝通透過平台也跟醫院的高層可以有一個即時調度的機制那我要問你的是 |
| transcript.whisperx[188].start |
5677.325 |
| transcript.whisperx[188].end |
5698.03 |
| transcript.whisperx[188].text |
除了高雄市政府這樣做之外其他的22個縣市有沒有比照這樣跟進辦理有沒有人在做這件事你掌握情況如何根文人報告其實好幾個縣市都是這樣啟動像桃園也是台南也這樣做所以衛生局都主動的去介入像台南市的開診率就很高 |
| transcript.whisperx[189].start |
5698.63 |
| transcript.whisperx[189].end |
5728.15 |
| transcript.whisperx[189].text |
他現在已經調查到800多家都要開了所以這個確實像您講的衛生局如果能夠更主動一點這個就會效果更好那我們現在也在2月2號還會再找所有各衛生局再開一次去了解目前的開診情形跟這個力道夠不夠所以我想這個我們會密切的您的這個所舉的這個基隆市的例子其實我們知道幾個縣市也都做得不錯我們會來跟他們分享這個做法 |
| transcript.whisperx[190].start |
5728.77 |
| transcript.whisperx[190].end |
5751.88 |
| transcript.whisperx[190].text |
你作為中央主管機關其實就是要掌握有些做比較好的就要讓其他縣市知道說事實上透過這樣的一個協調的機制溝通或者是你的一個監測你會讓整個的運作其實是達到你原來想要達到的目的不是只有獎金發出去好像它就自然產生效果其實並沒有還有中間你整個落實的部分所以這個部分我希望你們好好去督導 |
| transcript.whisperx[191].start |
5752.58 |
| transcript.whisperx[191].end |
5779.295 |
| transcript.whisperx[191].text |
那另外一個就是剛剛葉委員提到就是即時就醫的資訊夠不夠透明你剛剛說你可以透過APP就是在春節期間所有的醫療量能哪些診所開診幾點到幾點你現在已經佈建好這樣的一個即時就醫地圖了嗎對 已經Ready了Ready了是不是那它會即時更新嗎對 現在不斷的在更新都會即時更新那個資訊嘛那那個APP是在哪裡1月28號上線1月28號 |
| transcript.whisperx[192].start |
5782.156 |
| transcript.whisperx[192].end |
5797.361 |
| transcript.whisperx[192].text |
1月28號就是這禮拜已經上線了就會上線那在我們的健保的APP上面會有一個專區但是資訊還在不斷的更新因為有的還在調查所以現在是可使用了對 應該可以了嗎 |
| transcript.whisperx[193].start |
5798.64 |
| transcript.whisperx[193].end |
5819.671 |
| transcript.whisperx[193].text |
來我們那個署長好來是謝謝委員的指導所以我們在健保APP有一個春節專區上面有兩個鞭炮點進去點自己所在地點你要的時段就會跑出所有有開診的醫療院所是即時的所以一直在更新那我們昨天做的資訊測試這禮拜就可以對外公佈以上這禮拜什麼時候對外公佈 |
| transcript.whisperx[194].start |
5821.28 |
| transcript.whisperx[194].end |
5828.365 |
| transcript.whisperx[194].text |
已經上線了28號所以今天已經可以開始使用了那待會大家幫忙測試一下大家測試一下如果有什麼問題立刻跟我們反映 |
| transcript.whisperx[195].start |
5836.752 |
| transcript.whisperx[195].end |
5851.171 |
| transcript.whisperx[195].text |
我觉得这个部分其实非常的重要我希望我们今年的春节医疗量能是匆匆容容游刃有余不要连滚带爬我想希望在大家的通力合作底下可以达到这样的效果 |
| transcript.whisperx[196].start |
5851.711 |
| transcript.whisperx[196].end |
5870.087 |
| transcript.whisperx[196].text |
那最後我要問的是事實上醫院裡面這個護理人員其實非常的辛苦那你們的這個護病比獎勵金的制度現在施行下來呢有兩個問題我希望部長回去之後你還是要去思考一下第一個就是說醫學中心的門檻有沒有過高的問題你們在114年6月獎勵金這個 |
| transcript.whisperx[197].start |
5875.291 |
| transcript.whisperx[197].end |
5884.661 |
| transcript.whisperx[197].text |
幾家大的醫學中心都還有分到但是呢你們調高門檻之後呢瞬間歸零啊獎勵金突然就歸零部長你知道這樣的情況嗎 |
| transcript.whisperx[198].start |
5885.891 |
| transcript.whisperx[198].end |
5910.824 |
| transcript.whisperx[198].text |
我再了解一下這個是去年的事對我希望這個部分你們好好去去研議一下瞬間歸零那這個當然護理師就也一毛錢就拿不到了那另外一個是地區醫院你的公式設計你完全跟住院住院率就是來做聯動然後有護理師就說領到醫院發的幾十塊他覺得是被羞辱啊 |
| transcript.whisperx[199].start |
5912.065 |
| transcript.whisperx[199].end |
5928.397 |
| transcript.whisperx[199].text |
因為醫院分到很少 他就這樣分下去幾十塊也算獎勵金 這個覺得不生唏噓所以像這個護理人員 最近大家也在討論怎麼樣讓我們的護理師可以減少他的人力負擔 包括你們現在要引進 |
| transcript.whisperx[200].start |
5929.11 |
| transcript.whisperx[200].end |
5943.886 |
| transcript.whisperx[200].text |
一些外籍工他可以來從旁協助這個方向性我個人是支持的是降低這個護理師但是本職上面他們在第一線的現場有一些還是是工作負荷過高的一個問題我覺得這個真的是很長期以來的問題啦那我希望部長這個新上任這個問題 |
| transcript.whisperx[201].start |
5951.38 |
| transcript.whisperx[201].end |
5978.995 |
| transcript.whisperx[201].text |
你可能要多想想怎麼樣可以讓我們的護理師真的可以穩定下來因為我們在醫院的這個整個運作少了護理師病床都開不了他們真的很重要是 我們會來檢討不過剛剛提到這個幾十塊的我們有查最主要就是因為都是20床以下的醫院所以床數就是很少所以它也沒有什麼病人所以換句話說它的loading也很輕 |
| transcript.whisperx[202].start |
5979.955 |
| transcript.whisperx[202].end |
5995.385 |
| transcript.whisperx[202].text |
但是他不是住房的這部分他可能是在門診的部分不管門診的這是住院歸住院的護理師因為我們的加成是根據你收治住院病人的10%去加成他只住一天 |
| transcript.whisperx[203].start |
5996.266 |
| transcript.whisperx[203].end |
6021.242 |
| transcript.whisperx[203].text |
就是有一種沒有病人其實是沒有病人其實這樣的護理人員他上班的時候也輕鬆因為沒病人但是他需要有一個護理師在那邊病房要等不知道什麼時候會有但是確實又沒有什麼病人來所以他最後會領到的很少主要是這樣所以這樣的公視對這一類的醫院其實就沒有產生效果我們來討論看看分到幾十塊這還是 |
| transcript.whisperx[204].start |
6024.844 |
| transcript.whisperx[204].end |
6035.886 |
| transcript.whisperx[204].text |
怎麼讓這些小型醫院的這個功能能夠發揮出來這是另外一個要思考的好啊你們一併去檢討好不好好謝謝好謝謝委員謝謝王育民委員發言接下來請邱振軍委員發言好謝謝主席我們請部長有請石部長 |
| transcript.whisperx[205].start |
6054.83 |
| transcript.whisperx[205].end |
6070.237 |
| transcript.whisperx[205].text |
好 最後人長部長好剛剛大家都在關心這個議題就是我們春節期間那我看了一下資料這個去年的時候平均每天急診就3.7萬人次那最高單日達到4.5萬人 |
| transcript.whisperx[206].start |
6071.657 |
| transcript.whisperx[206].end |
6096.799 |
| transcript.whisperx[206].text |
不論對急診醫護人員或對正在等床等救命的病人來說都是一個非常緊繃甚至帶有風險的一個狀況尤其是對重症的重症者而言時間就是生命那部長你們所謂的強化區域聯防機制遇到某一家醫院或某一個區域急診跟ICU的量能已經飽和的時候實際負責調度跟轉送決策的是誰是中央還是地方 |
| transcript.whisperx[207].start |
6098.221 |
| transcript.whisperx[207].end |
6124.07 |
| transcript.whisperx[207].text |
這個當然是這個跟委員報告說我們第一個是監測系統把它建立起來所以包含這個ICU 膠物病房的量的情形都有然後地區上我們有一個這個地區的這個RMEOC這個區域的緊急醫療應變中心會協助衛生局來做病床的所以他是中央來主導還是地方在掌控 |
| transcript.whisperx[208].start |
6126.431 |
| transcript.whisperx[208].end |
6141.276 |
| transcript.whisperx[208].text |
地方失靈的時候我們中央什麼時候會介入因為我們也建立了這個平台所以我們會他需要跨區的協助的時候我們就會透過這個剛剛提到的REMOC來協助跨區的調度這樣 |
| transcript.whisperx[209].start |
6143.034 |
| transcript.whisperx[209].end |
6163.452 |
| transcript.whisperx[209].text |
您提的是這樣因為每個縣市衛生局他只能管到他轄內醫療院所那可能每一個縣市的醫療資源因為我看到有這個需要跨區的調度有這個東西但是就是沒有人負責我現在意思是這樣總是要有一個人負責去做這件事情不能說到時候出了狀況又推來推去的 |
| transcript.whisperx[210].start |
6165.974 |
| transcript.whisperx[210].end |
6189.555 |
| transcript.whisperx[210].text |
會會 今年我們特別強化這個區域的合作包含我們的這個健保的分區業務組的組長包含我們這個這個剛剛提到的這個REMOC都會在這個組組裡面協助我希望這個還是要有一個人負責這樣才有責任當然這樣做起來才會比較有效率 好吧那另外我看到你們這個春節的整備專案裡面 |
| transcript.whisperx[211].start |
6190.476 |
| transcript.whisperx[211].end |
6213.357 |
| transcript.whisperx[211].text |
你們投入了16億用在診察費跟護理費跟藥事服務費加成簡單說這16億其實有兩個目標啦當然是一個降低急診擁塞的情況嘛那第二個是安撫我們在線的這個第一線比較忙碌的這些人員嘛那我們先講第一個目標你們要避免春節急診擁塞核心的做法就是讓 |
| transcript.whisperx[212].start |
6214.398 |
| transcript.whisperx[212].end |
6224.584 |
| transcript.whisperx[212].text |
醫院門診 基層診所願意開診讓輕症患者有地方去嘛那不要全部都擠到急診去那你有沒有設定一個目標你們這一次要打到幾層啊 |
| transcript.whisperx[213].start |
6225.526 |
| transcript.whisperx[213].end |
6254.085 |
| transcript.whisperx[213].text |
就是說在醫院的部分過去大概開診率比較低的都是初一、初二、初三一般都初四、初五就開診了所以我們去提高初一、初二、初三這幾天的開診率那目前看起來醫院都會到七成以上都會開了那另外基層的部分過去這幾天大概都2%到4%左右而已那我們今年希望能夠提高到大概10%左右你怎麼做 你這個10%你要怎麼做 |
| transcript.whisperx[214].start |
6255.346 |
| transcript.whisperx[214].end |
6280.425 |
| transcript.whisperx[214].text |
怎麼做我們現在已經第一個我們有這個剛剛提到的這個獎勵的機制另外有衛生局可以協調地方的醫師公會去這個安排看診然後我們再把這個已經有具體做了嗎已經在進行了我不希望這只是這個花了錢在碰運氣啦不要說我有這個政策但是呢要看這個地方的診所自己願意參加我們提供獎勵當然要進去協調啦我覺得這個才會有效果 |
| transcript.whisperx[215].start |
6283.988 |
| transcript.whisperx[215].end |
6308.416 |
| transcript.whisperx[215].text |
因為再來就是我們這個疾病館這個疾管署我們2025年春節期間全國加開的傳染病特別門診大概是1230次這個診治那今年延續去年一樣會開今年要開多少次一樣就是急救責任醫院都會開因為你們去年好像只有提高一成嘛對不對 |
| transcript.whisperx[216].start |
6310.681 |
| transcript.whisperx[216].end |
6319.272 |
| transcript.whisperx[216].text |
對去年的這個只有這個CDC的這個流感門診有獎勵措施今年是全面性的有健保介入 |
| transcript.whisperx[217].start |
6320.714 |
| transcript.whisperx[217].end |
6341.773 |
| transcript.whisperx[217].text |
那第二個目標就是我們讓這個春節要上班急診與住院的這個病房醫師醫護人員在原本的加班費之外再有額外的補償加成嗎這樣沒有錯嗎對就是我們提供的提供在這個住院的部分的這個護理費、診察費還有這個藥事服務費都加成 |
| transcript.whisperx[218].start |
6342.193 |
| transcript.whisperx[218].end |
6363.239 |
| transcript.whisperx[218].text |
我看到你們的規定寫得非常明確,至少有80%要實際發給出勤的人員那我看到因為醫學中心為例,一名護理人員在春節期間只要實際上一個班在這個加成制度下,實際可以領多少錢?有算過嗎? |
| transcript.whisperx[219].start |
6364.264 |
| transcript.whisperx[219].end |
6383.566 |
| transcript.whisperx[219].text |
沒有這個是我們以這樣的方式去給醫院費用但是醫院還要去分攤給其他的比如說他可能也有清潔人員要出來或者是S光醫事檢驗師醫事放射師所以他們是要去以這個錢去給有上班的人大家去分配的 |
| transcript.whisperx[220].start |
6383.806 |
| transcript.whisperx[220].end |
6397.377 |
| transcript.whisperx[220].text |
那個護理師公會全國聯合會在社群上有幫你們計算這個做法把它計算出來那以醫學中心急性一般病床為例這個護理費第二天以後是888點 |
| transcript.whisperx[221].start |
6399.258 |
| transcript.whisperx[221].end |
6410.927 |
| transcript.whisperx[221].text |
春節加成100%每床大概多888點40床就是35520點如果一天三班合計16人出勤平均每人可以分配到2220點那其中至少八成約1776點應該要發給實際出勤的第一線人員一天有三班等於護理師 護理人員上一個班大概多600元左右這個數字對嗎 |
| transcript.whisperx[222].start |
6429.686 |
| transcript.whisperx[222].end |
6455.382 |
| transcript.whisperx[222].text |
我不太敢確定是醫院怎麼樣去處理這些費用因為他們本來就有在加我知道他實際是給院裡面處理但我現在問的不是個案差異而是制度設計下合理推估上一個班第一線護理人員到底能夠拿到多少這如果我們自己都講不出來這個加成對他們來說到底是不是一個有感的一個獎勵金我覺得部長要去思考好 |
| transcript.whisperx[223].start |
6455.802 |
| transcript.whisperx[223].end |
6480.895 |
| transcript.whisperx[223].text |
好不好 因為這個我覺得非常重要啦因為我們不曉得他們怎麼去處理嘛我覺得我們部裡面既然有這個心意我還是要讓醫護人員能夠感受到 好不好另外 我們賴總統在選前親自向護理人員做出明確的承諾開出一張很清楚的支票 三班護病筆要入法 兩年內要入法現在今年5月20賴總統就要兩年了 上任就要兩年了 |
| transcript.whisperx[224].start |
6482.276 |
| transcript.whisperx[224].end |
6490.564 |
| transcript.whisperx[224].text |
那目前只剩下半年的時間我請教部長我們總統的政見三班戶並比兩年要入法這這項承諾會不會跳票 |
| transcript.whisperx[225].start |
6492.879 |
| transcript.whisperx[225].end |
6519.856 |
| transcript.whisperx[225].text |
我想這個在這個三班互比比上我們做了很多的努力那現在看起來護理人員有在這個提升這個已經在回流了啦然後這個符合達標的比例也在提高那不過呢我們還有很多的做法包含這個自動化的措施簡化那麼對因為很多醫院所以到底這個互併比應該要做什麼樣的他已經達標的沒錯有很多已經到地區醫院到92.1% |
| transcript.whisperx[226].start |
6522.057 |
| transcript.whisperx[226].end |
6541.182 |
| transcript.whisperx[226].text |
那全台有400多間醫療診所也有86.7%的這個達標率那既然大多數醫院已經做得到數據也證明不會衝擊偏鄉的醫療那我想這個部分是不是能夠在這個520之前提出來我想這個護病比入法 |
| transcript.whisperx[227].start |
6542.673 |
| transcript.whisperx[227].end |
6554.114 |
| transcript.whisperx[227].text |
這個我想這個方向我們會朝這個方向來努力不過重點是那個比例應該是多少要讓它有彈性不要是一個很固定的一個數值反而那個彈性不見了那麼 |
| transcript.whisperx[228].start |
6555.416 |
| transcript.whisperx[228].end |
6575.903 |
| transcript.whisperx[228].text |
反而讓這個醫院沒有願意去投入讓他去降低這個臨床的負荷那同時也可能影響到病人的權益啦所以這個我們是要兩邊要兼顧的所以我是覺得這個部分還是要加快因為我們醫護人員這個大出走的時候我們再來處理就太慢了 |
| transcript.whisperx[229].start |
6577.286 |
| transcript.whisperx[229].end |
6605.141 |
| transcript.whisperx[229].text |
降低這個臨床的負荷這個目標是一致的這個不會改變但是我剛剛提到的這個護病比的數字不要用一個單我希望這樣啦這個議題這個法案不要變成一個政治議題啦不要說到時候萬一這個出了狀況之後在財囊來做趕快來入法然後來救生量我不希望把它變成一個政治工具好不好部長你這個盡快那另外最近看到新聞啦就是西醫 |
| transcript.whisperx[230].start |
6606.421 |
| transcript.whisperx[230].end |
6629.771 |
| transcript.whisperx[230].text |
這個印度西孟加拉省爆發的高致死率的立百病毒的疫情那我看到我們的報告就是說預告60天所以在3月中會將立百病毒列為第五類法定傳染病那我們在1月27號發布這個醫界通函提醒醫師詢問這個旅遊史等等這些但我看到看的就是說 |
| transcript.whisperx[231].start |
6631.051 |
| transcript.whisperx[231].end |
6653.773 |
| transcript.whisperx[231].text |
預告期60天是你們的行政慣例那可是其實亞洲國家其實就已經戰戰兢兢在在解決這個事情你不覺得60天太久嗎這個我們隨時來調整不過我們在一介通海裡面已經提到就可以開始通報了那這個預告完之後那個就變成強制性啦那現在我們已經是要求提高這個警覺如果 |
| transcript.whisperx[232].start |
6654.614 |
| transcript.whisperx[232].end |
6669.404 |
| transcript.whisperx[232].text |
排除了現有的病毒性感染特別是在腦炎的部分尤其現在是春節期間很多國人都會從這個在外面的都會回來或者出國旅遊的所以我覺得這是高峰期你這個我覺得這個東西你拖到60天會不會太慢不會 |
| transcript.whisperx[233].start |
6670.585 |
| transcript.whisperx[233].end |
6689.481 |
| transcript.whisperx[233].text |
應該跟委員說明這個是法律規定我們就這樣做可是實務上我們在進行的防疫措施已經啟動了那另外也藉這個機會也跟國人說明一下目前在印度發生的這一個立百病毒的案例看起來是控制住的 |
| transcript.whisperx[234].start |
6690.121 |
| transcript.whisperx[234].end |
6713.017 |
| transcript.whisperx[234].text |
你不要講控制 當初花蓮那個驗社會也是說控制住 後來不是出了狀況對不對 我覺得我們還是不管做什麼啦 就是說還是要未雨綢繆我希望這個東西就是未雨綢繆我們做好準備 但是國人不需驚慌不用太擔心 當然不用驚慌 可是因為要相信你們啦對不對 對但是我希望布裡面不要讓人民失望沒有問題 謝謝 |
| transcript.whisperx[235].start |
6719.957 |
| transcript.whisperx[235].end |
6724.021 |
| transcript.whisperx[235].text |
好 謝謝邱正軍委員發言接下來請圖全吉委員發言好 謝謝主席 那請問石部長有請石部長 |
| transcript.whisperx[236].start |
6737.112 |
| transcript.whisperx[236].end |
6750.608 |
| transcript.whisperx[236].text |
好 市部長那之前在總質詢的時候有跟院長還有衛福部說拜託檢討一下我們桃園沿海醫療量能的問題這部分部長有 |
| transcript.whisperx[237].start |
6752.43 |
| transcript.whisperx[237].end |
6766.444 |
| transcript.whisperx[237].text |
知道這件事嗎有有有就是委員一直在關心這個我們新屋分院桃園新屋分院那個一直在行政院審查當中應該快要有結果了我們在做最後的計畫修訂 |
| transcript.whisperx[238].start |
6767.865 |
| transcript.whisperx[238].end |
6790.544 |
| transcript.whisperx[238].text |
因為那時候講沿海醫療量能的問題因為我們說像我們全台灣有最大的三個工業區一個是張濱 雲林還有一個就是我們桃園沿海的觀音工業區那觀音工業區裡面它包含桃科工業區 環科工業區 大唐工業區還有旁邊的大園工業區那據我們了解我們看張濱工業區它裡面 |
| transcript.whisperx[239].start |
6793.186 |
| transcript.whisperx[239].end |
6810.506 |
| transcript.whisperx[239].text |
有一個區域教學醫院就是我們彰化秀傳醫院那在雲林工業區裡面有一個地區醫院是我們雲林長庚醫院所以我們發現我們為什麼說要討論這沿海醫療量呢你看我們這個北部最大的工業區觀音工業區那這裡面 |
| transcript.whisperx[240].start |
6813.469 |
| transcript.whisperx[240].end |
6828.884 |
| transcript.whisperx[240].text |
包含我剛剛講的那麼多個工業區都在裡面可是這裡面完全都沒有醫療院所然後也沒有急診所以這部分部長有幫我們了解有沒有什麼要怎麼樣去做改善的地方 |
| transcript.whisperx[241].start |
6829.96 |
| transcript.whisperx[241].end |
6844.425 |
| transcript.whisperx[241].text |
這個我們會再找這個桃園衛生局我們來討論看看因為這個這個桃園的副市長王副市長他很有想法那他的想法也很不錯我們會跟他來討論之後來協助對因為 |
| transcript.whisperx[242].start |
6847.426 |
| transcript.whisperx[242].end |
6859.62 |
| transcript.whisperx[242].text |
他們有討論過就是市府可能規劃要市立醫院然後在觀音成立一個分院可是成立分院他可能是會設門診但是一樣 |
| transcript.whisperx[243].start |
6862.423 |
| transcript.whisperx[243].end |
6888.771 |
| transcript.whisperx[243].text |
可能因為他說因為他本身資源的問題他沒有辦法去做這個急診對 跟委員說明這個王副市長很特別也跟我提到這個事情那他的想法也蠻務實的就是說你去弄一個醫院那但是呢這個醫院現在光是這個找人啦這個開病床這個問題啦那這個地方的主要任務就是向UCC啦就是向我們現在所提供的這個 |
| transcript.whisperx[244].start |
6890.331 |
| transcript.whisperx[244].end |
6906.456 |
| transcript.whisperx[244].text |
及輕症或者是重症的初步處理然後就後送所以大概會朝這個方向來設計讓我們來跟衛生局來討論看看如果需要我們協助的部分我們會全力來協助 |
| transcript.whisperx[245].start |
6907.476 |
| transcript.whisperx[245].end |
6928.794 |
| transcript.whisperx[245].text |
因為我們在講最主要除了它本身因為我們發現大園跟觀音完全都沒有急診便房然後它裡面除了一般它裡面居住的人口之外其實它現在人口一直在成長最主要每天到工業區上班的人數也是非常非常的多 |
| transcript.whisperx[246].start |
6929.454 |
| transcript.whisperx[246].end |
6953.982 |
| transcript.whisperx[246].text |
那如果說成立這個觀音分院是不是有接衛福部可以把他納入緊急醫療網的部分來加強他急診這個方面就是他的功能像我們現在做的UCC像我們UCC是做假日嘛然後再看他當時候因為有時候夜間不見得需要但是平常因為上班時間人比較多那萬一有什麼狀況的時候可以就近除的處理好 那這部分 |
| transcript.whisperx[247].start |
6955.442 |
| transcript.whisperx[247].end |
6974.509 |
| transcript.whisperx[247].text |
若市立醫院觀音草大分院成立之後是不是衛福部我希望說請他們送計畫跟衛福部討論納入緊急醫療網我們之前是這個對於這個為了避免妨礙到分級醫療政策的推動所以一般的醫院的所謂的院外門診部已經是禁止不設 |
| transcript.whisperx[248].start |
6975.129 |
| transcript.whisperx[248].end |
6998.911 |
| transcript.whisperx[248].text |
但是公立醫院如果是基於他的公共任務需要的話呢那麼我們可以專案來審查所以我們會請這個衛生局提出這個整個規劃之後我們來協助討論好那就請部長幫忙希望我們這個市立醫院觀音草大分院成立之後希望衛福部把他納入這個方向我很支持好希望把他納入我們就有機會在這邊設急診病房是 |
| transcript.whisperx[249].start |
7001.013 |
| transcript.whisperx[249].end |
7018.074 |
| transcript.whisperx[249].text |
好那剛剛部長也知道也有討論到就是我們因為剛前面有提到我們觀音不是我們部桃新屋分院綜合醫療大樓的擴建計畫那這部分現在部長你掌握的情形到哪裡 |
| transcript.whisperx[250].start |
7019.418 |
| transcript.whisperx[250].end |
7044.358 |
| transcript.whisperx[250].text |
這個在做最後的修訂了啦應該也快了應該也快了對 據我們了解好像說我們查詢我們在今年1月15號查詢說國發會已經把他的審議意見函附給行政院了對對對而且他們也說請行政院協助競訴核定表示他們也認同這個綜合醫療大樓部桃西屋分院擴建計畫應該也要馬上進行是 |
| transcript.whisperx[251].start |
7046.5 |
| transcript.whisperx[251].end |
7073.268 |
| transcript.whisperx[251].text |
所以這部分請部長再幫我們多叮嚀因為這關係到我們大園觀音新屋還有我們陽梅整個周邊因為這醫療資源真的匱乏所以我們把計畫在部桃新屋分院這擴建計畫提升我們的醫療量能提升它的醫療資源好 這個我們的責任好 這部分也請我們部長多幫忙那還有這個之前我們有提到我們目前真的 |
| transcript.whisperx[252].start |
7074.229 |
| transcript.whisperx[252].end |
7095.054 |
| transcript.whisperx[252].text |
我們這個醫事放射師還有護理師人力不足像今天大家討論我們春節急診還有我們三班戶病比的問題所以我們了解其實現在最擔心的就是我們護理師人力不足還有醫事放射師人力不足那這部分之前也跟部長來討論過那 |
| transcript.whisperx[253].start |
7097.455 |
| transcript.whisperx[253].end |
7107.292 |
| transcript.whisperx[253].text |
部長後來你有了解我們各縣市醫事放射師人力的缺口的情形部長這部分有沒有掌握是不是很缺啊 |
| transcript.whisperx[254].start |
7108.612 |
| transcript.whisperx[254].end |
7130.699 |
| transcript.whisperx[254].text |
我想醫事司昨天才跟醫事放射師團體大家有做過一些討論了解他們所面臨到的職業困境健保也在協助陳署長也親自跟他們談過所以我們未來會有一些新的改善方案 |
| transcript.whisperx[255].start |
7131.199 |
| transcript.whisperx[255].end |
7158.349 |
| transcript.whisperx[255].text |
對 據我們了解其實北部你看連續兩年我們查了一下連續兩年這放射師招募都不足那中部我看很多教學醫院居然高達大概有五成的缺口所以這個直接其實影響到我們民眾的醫療的權益你像他們排這個CT電腦斷層還有MRI 實證照影常常都要 |
| transcript.whisperx[256].start |
7159.353 |
| transcript.whisperx[256].end |
7172.979 |
| transcript.whisperx[256].text |
兩三個月甚至要到半年所以這我覺得這個人力的缺口已經嚴重影響到我們民眾醫療治療的權益那然後我們也了解看我們針對台灣這幾年來應屆畢業生 |
| transcript.whisperx[257].start |
7177.982 |
| transcript.whisperx[257].end |
7194.375 |
| transcript.whisperx[257].text |
這個醫事放射師尤其我們查了一下像中山醫學大學他應屆畢業生我們看到這幾年我看這幾年他大概高達500人次都跑到新加坡去不知道部長針對這部分你有瞭解有掌握到這個狀況嗎為什麼會有這樣的情形 |
| transcript.whisperx[258].start |
7201.423 |
| transcript.whisperx[258].end |
7225.981 |
| transcript.whisperx[258].text |
我補充這段是昨天在跟相關同仁在做一個了解的時候他們其實是表示是我們台灣訓練出來的數字很好然後新加坡開出來的薪資比較高所以對新手上路剛畢業的人而言他是一個吸力那同時我們台灣這邊面臨到的困境就是我必須把我們自己的吸力跟推力減少推力增加吸引力所以昨天在討論的過程當中 |
| transcript.whisperx[259].start |
7227.182 |
| transcript.whisperx[259].end |
7246.054 |
| transcript.whisperx[259].text |
就包括了是我們的那個醫療機構設置這邊是不是能夠從我們的平靜的條文做一些改善不是再從病床數這邊然後另外一個心智的保障的部分昨天也大概有初步的一個了解所以這邊的話我們部裡面就是爭據這些的一個結論我們會再做政策調整以上 |
| transcript.whisperx[260].start |
7246.394 |
| transcript.whisperx[260].end |
7261.128 |
| transcript.whisperx[260].text |
所以剛剛有提到所以這當然我們很欣慰說我們訓練出來的這些醫事人員很優秀可是也很可悲我們花了那麼多錢教育出來優秀的人才結果全部跑到國外去被他高薪 |
| transcript.whisperx[261].start |
7261.708 |
| transcript.whisperx[261].end |
7275.097 |
| transcript.whisperx[261].text |
去挖角你看中山大學這幾年就500人次當然我們也了解因為他的薪水月薪大概12萬到15萬所以我們才會一直講說我們是不是在很多制度面應該要好好去檢討我們這些護理師人員還有 |
| transcript.whisperx[262].start |
7279.559 |
| transcript.whisperx[262].end |
7305.817 |
| transcript.whisperx[262].text |
這個醫事放射師人員他說他們低薪高工時業務量大那當然我們最近很多的福利做得很好像乳癌年輕化乳癌年輕化他去做這個篩檢但是變成我們這些放射師他的工作量能就變得更大所以我們才會提出像我們健保總額跟公務預算我們現在發現加起來 |
| transcript.whisperx[263].start |
7306.718 |
| transcript.whisperx[263].end |
7332.557 |
| transcript.whisperx[263].text |
超過一兆可是他們認為並沒有實質回饋在他們的身上所以我們才會提出像我們護理師的達標獎勵金還有夜班津貼還有我們醫事放射師的放射技術服務費是不是可以直接納入他們的薪資這部分才能實質回饋到他們的身上像護理師跟醫事 |
| transcript.whisperx[264].start |
7333.317 |
| transcript.whisperx[264].end |
7361.267 |
| transcript.whisperx[264].text |
放射師情形都是一樣啊是不是應該實質回饋到他們薪資身上不然這麼多優秀的護理師放射師人員好不容易我們培養起來全部外流到國外去那部長這部分是不是應該要好好的來討論解答謝謝委員的提醒我們會特別關注在醫院裡面的這一些醫事人員的薪資還有他的工作條件我們會來討論一些方案來協助提升 |
| transcript.whisperx[265].start |
7361.967 |
| transcript.whisperx[265].end |
7389.787 |
| transcript.whisperx[265].text |
因為這醫事放射師全聯會他們也有研議一些試辦計畫跟他放射服務費的增加與計算公式那在這邊我是不是可以等下會後我給部長你們拿回去研議一下再跟他們討論一下因為我們真的很擔心這些人才的外流以及嚴重影響到我們台灣的醫療品質那像這個部分回去研議大概三個月內可以回覆嗎 |
| transcript.whisperx[266].start |
7390.506 |
| transcript.whisperx[266].end |
7419.978 |
| transcript.whisperx[266].text |
三個月了好那還有像我之前有提出護理師的達標獎勵金跟月班津貼一樣納入護理人員的薪資那這部分上次有提過那還沒有回覆我們會來這個調查一下清查一下盤點一下這個執行的情形那大概多久可以回覆那些本來就是要規定要給護理人員的那一個月內可以回覆處理情形嗎那個一個月我們查一下 |
| transcript.whisperx[267].start |
7420.518 |
| transcript.whisperx[267].end |
7445.438 |
| transcript.whisperx[267].text |
好那這部分就拜託部長為了台灣的醫療品質和民眾的權益那拜託部長那這個資料就下給部長好謝謝謝謝圖權級委員發言那本席宣告待會兒這個本席亮偉翔委員詢答後休息五分鐘那先請蘇清泉委員 |
| transcript.whisperx[268].start |
7455.543 |
| transcript.whisperx[268].end |
7464.786 |
| transcript.whisperx[268].text |
好 謝謝主席 大家辛苦部長 請署長護睡署專門委員部長辛苦啦 醫院就像一條船每一個人都很重要 |
| transcript.whisperx[269].start |
7482.406 |
| transcript.whisperx[269].end |
7503.198 |
| transcript.whisperx[269].text |
準定大副、二副、準機長主崩的也很重要這麼準,台北人主崩也不能吃所以喪最重要,莫定大家都很重要台灣很重要醫院裡面有醫師有放射檢驗15個醫事相關人力 |
| transcript.whisperx[270].start |
7509.144 |
| transcript.whisperx[270].end |
7531.232 |
| transcript.whisperx[270].text |
沒有說誰重要到不行但是婦理人員真的是很重要一個醫院婦理人力如果能夠搞定這個醫院差不多解這三分之二的事情所以保證得婦理界者得天下你把婦理搞定了你就可以出來選了來這是 |
| transcript.whisperx[271].start |
7538.14 |
| transcript.whisperx[271].end |
7556.357 |
| transcript.whisperx[271].text |
急診室觀察床的護理點數,上面那個是703,那第二天開始629點喔,那是點不是人,護理的費用來下一頁,這個是經濟病床,一天是819點 |
| transcript.whisperx[272].start |
7559.74 |
| transcript.whisperx[272].end |
7586.219 |
| transcript.whisperx[272].text |
那有另外一個是734那如果一個婦女能照顧10床就八千一百九十點但是是三班子喔三個人要搬喔所以搬下來一個人差不多兩千多那一個護理人員一個月上班上二十二天老計劃的規定所以一天兩千多二十二天差不多四萬幾個 |
| transcript.whisperx[273].start |
7589.073 |
| transcript.whisperx[273].end |
7601.893 |
| transcript.whisperx[273].text |
ICU的,我昨天給他查了一下,他一天的護理費ICU,這裡面沒有ICU,沒有,沒有都說出來ICU三千九百幾點,有的是四千幾點,但是ICU是一個護士夠兩層 |
| transcript.whisperx[274].start |
7605.117 |
| transcript.whisperx[274].end |
7630.243 |
| transcript.whisperx[274].text |
所以兩成都要八千多 也三萬多 也兩千多元所以一個人差不多四萬幾 四的喔這四萬幾還要喊他的退休準備金什麼什麼所以是遠遠不足啦 所以癥結就出在這裡啦處理說你們核定的點數太低嗎沒有啦沒有對不對委員你做的意見很清楚 |
| transcript.whisperx[275].start |
7633.038 |
| transcript.whisperx[275].end |
7654.937 |
| transcript.whisperx[275].text |
不是這樣算啦因為我們還有很多的儲置費裡面都有人力費用啦所以放一個鼻胃管有一個費用啦所以這個護理費是基本的當然我們要調我們連續去年調25億今年還會再調25億所以我們四年會打算調100億都給護理費啦 |
| transcript.whisperx[276].start |
7657.984 |
| transcript.whisperx[276].end |
7671.442 |
| transcript.whisperx[276].text |
把它調起來啊但是其他的費用在調的時候裡面也包含人力費用啦在ICU最明顯啦ICU會有很多處置裡面都有護理人員執行的費用所以不是把護理費一調啦啊你一個企業裡面有 |
| transcript.whisperx[277].start |
7675.261 |
| transcript.whisperx[277].end |
7694.635 |
| transcript.whisperx[277].text |
清潔的有電力的有什麼東西都在裡面那個另外一筆是訂房費所以我要跟部長報告就是癥結點就在這裡昨天某一個醫學中心的院長跟我講他們的N1他們一年已經給他86萬了 |
| transcript.whisperx[278].start |
7697.679 |
| transcript.whisperx[278].end |
7716.414 |
| transcript.whisperx[278].text |
年薪啦,這付不去嘛,但是平時也是拿其他地方來賺,那你以前的肚腩,大家都叫我們硬來切去,因為你什麼都做過,你負責急診一直做,幼稚園一直做到急診,做到什麼什麼公務,你都做了 |
| transcript.whisperx[279].start |
7719.076 |
| transcript.whisperx[279].end |
7745.788 |
| transcript.whisperx[279].text |
你想知道這個問題是出在哪裡所以你剛剛講的我們很欣慰啦那對於中華民國在第一線執行護理的工作人員19萬人嘛那領召的30萬人我們對於在第一線執行的人我們都對他們非常的致敬跟最高的謝意啦台灣的那個健保能夠 |
| transcript.whisperx[280].start |
7747.25 |
| transcript.whisperx[280].end |
7762.191 |
| transcript.whisperx[280].text |
世界第一名台灣的國民平均壽命能夠一年一年增加最大的貢獻者是護理人員因為一個病人跟護理人員接觸的時間是超過所有醫事人員瞎起來 |
| transcript.whisperx[281].start |
7763.554 |
| transcript.whisperx[281].end |
7782.246 |
| transcript.whisperx[281].text |
有統計 差不多一個月兩次要跟病人差不多半個月八十個時間都跟護理監管接觸其他的醫師相關的都是很短暫醫師也是占5%到7%的時間所以護理人員是真的是要好好的照顧那這個負病比那個是 |
| transcript.whisperx[282].start |
7783.737 |
| transcript.whisperx[282].end |
7802.931 |
| transcript.whisperx[282].text |
你們也是往這個方向在挪念嘛對不對雖然沒有入伐我為了跟從要入伐的事情提一個案被罵得要死不然我看人家沒在美麗耶不錯耶你不錯你都沒人在美麗所以你真的得婦女戒你要得天下你講一下我聽你講一下你這樣問我也要怎麼接 |
| transcript.whisperx[283].start |
7813.226 |
| transcript.whisperx[283].end |
7827.624 |
| transcript.whisperx[283].text |
其實跟委員報告確實那個剛剛講的護理費我們在調嘛去年調了25億今年還會再調連四年要一共調100億進來那這次調我們特別去扣合那個薪資的成長 |
| transcript.whisperx[284].start |
7828.625 |
| transcript.whisperx[284].end |
7852.888 |
| transcript.whisperx[284].text |
所以不是調薪去錢就進去醫院的口袋啦是一定要搭配那個護理人員的薪資要調升我們會監測那個投保薪資所以我們看起來確實投保薪資去年年中12月跟前一年113年的投保薪資都有增加沒有錯所以本來有在做啦所以不會說我們只把護理費調升結果護理人員都 |
| transcript.whisperx[285].start |
7853.308 |
| transcript.whisperx[285].end |
7866.558 |
| transcript.whisperx[285].text |
都沒有薪資的調整 倒是我們很欣慰說大家有在做這方面的努力那我們會持續的來逐年逐年把它調升這個護理費的部分 |
| transcript.whisperx[286].start |
7867.322 |
| transcript.whisperx[286].end |
7890.219 |
| transcript.whisperx[286].text |
至於偏鄉的部分我們現在是也在爭取公立醫院能夠讓醫護人員在偏鄉加急讓願意留在偏鄉的醫護人員因為多數偏鄉的所在都公立醫院所以我們公立醫院爭取行政院的預算我知道也有一些醫院 |
| transcript.whisperx[287].start |
7890.959 |
| transcript.whisperx[287].end |
7900.884 |
| transcript.whisperx[287].text |
是在偏鄉的私立醫院我們更敬佩嘛所以我們來看看有什麼方式來一起協助你會主動講到偏鄉我很佩服你 |
| transcript.whisperx[288].start |
7903.326 |
| transcript.whisperx[288].end |
7925.058 |
| transcript.whisperx[288].text |
三地離島啊 偏鄉啊 這個真的我們在做第一線 我在做第一線的重症我感觸想最深嘛 諸位區裡面這個醫院大部分都比較正常 諸位區裡面的人他們的保險也多 個人健康保險也多所以他們的對於醫療的給付 醫療額外支出他們都沒問題 |
| transcript.whisperx[289].start |
7926.315 |
| transcript.whisperx[289].end |
7945.746 |
| transcript.whisperx[289].text |
整個吃飯就有些問題,大家又要吃土啊,你還有負的氣,那偏鄉的衣服呢,金門就找不到,金門就欠,就像你看的恆春半島,你如果在那裡不久,金門就找不到人,所以這點最重要。 |
| transcript.whisperx[290].start |
7948.491 |
| transcript.whisperx[290].end |
7972.5 |
| transcript.whisperx[290].text |
剛才說得富你得天下,偏香港搞定了你也可以得天下所以我現在都給他幾點名錄,你以後要算都沒問題來,下一張那這個春節這個剛剛你也講很多了啦所以我覺得這個錢一定一定一定會回饋給所有的人力 |
| transcript.whisperx[291].start |
7973.776 |
| transcript.whisperx[291].end |
7996.201 |
| transcript.whisperx[291].text |
錢最好是落到員工的口袋最好啦其他的都不重要現在最重要就是讓他們能夠有實質的回饋那你說80%多回饋給第一線嘛對不對對那這個可以這個很簡單啊你就看幾個三人三人的身份證資料回報回來一審查就知道了嘛那很簡單的啦對 |
| transcript.whisperx[292].start |
7997.113 |
| transcript.whisperx[292].end |
8014.179 |
| transcript.whisperx[292].text |
健保署什麼都沒有,這最厲害啦要monitor你最厲害所以我對這個我一點都不擔心我們現在醫院真的大家都很戰戰兢兢雖然是很辛苦,大家忙很久兩天 |
| transcript.whisperx[293].start |
8016.886 |
| transcript.whisperx[293].end |
8021.41 |
| transcript.whisperx[293].text |
對醫療院所要聽受啦,對醫務人員也要聽受啦,不然怎麼顧你我告訴你最近,我們屏東某醫院,其實沒有藏人住用坐的也坐到年齡,反正是站在吊墊上用手站這樣有誇張嗎?藏寶也不會進去 |
| transcript.whisperx[294].start |
8041.655 |
| transcript.whisperx[294].end |
8052.944 |
| transcript.whisperx[294].text |
這個都要持續的關注啦都會去的醫院就好好的營造他的環境他就會做得很好了啦好來最後一個我們護睡署我三天前我找你署長我跟他說這說了怎麼說補貼給我答應 |
| transcript.whisperx[295].start |
8064.52 |
| transcript.whisperx[295].end |
8083.44 |
| transcript.whisperx[295].text |
補充到財政部部長答應,說理財要改革,醫生的加班費、值班費,結果現在怎樣?陳時中次政委也出來協調,他告訴我這個案已經上議,行政院院長還在等,有沒有?補充有沒有? |
| transcript.whisperx[296].start |
8090.488 |
| transcript.whisperx[296].end |
8100.998 |
| transcript.whisperx[296].text |
我們一直在跟負稅署財政部跟還有這個人總大家都在討論所以差不多共識差不多了我們應該在 |
| transcript.whisperx[297].start |
8102.939 |
| transcript.whisperx[297].end |
8129.113 |
| transcript.whisperx[297].text |
這個二月的時候我們就會發一個這個函給財政部來做這個未來這個醫師在加班費的這個認定跟他使用 加班跟值班啦對 加班跟值班 醫生已經十五年不夠年齡了耶十五年都沒頂檔了耶所以現在這個誘人啊 遭了了耶現在這個重症醫師傳播每個醫生都遭遭一開業 |
| transcript.whisperx[298].start |
8130.644 |
| transcript.whisperx[298].end |
8146.286 |
| transcript.whisperx[298].text |
我那天有跟副市長說開業地也要處理啦 看要怎麼處理啦但是醫院這邊加班費吃飯川普總統你看他笑笑 但是他說加班費免稅 我覺得這真的不怪大家 |
| transcript.whisperx[299].start |
8147.808 |
| transcript.whisperx[299].end |
8174.311 |
| transcript.whisperx[299].text |
公共一站加班費 值班費 還有小費免費 免稅啊所以不然你把人家帶成這樣我這件種族事件我還可以自己問喔沒關係 不可以這樣做這個一定要解決啊不然的話越來越嚴重很快會有好消息長庚醫院 停國長庚五個GS醫師一幫肝臟外科醫師最近三個跑去診所這像話嗎 |
| transcript.whisperx[300].start |
8176.193 |
| transcript.whisperx[300].end |
8180.314 |
| transcript.whisperx[300].text |
部長這個太嚴重了 好不好好 謝謝 謝謝委員接下來我們請廖偉強 張偉來質詢 |
| transcript.whisperx[301].start |
8209.505 |
| transcript.whisperx[301].end |
8211.147 |
| transcript.whisperx[301].text |
我們怎麼最後可以這麼快樂 |
| transcript.whisperx[302].start |
8244.94 |
| transcript.whisperx[302].end |
8245.641 |
| transcript.whisperx[302].text |
謝謝主席 請時部長部長請 |
| transcript.whisperx[303].start |
8249.386 |
| transcript.whisperx[303].end |
8269.614 |
| transcript.whisperx[303].text |
六點好部長好我要接續我們醫界很敬重我們的蘇清泉院長的問題你剛剛說醫師加班費免稅這件事你剛剛說很快會有好消息什麼時候我們追蹤很久了本來上次你跟我說今年就可以用了那到底是什麼時候 |
| transcript.whisperx[304].start |
8270.374 |
| transcript.whisperx[304].end |
8295.256 |
| transcript.whisperx[304].text |
因為當然我們要釐清像剛剛這個蘇委員特別提到有的是加班有的是值班其實簡單講就是有正常工時制的跟輪班制的等一下部長怎麼說什麼時候有這個好消息應該你什麼時候公佈然後你們協調怎麼樣下個月我們大概協調的還有一次會議還有一次再一次就沒確定了嗎最後就拍板了 |
| transcript.whisperx[305].start |
8295.676 |
| transcript.whisperx[305].end |
8324.365 |
| transcript.whisperx[305].text |
再一次會議就排版了所以最快是什麼時候會有定案2月農曆年前可不可以給一個好消息農曆年前你要這個對不對我們在講今天急診的像血汗醫護你要在農曆年前給大家一個小紅包吧過年以前我們發個函啦過年以前發函我們趕一下看看我們發函好過年以前可以發函喔我今天的質詢這樣子就有一個有一個成果 |
| transcript.whisperx[306].start |
8325.526 |
| transcript.whisperx[306].end |
8354.496 |
| transcript.whisperx[306].text |
好那部長再來我要再剛這題剛這題你答應了過年前發汗好那再來就是我要問一下部長這個現在有這個多重病毒傳播國際化的問題那這個當然最近這個世界上動盪很大那部長美國的衛生部長小蘿蔔甘奈迪他說基於世衛與COVID-19的這個疫情期間的失職表現 |
| transcript.whisperx[307].start |
8355.663 |
| transcript.whisperx[307].end |
8357.907 |
| transcript.whisperx[307].text |
美國已經正式要退出WHO |
| transcript.whisperx[308].start |
8359.232 |
| transcript.whisperx[308].end |
8385.424 |
| transcript.whisperx[308].text |
那他的副部長歐尼爾又說WHO忽視台灣在2019年對於COVID-19的早期示警陷入官僚主義利益衝突以及國際的權力政治但是世衛的專家范科霍夫卻說歐尼爾所說的完全不實他又說台灣並未警告世衛台灣是在同一天向世衛 |
| transcript.whisperx[309].start |
8387.06 |
| transcript.whisperx[309].end |
8410.394 |
| transcript.whisperx[309].text |
這個索取資訊那是會沒有忽視台灣那我也注意到我們陳時中政委有反駁說台灣雖然沒有明確的說出會人傳人但是強調非典肺炎的特性且這個病患呢均隔離治療強烈的暗示人傳人的可能性那我想要請問一下部長台灣有確實依照 |
| transcript.whisperx[310].start |
8411.547 |
| transcript.whisperx[310].end |
8426.956 |
| transcript.whisperx[310].text |
國際衛生條例IHR的第六條通報世衛但為何會出現這樣的資訊落差那我也有去看了一下這個IHR的條文跟附件通報的條文和適用的決策文件的實例的確不需要指名說人傳人 |
| transcript.whisperx[311].start |
8428.237 |
| transcript.whisperx[311].end |
8455.678 |
| transcript.whisperx[311].text |
那就是要問一下部長現在美國要正式退出WHO那也打算成立新的國際衛生體系那我們未來會參加美國新成立的衛生體系嗎好 跟委員說明有關於當時候的通報2020年4月的時候指揮中心特別把當時候我們CDC發給衛生組織的那一個英文信公開給大家看上面明確的提到 |
| transcript.whisperx[312].start |
8456.198 |
| transcript.whisperx[312].end |
8474.779 |
| transcript.whisperx[312].text |
那麼有幾例的有7例的Atypical pneumonia就是不典型肺炎的發生同時呢正在接受Isolated treatment就是隔離的治療所以這已經很明顯的暗示這是一個不尋常的這個可能有人傳染感染的風險 |
| transcript.whisperx[313].start |
8476.861 |
| transcript.whisperx[313].end |
8494.072 |
| transcript.whisperx[313].text |
所以這個當時候可惜的是WHO忽略了台灣的這封信沒有及時的反映出說這個可能是一個人傳人的非典型肺炎所以確實我覺得這個美國次長所言是正確的 |
| transcript.whisperx[314].start |
8494.972 |
| transcript.whisperx[314].end |
8511.688 |
| transcript.whisperx[314].text |
那麼至於說美國退出WHO我想對WHO的衝擊可能遠比對台灣的衝擊更大但是WHO仍然是目前重要的國際公共衛生醫療上面的一個 |
| transcript.whisperx[315].start |
8512.569 |
| transcript.whisperx[315].end |
8535.871 |
| transcript.whisperx[315].text |
平台所以我們還是希望積極的爭取那麼參加那麼積極的參與活動那未來如果美國成立有另外的這個公共衛生的國際平台當然我們也會去積極的爭取加入那麼總是希望這個病毒或傳染病是沒有國界的所以意思就是說我們也會去爭取加入啦會會會 |
| transcript.whisperx[316].start |
8536.932 |
| transcript.whisperx[316].end |
8556.491 |
| transcript.whisperx[316].text |
因為我也是在想說你剛剛的答案就是說兩個你們都還是要持續的參與因為我剛剛也是的確我是覺得說因為過去年年編預算你們發新聞稿說要爭取加入WHO可是其實剛剛你說的對WHO衝擊很大這個美國是帶頭大哥他都跑走了那這個組織的 |
| transcript.whisperx[317].start |
8559.734 |
| transcript.whisperx[317].end |
8580.312 |
| transcript.whisperx[317].text |
資源大幅縮水所以我剛剛也是很想要問一下說那我們現在到底怎麼辦所以你現在一直說我們兩邊還是要持續爭取對好所以我想這個部分我們要拜託你要持續的追蹤希望可以持續的這個爭取實質的有意義的參與這些國際組織好再來我想要問一下 |
| transcript.whisperx[318].start |
8584.653 |
| transcript.whisperx[318].end |
8597.487 |
| transcript.whisperx[318].text |
部長我們也可以看到台灣的現況現在台積電為主的相關產業鏈和最優秀的人才最充裕的資金都向美輸出但是根據台大醫院的研究以往在台灣極為罕見的這個 |
| transcript.whisperx[319].start |
8600.819 |
| transcript.whisperx[319].end |
8627.211 |
| transcript.whisperx[319].text |
球黴菌症尤其在這個高風險族群如免疫力低下的相關的族群都可能會發生嚴重的肺部或這個擴散性的感染那在2021年前的我們我國只有一例但是最近呢這兩年它增加了12例也就是增加了變多了而且所有的病例呢都曾經赴美國的亞利桑那州跟加州 |
| transcript.whisperx[320].start |
8627.831 |
| transcript.whisperx[320].end |
8653.602 |
| transcript.whisperx[320].text |
那其中有六成呢從事半導體相關的產業他的這個趨勢跟台灣半導體去亞利桑那州的擴張持續有點蠻吻合的啦所以這個患者多半雖然目前是這個所謂的輕微啦或感冒啦或者是肺炎但是如果是免疫力差的就會變重症喔那針對這波的病毒換人才的公共衛生逆差 |
| transcript.whisperx[321].start |
8654.382 |
| transcript.whisperx[321].end |
8674.453 |
| transcript.whisperx[321].text |
那衛福部除了加強監測有沒有什麼具體的邊境的這個風險管控的方案那有沒有針對這部分的高風險的地區返台人才建立專屬的這個指引或者是通報的SOP或是像宣導這個立百病毒一樣加強宣導前往該地區的旅客應該注意的事項是 |
| transcript.whisperx[322].start |
8675.333 |
| transcript.whisperx[322].end |
8697.938 |
| transcript.whisperx[322].text |
是跟委員說明確實如同我剛剛提到病毒或者是傳染病是沒有國界的而且隨著這個人員移動的頻繁它就會造成這個疾病的這個散播那所以這個加強監測都是我們CDC一直在做的事情那這個監測不只是監測國內也要監測全球發生的這個 |
| transcript.whisperx[323].start |
8703.199 |
| transcript.whisperx[323].end |
8723.331 |
| transcript.whisperx[323].text |
變化統統要納入所以像立白病毒也是一樣雖然國內至今沒有驗出任何一例或者任何的確診病例可是因為國際有這個狀況為了強化這個通報監測及時察覺所以我們才會去預告說把它列為第五類傳染病那這個我們也會評估對我剛剛就是講到講的就是針對這一塊我們就 |
| transcript.whisperx[324].start |
8726.213 |
| transcript.whisperx[324].end |
8753.119 |
| transcript.whisperx[324].text |
因為時間有限我就是要提醒部長這塊你可能也要去注意監控一下趕快去做相關的這個這個宣導是對不對那另外就是除了這個球媒菌症之外類似的傳播途徑啊跟這個各類的變種病毒的也是很多啦所以包含著你們有監測的這個中國大陸目前的鼻病毒那它的還有流感疫情都處於高點那國內也出現首例 |
| transcript.whisperx[325].start |
8754.12 |
| transcript.whisperx[325].end |
8774.191 |
| transcript.whisperx[325].text |
這個俗稱這個蘋果病的B19的微小病毒那它會併發這個心肌炎那也有這個個案甚至我們台中啊有有名女童忽然在跟家人出遊的時候她就大叫一聲她就猝死了所以我想這個很多人都人心惶惶啦那所以大家會這麼害怕的原因主要是因為 |
| transcript.whisperx[326].start |
8774.771 |
| transcript.whisperx[326].end |
8794.769 |
| transcript.whisperx[326].text |
目前這個B19病毒它好像沒有疫苗也沒有特效藥那會併發心肌炎的死亡率也高達30%所以現在面對這個春節返鄉草基層診所有沒有配備足夠的這種快篩或是診斷的試劑或是還是要等到他們必須送到這個醫學中心才可以確診 |
| transcript.whisperx[327].start |
8796.605 |
| transcript.whisperx[327].end |
8822.274 |
| transcript.whisperx[327].text |
當然有一些比較罕見的病確實這個只能是提高警覺那適時的要要後送因為這個經驗的累積還是重要的所以我們會去強化所以我們有這個醫界通函經常會去提醒這個所有的第一線的人員注意那有發覺的時候就要通報後送這個還是有需要大概不太可能說這個 |
| transcript.whisperx[328].start |
8824.054 |
| transcript.whisperx[328].end |
8829.357 |
| transcript.whisperx[328].text |
這些病都在第一線就完全治療大概我們是強化這個體系之間的這個轉診這樣好 |
| transcript.whisperx[329].start |
8833.752 |
| transcript.whisperx[329].end |
8859.752 |
| transcript.whisperx[329].text |
那這個部分也是要提醒一下部長那另外就是剛剛最後因為其實今天題目蠻多的最後一天不過我最後還是問一下你們的這個APP你們現在去年的春節的急診擁塞的產況我想大家今天都很關注那你們預估急診人次也是平日的1.5倍到1.7倍左右那你們宣稱你們專案有七大監測指標那也針對這次的這個緊急醫療管理資訊系統 |
| transcript.whisperx[330].start |
8863.315 |
| transcript.whisperx[330].end |
8886.993 |
| transcript.whisperx[330].text |
的部分我想要問說你沒有經過相關的壓力測試嗎因為你們每一秒可能都有幾萬筆的資料要更新等等的那你們可不可以承諾說到時候這個APP是不會當機不會延遲那另外你們更新是30分鐘有落差喔我在想因為很多就醫是很很緊急的狀況有沒有辦法做到10分鐘內更新等等的 |
| transcript.whisperx[331].start |
8888.84 |
| transcript.whisperx[331].end |
8909.375 |
| transcript.whisperx[331].text |
那個EMIS的更新那個我們是跟醫院的資訊系統直接串接的所以它的更新我記得是兩分鐘幾分鐘我先補充一下就是說我們分兩塊一塊是民眾這邊就醫的是健保的那個健保快醫 |
| transcript.whisperx[332].start |
8910.296 |
| transcript.whisperx[332].end |
8925.591 |
| transcript.whisperx[332].text |
然後那我們的那個在跟醫院接接的時候我們是那個急救責任是200多家醫院所以我們其實從1月12號之後其實就開始做所謂的壓力測試就是他們上傳資料然後那因為這個資料目前是手動的 |
| transcript.whisperx[333].start |
8926.252 |
| transcript.whisperx[333].end |
8952.731 |
| transcript.whisperx[333].text |
目前是手動的所以他更新速度沒有辦法那麼快可是我們在這個調整過程當中如果要做自動化的話其實大概委員講的那個剛剛我們部長講的是已經自動化的他大概就可以做到就是那個10分鐘內絕對可以做update完現在是因為那個指標部分還在做標準化所以所以這個地方上面的那個更新的速度就沒那麼快指標還沒有那麼快嗎對指標還沒那麼快那什麼時候可以 |
| transcript.whisperx[334].start |
8954.281 |
| transcript.whisperx[334].end |
8980.244 |
| transcript.whisperx[334].text |
就是你們打算什麼時候他可以就是你剛說手動的部分對手動的部分因為現在只有填數字所以也不會造成是說第一線同仁的困擾然後那預計就是這個春節完之後有一些東西因為我們的春節是這個大概就是七九天的假期嘛所以春節完之後最重要的是後面春節完通常才是急診用篩的一個 |
| transcript.whisperx[335].start |
8981.165 |
| transcript.whisperx[335].end |
9000.233 |
| transcript.whisperx[335].text |
更恐怖的一個 另外一個要去調整的空間那個地方的話 我們是在那段時間會再去做調整對 以上OK 好 謝謝 以上謝謝 謝謝石部長好 謝謝委員好 謝謝廖委員 謝謝部長我們現在休息五分鐘接著期待林淑恩來時請 |
| transcript.whisperx[336].start |
9012.307 |
| transcript.whisperx[336].end |
9019.353 |
| transcript.whisperx[336].text |
今天要親吻今天要親吻你們要先那個那個來示範一下 |
| transcript.whisperx[337].start |
9041.151 |
| transcript.whisperx[337].end |
9063.45 |
| transcript.whisperx[337].text |
社保司啊 社會保險司啊社保司所以現在你社保司啊為什麼你現在不給我點名啊我不知道 我以為你叫我就給你點名啊你現在社保司社保司所以你可以點名劉市長 劉市長 |
| transcript.whisperx[338].start |
9070.332 |
| transcript.whisperx[338].end |
9071.813 |
| transcript.whisperx[338].text |
看你臉變圓了我收保險先 |
| transcript.whisperx[339].start |
9093.222 |
| transcript.whisperx[339].end |
9093.242 |
| transcript.whisperx[339].text |
劉醫師回來 |
| transcript.whisperx[340].start |
9121.71 |
| transcript.whisperx[340].end |
9140.468 |
| transcript.whisperx[340].text |
要叫人家走嗎?他要走回去啊就是這樣嗎?這個有 這個有 這個有啊你詳細的可以講嗎?你先問你先問你先問你先問你先問你先問你先問 |
| transcript.whisperx[341].start |
9147.887 |
| transcript.whisperx[341].end |
9158.3 |
| transcript.whisperx[341].text |
你可以去選日期比如說今年過年17號你就選時段上午 下午 下午要唱就下午就選時段點掉 看下午下午的話就選4 |
| transcript.whisperx[342].start |
9167.237 |
| transcript.whisperx[342].end |
9192.869 |
| transcript.whisperx[342].text |
他就會跑出來說 這個就是下午的開檯他呈現的就是下午的開檯 包含醫院 包含診所在這個區域 他很清楚如果你要詳細知道 他有什麼特別的服務他開的是什麼科 那你就去看醫院去參考因為診所就沒有分科 那醫院就會分科那你再去看說 他開什麼科 那你就去看 |
| transcript.whisperx[343].start |
9195.074 |
| transcript.whisperx[343].end |
9211.079 |
| transcript.whisperx[343].text |
這個時間還在休息 以後會是最完整的時間他只有半小時所以只要院所他們到上來 辦獎的時候就會點線上去因為如同今天部長講的 我們這22個縣市還有1個縣市會在開會因為我們獎金下去之後 很多人都會參與 |
| transcript.whisperx[344].start |
9217.861 |
| transcript.whisperx[344].end |
9221.024 |
| transcript.whisperx[344].text |
像部立醫院醫療院醫療院醫療院醫療院醫療院醫療院醫療院 |
| transcript.whisperx[345].start |
9245.183 |
| transcript.whisperx[345].end |
9251.07 |
| transcript.whisperx[345].text |
需要那麼看完還是資訊不完整我們調查的話是有一個時間下禮拜我們再發二月我們再發因為我們會去統計 |
| transcript.whisperx[346].start |
9265.927 |
| transcript.whisperx[346].end |
9274.253 |
| transcript.whisperx[346].text |
各縣市的開診所以下禮拜會一起開診?對對對 各縣市的開診我剛講的就是全部 因為我們下禮拜還有各縣市的開診 還有專區查驗查診會不會有健保部門? |
| transcript.whisperx[347].start |
9285.06 |
| transcript.whisperx[347].end |
9285.62 |
| transcript.whisperx[347].text |
沒有端區域 |
| transcript.whisperx[348].start |
9304.687 |
| transcript.whisperx[348].end |
9321.871 |
| transcript.whisperx[348].text |
而且就是像大家看的那樣,你要點進去看,點進去看才知道說今天你下一站,那這個專區就是直接把時段都拿出來了,日期的時段,過去是沒有啦,過去就是我在這裡,就會出現旁邊有什麼,然後就點進去,點進去看看有沒有看那個時段拍成這樣, |
| transcript.whisperx[349].start |
9327.732 |
| transcript.whisperx[349].end |
9339.079 |
| transcript.whisperx[349].text |
現在是直接整理 按照時段 日期設施出來醫院的部分反應很好人力上比較好調 醫院的人力比較好調這個獎勵技術大家都會學我都知道有些都要連班的方向 |
| transcript.whisperx[350].start |
9353.287 |
| transcript.whisperx[350].end |
9362.478 |
| transcript.whisperx[350].text |
那診所的部份因為他人力比較吃緊他有的都是一人診所所以他就可能是他在猶豫的一段時間比較期待他的假期出來開診診所的部份 |
| transcript.whisperx[351].start |
9370.387 |
| transcript.whisperx[351].end |
9372.047 |
| transcript.whisperx[351].text |
像台南 我知道他們調查過800多家 |
| transcript.whisperx[352].start |
9393.872 |
| transcript.whisperx[352].end |
9408.296 |
| transcript.whisperx[352].text |
診所診所醫院沒有那麼多人 醫院就只加了五千人目標啦 目標啦要看哪一天啦 比較緊的還是在初一啦往後初三就開始保險了今年的狀況比較好 初三就保險了以前是二到四十度 |
| transcript.whisperx[353].start |
9423.741 |
| transcript.whisperx[353].end |
9434.631 |
| transcript.whisperx[353].text |
還要在裡面居住所以他們現在各縣市公會也在裡面協調會員你好 會員一方指出這個主席到中山這個基層的主席到中山這個基層在中山所以有一些沒有 努力 |
| transcript.whisperx[354].start |
9443.906 |
| transcript.whisperx[354].end |
9455.192 |
| transcript.whisperx[354].text |
目標啦 不是目前啦 目前大概到7%目前來的調查是有問題那過往會不會除以對 初三現在比較好 現在就是初一 初二初一 初一 初一最低 |
| transcript.whisperx[355].start |
9473.362 |
| transcript.whisperx[355].end |
9488.595 |
| transcript.whisperx[355].text |
傳統上出於大家的不幸感所以大家就覺得我開了也沒有用沒有人來因為我們的家等級要有人來駕駛那裡沒有人要來駕駛所以我們試試看也不要說真的很多啦出於真的差別的人數現在不太多但是我們去年是特寫的去年出於這個 |
| transcript.whisperx[356].start |
9524.202 |
| transcript.whisperx[356].end |
9524.803 |
| transcript.whisperx[356].text |
來不好意思這個 |
| transcript.whisperx[357].start |
9529.103 |
| transcript.whisperx[357].end |
9536.306 |
| transcript.whisperx[357].text |
好謝謝媒體朋友那我們現在繼續開會那請林淑芬委員發言好謝謝主席我們是不是請石部長請石部長林委員早部長這個中榮的這個業務到底有沒有帶到 |
| transcript.whisperx[358].start |
9559.443 |
| transcript.whisperx[358].end |
9585.538 |
| transcript.whisperx[358].text |
到底有沒有抄刀你說要一個禮拜給大家報告早超過一個禮拜了這個以他送來的這個報告他送來的報告我們都知道是說沒有但他送來報告說沒有之後人家影像就曝光了所有的媒體都看過了人民也看過了就是有你現在還在講他送來的報告你知道你們醫師法 |
| transcript.whisperx[359].start |
9587.279 |
| transcript.whisperx[359].end |
9606.212 |
| transcript.whisperx[359].text |
怎麼規範密醫行為6個月以上5年以下嘛對不對可是醫生有什麼責任你們的醫師法如果醫師法28條之4聘僱容留密醫去執行這個手術你們28條之4對醫師怎麼處罰有刑責嗎 你先回答我有沒有刑責 |
| transcript.whisperx[360].start |
9616.328 |
| transcript.whisperx[360].end |
9627.452 |
| transcript.whisperx[360].text |
容留啊容留跟聘僱密醫來幫我做手術這個醫師有沒有刑責容留的部分沒有了聘僱有沒有聘僱容留容留跟聘僱通通都沒有你們的醫師去找一個密醫來幫他帶刀只有罰10萬到50萬你覺得這個機制這樣子 |
| transcript.whisperx[361].start |
9645.305 |
| transcript.whisperx[361].end |
9662.352 |
| transcript.whisperx[361].text |
公平嗎那個密醫是有刑責但是聘僱密醫的人的醫師沒有刑責罰十萬元可以了事這樣醫生敢去請密醫來操刀嗎大家也敢 |
| transcript.whisperx[362].start |
9664.053 |
| transcript.whisperx[362].end |
9666.035 |
| transcript.whisperx[362].text |
你覺得這種法律的設計有沒有公平?沒有公平 太檢討沒有公平嘛 第一 你知道 我跟你說過嘛在開刀房裡面 醫師 護理師 麻醉科醫師 大家都參與其中 |
| transcript.whisperx[363].start |
9684.332 |
| transcript.whisperx[363].end |
9710.078 |
| transcript.whisperx[363].text |
病人可以告他們加重詐欺是不能緩刑的非關不可的喔但是檢舉的人自己就有刑責不能緩刑的不能一顆罰金的加重詐欺喔我說過嘛但是我要問你崔少哲保護法能不能保護讓這個崔少哲揭弊的人可以免除刑責可不可以 |
| transcript.whisperx[364].start |
9713.083 |
| transcript.whisperx[364].end |
9722.072 |
| transcript.whisperx[364].text |
你不知道好我先問你吹哨者保護的揭弊的對象限於什麼資格他揭弊的範圍 |
| transcript.whisperx[365].start |
9723.908 |
| transcript.whisperx[365].end |
9749.09 |
| transcript.whisperx[365].text |
不涉及私人企業啦你懂嗎所以只有公部門的醫院公立醫院的接避者可以讓這個吹哨者保護法去協助給他網住接住現在我問你公立醫院占整體醫院幾個百分比我們的大概是20個百分比 |
| transcript.whisperx[366].start |
9750.171 |
| transcript.whisperx[366].end |
9764.456 |
| transcript.whisperx[366].text |
所以有八成八成的醫院而且私立醫院才是這種讓業務操刀的可能問題更多私立醫院的接避者是得不到接避者保護的 |
| transcript.whisperx[367].start |
9766.144 |
| transcript.whisperx[367].end |
9777.541 |
| transcript.whisperx[367].text |
所以他們怎麼接避你說三個手段嘛你的三個手段就是組一個調查小組第二個訂一個手術室指引第三個請醫策會積極輔導這個東西有辦法 |
| transcript.whisperx[368].start |
9783.488 |
| transcript.whisperx[368].end |
9808.161 |
| transcript.whisperx[368].text |
解決這個問題嗎 有限 有限啦 不中我現在要跟你說 我再跟你講一次 接避者保護的這一個機制對私立醫院的接避者來講很重要你說要怎麼處理這個事情 沒有比接避出來接避免除刑責的這一個保護機制更重要的 好 |
| transcript.whisperx[369].start |
9809.261 |
| transcript.whisperx[369].end |
9822.71 |
| transcript.whisperx[369].text |
那醫師法28條之4醫師去聘僱一個密醫來操刀沒有刑者只有罰10萬 這個事情你應該去討論一下那我現在一併要跟你討論的是 |
| transcript.whisperx[370].start |
9825.199 |
| transcript.whisperx[370].end |
9829.74 |
| transcript.whisperx[370].text |
我們希望你藉著這次事件一併修正改進我下面要講的這一個議題這個議題就是說啊你劉月餅市長在這我先抱怨一下他說你們就根據中榮的報告業態沒有操刀然後劉市長你說啊醫學院畢業大家都資優生畢業的醫生給他們寄生借就很可惜不可能 |
| transcript.whisperx[371].start |
9854.846 |
| transcript.whisperx[371].end |
9867.855 |
| transcript.whisperx[371].text |
不可能會這樣做啦那個劉市長天兵啊厲害啦但我現在不是要講這個現在教學醫院當中除了主治醫師通常還會有 |
| transcript.whisperx[372].start |
9869.438 |
| transcript.whisperx[372].end |
9890.18 |
| transcript.whisperx[372].text |
醫院的門診除了主治醫師有時候就是住院醫師 實習醫生或是PGY因為是教學醫院但他們這些教學醫院的門診在主治醫師的指導下他會進行病史詢問 病理學的檢查病人可以自由選擇是不是要接受教學服務 |
| transcript.whisperx[373].start |
9891.641 |
| transcript.whisperx[373].end |
9914.607 |
| transcript.whisperx[373].text |
他可以自由選擇要不要有其他醫師在場他可以告訴這個主治醫師嘛他有執行權因為他沒有被麻醉嘛 他意識清楚嘛所以他可以選擇權他說我這個不想要但是也有很多醫師啊大牌的醫師啊在門診的時候掛號的時候就已經揭露了 |
| transcript.whisperx[374].start |
9915.187 |
| transcript.whisperx[374].end |
9928.703 |
| transcript.whisperx[374].text |
本診為教學門診診療時會有住院醫師、實習醫師跟診學習如果你不方便我就是一定要教你不方便你不要來看這一診這也是一個方法 |
| transcript.whisperx[375].start |
9929.964 |
| transcript.whisperx[375].end |
9956.841 |
| transcript.whisperx[375].text |
但是呢 我要講的 這狀況很容易監督啊因為病人意識清楚啊 有資訊告知啊有執行權啊 病人也有選擇權啊隨便你要不要 我就是要教學也在教學當中 我們的醫療技術也在進步也是靠這個 也是要純誠啊當然是要靠這樣子進步但是我要問你是教學手術呢 |
| transcript.whisperx[376].start |
9957.862 |
| transcript.whisperx[376].end |
9961.994 |
| transcript.whisperx[376].text |
教學手術保證到自己的知情權和選擇權 |
| transcript.whisperx[377].start |
9965.748 |
| transcript.whisperx[377].end |
9991.527 |
| transcript.whisperx[377].text |
教學手術就是手術當中有有實習醫師或者是學生在旁邊對啊他是教學型的手術操作我想這個手術過程當中也是一個在醫學生學習或者是這個住院醫師也好實習醫師也好對啦我現在講的是有沒有知情權有沒有讓這個因為被麻醉躺在那裡啊誰進來手術事實上不知道啦那我的意思是說 |
| transcript.whisperx[378].start |
9992.708 |
| transcript.whisperx[378].end |
9999.37 |
| transcript.whisperx[378].text |
你們現在的這個設計步驟程序有沒有讓被手術的人知情有沒有可做選擇的選擇權就像門診你都這麼縝密了連門診大家都這麼做了那操刀的風險是更大的那操刀的程序裡面教學型的手術操作這個受術者有沒有這一些規範 |
| transcript.whisperx[379].start |
10024.495 |
| transcript.whisperx[379].end |
10047.155 |
| transcript.whisperx[379].text |
這個兩個層面第一個就是說過去我們有訂了這個教學的指引裡面把這些倫理規範要求進去那麼住院的部分跟這個手術的部分我們來檢討一下剛剛有沒有需要去擴充之前的那個門診我們現在不是在講倫理規範我們現在講的就是制式規定世代已經走到現在來了 |
| transcript.whisperx[380].start |
10050.538 |
| transcript.whisperx[380].end |
10073.788 |
| transcript.whisperx[380].text |
為什麼要講呢 教學手術除了 大家知道沒有告知這個病人 因為手術要填寫一個同意書嘛你們自私的手術同意書的內容就是疾病名稱 建議手術名稱 建議手術的原因醫師的生名 手術負責醫師的姓名專科別簽名 病人生名 立同意書人姓名病人的關係人簽名 |
| transcript.whisperx[381].start |
10075.308 |
| transcript.whisperx[381].end |
10093.577 |
| transcript.whisperx[381].text |
但門診是意識清醒的 但手術的受術者是意識不清醒的所以其實是只有填寫這一個手術同意書是不夠的2021年張基的院長陳木寬大家都知道瘋者的風風雨雨 |
| transcript.whisperx[382].start |
10095.875 |
| transcript.whisperx[382].end |
10123.707 |
| transcript.whisperx[382].text |
則目關遭多名離職的醫護人員指控偽造開刀房的記錄 詐領保險費 涉及不法還踢爆他一天就排17刀 而人在台北開會髒話還有掛名的手術在進行不僅如此 還有離職的醫師爆料說一天三四十刀都是常態 |
| transcript.whisperx[383].start |
10125.748 |
| transcript.whisperx[383].end |
10144.485 |
| transcript.whisperx[383].text |
醫生遭到霸凌離職了就這樣子檢舉然後醫院說前置後續作業可由醫療團隊執行主導醫師可以到另外一間手術進行手術關鍵部分然後所以那個張基就出了一個聲明 |
| transcript.whisperx[384].start |
10145.606 |
| transcript.whisperx[384].end |
10172.553 |
| transcript.whisperx[384].text |
他說手術參與的醫師有團隊總醫師住院醫師主刀醫師組織醫師以上繁雜卻必要的程序不可能由主刀醫師一人完成由醫療團隊們進行關鍵步驟之外的前置與後續在此同時主刀醫師便可以到另外一間手術為另外一個病人進行手術關鍵的部分好他講的原則我們都同意但真正的是這一個 |
| transcript.whisperx[385].start |
10173.613 |
| transcript.whisperx[385].end |
10200.66 |
| transcript.whisperx[385].text |
院長當天到底是不是這樣子 那可就不一定啦他們的聲明講的我們都同意但真正操作的是不是如聲明所講的 不知道捏像一天三四十刀 像生產線一樣麻醉之前露個臉 下面之後是誰開的 不知道欸所以我常說這是一個模糊的地帶 |
| transcript.whisperx[386].start |
10203.049 |
| transcript.whisperx[386].end |
10218.761 |
| transcript.whisperx[386].text |
那有沒有需要再更精緻的規範啊手術當中到底有幾個醫師動刀病人在上手術台以前有沒有基本的知情權啊部長手術教學的風險會不會高手術的風險總是高於門診的風險 教學嘛 |
| transcript.whisperx[387].start |
10230.208 |
| transcript.whisperx[387].end |
10242.785 |
| transcript.whisperx[387].text |
那病人的安全保障應該比看門診的時候還更嚴謹啊他的知情權也應該要更獲得保障啊那他要不要有選擇權也應該要有啊所以在這種狀況你覺得呢 |
| transcript.whisperx[388].start |
10248.42 |
| transcript.whisperx[388].end |
10271.162 |
| transcript.whisperx[388].text |
跟委員說明以現在來講我們剛剛提到的三個層次第一個過去已經在門診需要有告知知情的部分我們來研議把它納入那特別是學生的部分大概都OK因為意識清醒也沒有辦法變住院跟手術的部分我們來研修這是第一個第二個 |
| transcript.whisperx[389].start |
10271.983 |
| transcript.whisperx[389].end |
10291.439 |
| transcript.whisperx[389].text |
有所謂的接刀或跨刀的情形這個確實會有這個需要那但是我們也把它訂出一個原則出來那第三個呢那實務上呢可以透過我們健保的申報可以了解它的合理性我們去勾結一下那些高量當初這個案件來市長你當市長了嗎當初張基這個案件 |
| transcript.whisperx[390].start |
10295.11 |
| transcript.whisperx[390].end |
10300.195 |
| transcript.whisperx[390].text |
狀況怎麼樣好你提供給我一個調查報告沒關係好來我現在再問一下就曾經有一個離譜的案件安裝心臟支架的手術主治醫師是為了訓練住院醫師這個我覺得是一定要這樣子嘛教學嘛教學相長然後大家都 |
| transcript.whisperx[391].start |
10315.689 |
| transcript.whisperx[391].end |
10333.791 |
| transcript.whisperx[391].text |
一定要這樣子來學習嘛但是呢他在訓練的過程裡面在沒有告知病人的狀況裡面放手讓這個住院醫師去指導結果發生安裝的疏失了最後主治醫師推卸責任推卸給住院醫師 |
| transcript.whisperx[392].start |
10335.793 |
| transcript.whisperx[392].end |
10353.994 |
| transcript.whisperx[392].text |
結果家屬自始至終的蒙在鼓裡根本不知道這台攸關性命的手術除了主治醫師之外還有住院醫師也參與指導所以這大家就說你隱瞞病人術後推諉因為發生事情了才講說這不是我來住院 |
| transcript.whisperx[393].start |
10355.114 |
| transcript.whisperx[393].end |
10383.37 |
| transcript.whisperx[393].text |
在這種狀況這責任的確是責任在你們現行的規範裡面責任屬誰你告訴我主治醫師啦這個醫病關係的建立是在主治醫師的我說法律責任法律責任也是啊因為在這裡面是你授權嘛你授權那你在這裡面破壞了病患對你主治醫師的信任以外但病患都不知道操刀的是住院但是我們如果沒有這一個過程你怎麼訓練 |
| transcript.whisperx[394].start |
10384.932 |
| transcript.whisperx[394].end |
10396.741 |
| transcript.whisperx[394].text |
住院醫師呢那這個責任要怎麼界定因為沒事情就沒事情嘛有事情要怎麼辦我現在問你你說你瘦了這樣沒人要做責任很清楚因為這個醫病關係的建立是在組織醫師所以這個責任是很清楚但是這一些情形為了 |
| transcript.whisperx[395].start |
10408.971 |
| transcript.whisperx[395].end |
10427.268 |
| transcript.whisperx[395].text |
我們不是也通過了一個醫療事故預防及正義處理法其實就是要解決像這一類的事情他並不是故意所為但是就有這樣的發生你完全把責任歸咎於他但我的意思是說責任上是這樣沒有錯那現在病人 |
| transcript.whisperx[396].start |
10428.53 |
| transcript.whisperx[396].end |
10447.129 |
| transcript.whisperx[396].text |
他是第一線的第一線第一線直接就如果有疏失當然不是故意你免刑者沒關係但是他是第一線就是受害的那他這種病人難道不應該有知情權在事前要知情要同意吧 |
| transcript.whisperx[397].start |
10448.018 |
| transcript.whisperx[397].end |
10476.235 |
| transcript.whisperx[397].text |
所以知情很重要知情而且要取得他同意吧如果沒有的話會不會很糟糕這個在倫理上也是需要啦知情一定需要啦那事後的告知也是需要我們在那個醫療事故預防性正義處理法就有談到這個事後發生的事情也要告知嘛我現在跟你說那要不要事前同意事前也要啊對不對現在有這種知情和同意權嗎現在 |
| transcript.whisperx[398].start |
10478.423 |
| transcript.whisperx[398].end |
10502.208 |
| transcript.whisperx[398].text |
我們來規範你們現在沒有啦所以我們現在手術同意書的規範不足是否為教學手術參與動刀的醫師有誰我們都要透明嘛那是否涉及新進的技術或設備要不要告知手術的我應該是講的是說在 |
| transcript.whisperx[399].start |
10503.808 |
| transcript.whisperx[399].end |
10530.235 |
| transcript.whisperx[399].text |
這個手術同意書上要不要擴充到包含手術的團隊那麼中間有沒有涉及到你如果是教學型的有住院醫師有誰要來可能會涉及到Involve到裡面要教學啊那要不要告知那涉及到新進的技術或設備要不要告知新進的技術或設備要不要告知 |
| transcript.whisperx[400].start |
10532.119 |
| transcript.whisperx[400].end |
10534.005 |
| transcript.whisperx[400].text |
這個告知要到什麼程度我們來研議的所以我現在在講就是說 |
| transcript.whisperx[401].start |
10540.959 |
| transcript.whisperx[401].end |
10560.46 |
| transcript.whisperx[401].text |
整個中榮的案件的核心不是只有業帶是不是進入手術室其實更核心是我們國家對於新進的醫療技術跟設備是否已經有清楚的規範到操作的資格和訓練的門檻 |
| transcript.whisperx[402].start |
10563.069 |
| transcript.whisperx[402].end |
10567.454 |
| transcript.whisperx[402].text |
你都一直說 業代比他更容易做啊醫生不要 業代要來幫忙組裝啊來幫忙協助啊但我就從這裡來問你們這樣子的問題難道你們都不用去規範新進的技術越來越多與時俱進 |
| transcript.whisperx[403].start |
10582.771 |
| transcript.whisperx[403].end |
10607.338 |
| transcript.whisperx[403].text |
新進的醫材設備這麼多與時俱進那你不用去規範每一種新的進來食藥署如果核准了一種了那你的訓練門檻要不要規範要不要現在有沒有規範我們在特管辦法就是醫療法的授權辦法有個特管辦法裡面有一些特定的技術是有規範的它就有一些門檻 |
| transcript.whisperx[404].start |
10608.939 |
| transcript.whisperx[404].end |
10633.195 |
| transcript.whisperx[404].text |
像新的像Proton新導管的不是一般的新導管有一些新的那種會刮除的那種的新導管速適風險比較高的高的他有規範在裡面什麼資格那像達文西手術也是一樣他一定要受過幾台的跟刀訓練之後他才能夠獨立操作才能取得執行的資格那每個都已經規範完整了嗎但是沒有辦法 |
| transcript.whisperx[405].start |
10635.101 |
| transcript.whisperx[405].end |
10638.936 |
| transcript.whisperx[405].text |
不可能完全啦所以我們隨時就調整就調整這樣 |
| transcript.whisperx[406].start |
10640.55 |
| transcript.whisperx[406].end |
10669.12 |
| transcript.whisperx[406].text |
對 所以有人講說你對於這個病人安全始終是醫療行為的首要考量你曾經這樣講嗎醫生面對新興的醫療技術必須接受完整的訓練醫生在過去的訓練當中可能會碰到新的技術或設備你曾經說例如達文西手術系統在他還是醫師訓練的階段可能沒有接觸過但在未來醫師要操作這類設備當然必須要接受訓練那你也說過 |
| transcript.whisperx[407].start |
10670.1 |
| transcript.whisperx[407].end |
10688.111 |
| transcript.whisperx[407].text |
病人安全才是最重要的醫療人員至少不能傷害病人所以訓練訓練絕對是必要的所以你講了兩種嘛第一種第一種訓練是模擬訓練嘛那像達文西手術系統就有模擬機可以讓醫師在模擬環境當中學習操作 |
| transcript.whisperx[408].start |
10688.931 |
| transcript.whisperx[408].end |
10694.62 |
| transcript.whisperx[408].text |
第二種是實務訓練許多國外的做法是讓受訓醫師有經驗的醫院具備經驗的醫師帶領一下學習也不是交給業務代表來教導不是 |
| transcript.whisperx[409].start |
10704.895 |
| transcript.whisperx[409].end |
10733.577 |
| transcript.whisperx[409].text |
可是你知道現在很多醫院喔你到醫院去陸陸續續都會看到號稱全國第一套某種儀器設備全國第一套經常那這些醫院在引進新興的醫療設備發布新聞稿說我們今天終於幾月順利完成裝機再幾月要開始實施手術經常常常上一個月完成裝機下個月就要做 |
| transcript.whisperx[410].start |
10734.422 |
| transcript.whisperx[410].end |
10734.647 |
| transcript.whisperx[410].text |
手术 |
| transcript.whisperx[411].start |
10735.629 |
| transcript.whisperx[411].end |
10764.808 |
| transcript.whisperx[411].text |
那用這個當廣告那作為提升醫療服務造福病人的主要宣傳和訴求但是作為病患和家屬我們希望的新設備不僅是要快我們希望的是操作的人操作的能力操作的專業要完善和安全可是你們的特管辦法裡面沒有辦法更改的速度沒辦法改這麼快 |
| transcript.whisperx[412].start |
10765.889 |
| transcript.whisperx[412].end |
10786.834 |
| transcript.whisperx[412].text |
新的醫材設備發展的速度比你的法律還快啊那怎麼辦 這些高階的儀器設備你們沒有辦法 現行的法規沒有辦法發展的那麼快那你們要求實際操作人員需要具備合格的証明也來不及要求 這樣要怎麼辦 |
| transcript.whisperx[413].start |
10789.2 |
| transcript.whisperx[413].end |
10813.4 |
| transcript.whisperx[413].text |
這個我們來研究一下就是更新不急的問題可能要從源頭因為這些比較侵入性比較侵犯性的都是從FDA就許可所以我們要從前端開始如果他這個在查驗登記的時候要許可的時候那麼這個就是屬於有高門檻的就應該要直接寫進他的訪單裡面 |
| transcript.whisperx[414].start |
10814.981 |
| transcript.whisperx[414].end |
10838.437 |
| transcript.whisperx[414].text |
就是要求你要受過什麼訓練才能夠操作這台儀器的我們過去在醫財部等位他會這麼清楚就知道風險是什麼嗎所以未來我們要建立這個技術我們來檢討從源頭開始所以你的實際操作人員操作這種儀器要不要定合格操作的合格門檻最低訓練時數標準化的訓練程序達到門檻之後才能夠執行相關手術 |
| transcript.whisperx[415].start |
10844.841 |
| transcript.whisperx[415].end |
10864.831 |
| transcript.whisperx[415].text |
所以簡單的講就是說未來我們在審查這一類的比較侵犯性或者是很新的高科技的東西不是只有在審查文件還要去詢問這個專業醫學會的意見能夠操作這個的是不是要有一些人員的限制那現在有這樣子跑嗎還沒有現在都沒有嗎對我們來檢查所以現在實務上就是業務人員在教學 |
| transcript.whisperx[416].start |
10873.376 |
| transcript.whisperx[416].end |
10893.128 |
| transcript.whisperx[416].text |
所以你們是現在交給廠商在教學你剛才講到一個重點我們的醫學會難道是擺著放著而已嗎所以現在你們交給廠商會發生什麼問題有媒體報導指出部分醫生對於設備組裝流程不熟悉實際操作時一旦發生問題緊急聯絡的是廠商業務人員到場 |
| transcript.whisperx[417].start |
10899.131 |
| transcript.whisperx[417].end |
10917.899 |
| transcript.whisperx[417].text |
所以在這種狀況裡面 我想作為主管機關 保證你覺得說目前這樣是不合理的吧也不符合醫療安全要求的常態作業吧現在是這樣喔 這樣你要長久的時間要改進我們把這一套制度 我們把它研究要研究多久 三個月 |
| transcript.whisperx[418].start |
10922.241 |
| transcript.whisperx[418].end |
10930.193 |
| transcript.whisperx[418].text |
我們希望這些新進的醫療技術和儀器設備的合作合格的操作標準訂出最低的訓練時數這個可以交給醫學會啊我們業必歸會要幹嘛業必歸會讓他們業 |
| transcript.whisperx[419].start |
10937.082 |
| transcript.whisperx[419].end |
10954.647 |
| transcript.whisperx[419].text |
會裡面可以他們自己對會員有這個自律去管理嘛所以不是交給業代那你知道婦產科內市競技微創醫學會他們規範的婦科機器所被協助下微創手術醫師資格認證婦產科這個就訂的很詳細喔他說 |
| transcript.whisperx[420].start |
10959.288 |
| transcript.whisperx[420].end |
10985.458 |
| transcript.whisperx[420].text |
必須是台灣婦產科醫學會認證的婦產科專科醫師才能夠執行第二個至少要執行20例的婦科手術含開腹或及腹腔鏡手術其中腹腔鏡手術需要占10例以上並需要有主刀者手術紀錄第三參與本學會舉辦或本學會認可的機械手臂輔助婦科手術相關課程8小時 |
| transcript.whisperx[421].start |
10987.881 |
| transcript.whisperx[421].end |
11000.065 |
| transcript.whisperx[421].text |
第四 機械手臂操作要12個小時 含模擬機和實機操作保長你也稍微聽一下我聽你說婦產科醫學會在規定有有很多啦 包括你必須至少參與一台的動物實驗擬真組織大體或AI模擬訓練以及至少一台的機械手臂輔助婦科手術觀摩或擔任助手經驗或是 |
| transcript.whisperx[422].start |
11015.231 |
| transcript.whisperx[422].end |
11021.123 |
| transcript.whisperx[422].text |
至少10台機械手臂輔助婦科手術觀摩或擔任住所經驗這兩項則依記錄就可以了然後 |
| transcript.whisperx[423].start |
11025.42 |
| transcript.whisperx[423].end |
11047.432 |
| transcript.whisperx[423].text |
執行醫師新取得認證資格後一年內如果沒有單獨主刀執行機械手臂相關輔助的手術則暫停其資格需要再接受再培訓課程使得恢復資格那如果要擔任指導醫師當然更嚴謹那我的意思是說我看這個啦我覺得婦科 |
| transcript.whisperx[424].start |
11049.514 |
| transcript.whisperx[424].end |
11076.116 |
| transcript.whisperx[424].text |
這個是什麼醫學會叫做婦產科內試競技微創醫學會的規範其實是蠻完整的那從上述的規範可以證明專科醫學會在這個制度當中可以扮演更積極的角色新進的醫療技術和設備的合格操作標準最低的訓練門檻指定醫師的資格這個專業的自律範疇真的不要交給醫院更不能交給廠商 |
| transcript.whisperx[425].start |
11078.237 |
| transcript.whisperx[425].end |
11103.477 |
| transcript.whisperx[425].text |
應該要交給醫學會那你們不可以憑以形式說從中榮事件你訂一個限縮在開刀房秩序業務人員不得帶刀這麼簡單粗糙的指引而是你必須從制度層次全心去檢視新技術導入後的訓練認證和責任架構是否健全 |
| transcript.whisperx[426].start |
11104.398 |
| transcript.whisperx[426].end |
11118.929 |
| transcript.whisperx[426].text |
所以你要去統籌結合各專科醫學會針對不同類型的新進醫療技術建立分級分專科的操作案訓練指引而不是一個概括性的手術開刀房的指引 |
| transcript.whisperx[427].start |
11120.251 |
| transcript.whisperx[427].end |
11133.646 |
| transcript.whisperx[427].text |
所以在這種狀況對病患而言我覺得站在病患的角度立委最重要我們要緊的不是你多快用上最新的設備而已而是能不能再確信執行手術的醫療團隊已經具備充分的專業訓練和經驗 |
| transcript.whisperx[428].start |
11139.532 |
| transcript.whisperx[428].end |
11154.201 |
| transcript.whisperx[428].text |
而不是在默許現在的醫療技術資本競逐的過程當中任由科技和新興的醫材的風險轉嫁給病人自己去承擔不能這樣子啊 |
| transcript.whisperx[429].start |
11156.811 |
| transcript.whisperx[429].end |
11168.556 |
| transcript.whisperx[429].text |
你給我最後我就只想講你們跟各個醫學會開會每開完一次會給我們一次報告給我們委員會報告那你們三個月內你們到底開了幾次會達成什麼共識討論出什麼 |
| transcript.whisperx[430].start |
11171.357 |
| transcript.whisperx[430].end |
11190.062 |
| transcript.whisperx[430].text |
可以都送我們未還委員會給大家報告一下嗎可以可以 我們把這整個這個制度把它規劃好不要變成開刀房 開刀房的指引而已喔不會不會不會 從源頭啦對對對 好 謝謝謝謝委員好 謝謝林淑芬委員發言接下來請盧憲毅委員發言有請部長 |
| transcript.whisperx[431].start |
11200.684 |
| transcript.whisperx[431].end |
11226.46 |
| transcript.whisperx[431].text |
請石部長好 羅遠 早部長 針對那個國民年金會有三個問題問你就是說現在的版本很像是突然調高到八千到一萬二那我想說先確認財源的部分就是中央跟地方的一個分攤的部分我看到我們那個執政黨現在是希望有中央跟地方來有一些比例 按照他的財政的一個來源 |
| transcript.whisperx[432].start |
11227.521 |
| transcript.whisperx[432].end |
11234.351 |
| transcript.whisperx[432].text |
那如果說按照國民黨跟民眾的版本是希望是完全是中央來支撐那你的態度是什麼 |
| transcript.whisperx[433].start |
11236.308 |
| transcript.whisperx[433].end |
11259.749 |
| transcript.whisperx[433].text |
跟委員報告現在我們談的有幾個不同的項目就是在這個基本數的部分會涉及到保險給付跟津貼那我們現在目前的設計就是提高的部分的差額是由就是院的版本是由中央來支付第二個就是 |
| transcript.whisperx[434].start |
11260.61 |
| transcript.whisperx[434].end |
11282.217 |
| transcript.whisperx[434].text |
關於商帳給付的爭議就是希望說能夠增加到10個月那現在你們提的版本是大概商帳商帳我們沒有在這一次我們的這個增加的範圍裡面因為它是一次性的我們這一次修法主要是針對那個年金的部分的保障 |
| transcript.whisperx[435].start |
11282.837 |
| transcript.whisperx[435].end |
11306.246 |
| transcript.whisperx[435].text |
配偶的罰則 因為它其實沒有設計很大的預算是不是應該立即施行配偶罰則我看幾位委員也有這個版本我們行政院的版本也是把它刪除的盡快可以審查之後就可以實施針對這次的急診主題就是想要問一些問題為什麼只有13處的UCC |
| transcript.whisperx[436].start |
11309.216 |
| transcript.whisperx[436].end |
11329.376 |
| transcript.whisperx[436].text |
這個是一開始我們針對當然一開始是想到那個庸塞的醫院主要都是在六都啦所以先從六都試辦那未來呢我們會按照這個民眾的需求會去評估是不是在其他的縣市也會擴大那我們先用試辦完之後再來檢討就是醫療院所只有一個是診所 |
| transcript.whisperx[437].start |
11330.057 |
| transcript.whisperx[437].end |
11358.986 |
| transcript.whisperx[437].text |
那我想說這個一個診所他目前到現在為止跟其他醫院的那個他所服務的量的比較有沒有特別不好還是特別好還是差不多根文報告因為我們在這一次設UCC的時候的一個考量就是希望能夠一站式服務所以他不是像一般的診所他要能夠提供X光那他要提供這個檢驗還要能夠提供藥品才不會讓病人進來到處去轉診跑來跑去因為我看到那個所以要 |
| transcript.whisperx[438].start |
11359.526 |
| transcript.whisperx[438].end |
11384.802 |
| transcript.whisperx[438].text |
同時達到這三個條件那個診所的規模要比較大我看到五大症狀我覺得說如果要用到醫院的陳檢像是大採小用我是想說是不是應該是比較剛剛講的那幾個規模有的話就可以懲罰不然這樣子的話只有13處然後全國這麼多地方而且只有六都才有那我們就在屏東的還有就在台東就是只會流口水 |
| transcript.whisperx[439].start |
11385.262 |
| transcript.whisperx[439].end |
11401.291 |
| transcript.whisperx[439].text |
那我想說這次我們這個急診的大概你說目前是只有開診率是17%那我們這個偏鄉地區怎麼辦開診率啊就是過年的開診率我們現在還在調查當中那這個在 |
| transcript.whisperx[440].start |
11403.852 |
| transcript.whisperx[440].end |
11426.658 |
| transcript.whisperx[440].text |
以台東來講啦 這個醫院都開了啦是嗎 醫院都開了對 醫院都開了 診所的部分還在鼓勵啦我剛剛現在聽到你們講到APP的部分是不是我 比如說我今天旅行到南投好了那我是不是我周圍10公里內的有開業的診所或者是醫院就會如果有需求的我可以查得到嗎我們那個APP就是先選你在哪個縣市 哪個區 |
| transcript.whisperx[441].start |
11428.078 |
| transcript.whisperx[441].end |
11456.813 |
| transcript.whisperx[441].text |
然後區域之後還可以選你這個是哪一天你在哪一天今天是哪一天你是要看上午還是下午還是晚上時段然後選完之後它就有開的通通就會列出來民眾已經可以完全的就是說上手了嗎有去實地去試看看嗎我們剛上線今天才剛上線我是覺得你可以做一個evaluation比如說一個禮拜一個月以後一個月我們再調整然後下禮拜我們正式發布新聞稿 |
| transcript.whisperx[442].start |
11457.674 |
| transcript.whisperx[442].end |
11466.522 |
| transcript.whisperx[442].text |
我剛剛看到UCC的一些就是說申請的或者說一些懶人包那我比較沒有看到就是說針對UCC這個部分它有沒有所謂的考評 |
| transcript.whisperx[443].start |
11467.915 |
| transcript.whisperx[443].end |
11490.951 |
| transcript.whisperx[443].text |
你們以後針對他們的這個以後他們的績效或是怎麼樣我們有幾個KPI啦除了看診量之外還有一個就是民眾的就醫滿意度那個都有在評估裡面最後就是我們針對我們醫療獎勵金發放的這個部分當然很多人都在講說加班費或是值班費應該免稅啦當然我們是百分之百支持 |
| transcript.whisperx[444].start |
11491.511 |
| transcript.whisperx[444].end |
11505.767 |
| transcript.whisperx[444].text |
那是不是各個類型的子斑肺炎所以有些的名稱都不太一樣所以你要怎麼去全部那邊在裡面比如說我們3D離島那個叫做它的名稱就叫IDS嘛 |
| transcript.whisperx[445].start |
11506.908 |
| transcript.whisperx[445].end |
11534.967 |
| transcript.whisperx[445].text |
真的是可以納入在這次所謂的加班費值班費的一個免稅的因為這個這個其實對像我們偏鄉服務的人其實大部分的收入都是來自於這些他明明就是值班費可是他的名稱不是這個名稱嘛他就是什麼醫療獎助計畫然後那個名稱所以我是覺得說是不是應該全部全面只要是醫護人員領到的相關的這個費用只要是關於值班費應該是加入納入那個免稅的範圍 |
| transcript.whisperx[446].start |
11536.288 |
| transcript.whisperx[446].end |
11564.968 |
| transcript.whisperx[446].text |
對 跟委員說明就是說在醫院的工作人員除了醫師以外都納入勞基法所以勞基法他就有工時規定跟他加班費免稅這已經適用那我們現在處理的是因為醫院沒有納入勞基法所以他的很多加班費他沒有辦法適用免稅規定所以才有這一次這個議題的討論那我們現在在計算的時候就醫師的部分我們是用他的總收入除以總工時所以即使你去IDS他也算入工時也算入收入所以他會被納在裡頭 |
| transcript.whisperx[447].start |
11566.008 |
| transcript.whisperx[447].end |
11585.25 |
| transcript.whisperx[447].text |
這個解決的方向對對對對那最後就是關於那個獎勵金的那個他確實有沒有領到是不是一個申訴專線啊或者申訴的制度啊讓醫護人員去不要因為醫院的一些他的考量而延遲發放或者是說沒有發放給他是不是要讓醫護人員知道有這方面的一個訊息 |
| transcript.whisperx[448].start |
11585.771 |
| transcript.whisperx[448].end |
11609.464 |
| transcript.whisperx[448].text |
好 我們同步也在新聞稿裡面也把它提出來我們是有一個護理的那個爭議的申訴平台那因為這次可能還涉及到其他我們看看是不是用同樣的平台我看到一個所謂的門診打抗申訴這個部分就是OPAT那如果說他確實是在家裡需要一些諮詢的話他要怎麼來跟相關的醫療人員來聯絡 |
| transcript.whisperx[449].start |
11611.645 |
| transcript.whisperx[449].end |
11633.658 |
| transcript.whisperx[449].text |
我在家裡打疫苗 打抗生素結果我有一些醫療的問題我要怎麼去呈現我們這個OPAT的這個方案都是要求醫院要設立那個專線的就是他在過程當中有需要他有可以接觸的窗口 都有所以我們才有給管理費 |
| transcript.whisperx[450].start |
11634.178 |
| transcript.whisperx[450].end |
11653.48 |
| transcript.whisperx[450].text |
我一個建議就是說其實在各個衛生局的那個窗口其實可以用一個APP就是說讓今天我原本放假可是後來我不想放假可是我有些地方可以去值班或者是去做這些諮詢的服務的一個工作因為一定會遇到一些人力的問題嘛 |
| transcript.whisperx[451].start |
11654.361 |
| transcript.whisperx[451].end |
11682.737 |
| transcript.whisperx[451].text |
那我覺得我們常常會卡在什麼報備啊這些東西所以如果說你是把這些醫療的量能把它放在我們的衛生局的一個平台上面的話如果說我今天想要上班然後我就可以去看比如說恆春這邊可能缺醫生或者是缺護理人員我可以就就可以即時去報備然後我就可以去做這樣一個支援的動作其實也可以相對簡體我們偏向的這個醫療的量那個服務量 |
| transcript.whisperx[452].start |
11683.237 |
| transcript.whisperx[452].end |
11690.42 |
| transcript.whisperx[452].text |
那是很好的主意,我們來研究看看,看看怎麼做這個,謝謝盧委員好,謝謝盧縣議委員發言,接下來請王振旭委員發言好,謝謝主席,我們還是請石部長 |
| transcript.whisperx[453].start |
11711.212 |
| transcript.whisperx[453].end |
11729.393 |
| transcript.whisperx[453].text |
部長好 今天有兩個題目想要跟部長來討論一個就是強化我國癌症學名藥的韌性那第二個部分就是醫事人員繼續教育公職任內的部分不過扣著今天的主題我還是先請教一下就是針對假日及連續假期重疾 |
| transcript.whisperx[454].start |
11731.807 |
| transcript.whisperx[454].end |
11758.182 |
| transcript.whisperx[454].text |
分級醫療政策的執行成效與改善方向的書面報告的第二頁裡面剛剛有蠻多委員都有關心到就是說UCC的服務好像當初設計是經過地方衛生局的評估那目前有13處那在執行的成果到現在剛好幾乎要兩個月這個兩個月以來就是服務的部分呢 |
| transcript.whisperx[455].start |
11758.786 |
| transcript.whisperx[455].end |
11782.131 |
| transcript.whisperx[455].text |
看到就是有點好像白冷藍熱就是台北市現在平均每個月200人次那台南市就有到800人次當初在推估的時候有沒有設想到這些各方面的可能性有什麼因素 再來有什麼就是很快能夠有應變的方案 |
| transcript.whisperx[456].start |
11783.232 |
| transcript.whisperx[456].end |
11797.989 |
| transcript.whisperx[456].text |
跟委員說明 當時候我們也是在開設之前都有導衛生局還有專業學會 急診醫學會大家來討論那時候的幾個原則是第一個希望是民眾就醫在社區裡面方便的地方 |
| transcript.whisperx[457].start |
11799.17 |
| transcript.whisperx[457].end |
11823.589 |
| transcript.whisperx[457].text |
能夠提供一站式的服務啦至少要能夠做檢查檢驗基本的檢驗檢查還有提供藥品第三個很重要的是說希望鄰近這個庸塞的醫院達到分流的效果所以才會做我們是給這個原則然後由衛生局去責定所以這個台北市確實他現在責定的三個點 |
| transcript.whisperx[458].start |
11824.85 |
| transcript.whisperx[458].end |
11847.952 |
| transcript.whisperx[458].text |
看起來績效並不好所以我們也提到當時候就講十四半年後因為這是一個事半十四半年後會再進行檢討因為我們比較擔心就是算那個點當初也評估過如果說真的無法像台中的點也慢慢在增加那桃園有的點也很好量也很大 |
| transcript.whisperx[459].start |
11849.874 |
| transcript.whisperx[459].end |
11868.408 |
| transcript.whisperx[459].text |
台南就更不用說它是功能非常好的如果店不是說很好寫那有什麼其他的配套給他更方便一點好這就是根據今天的主題先跟部長請教的部分那第二個其實就是有關於這個癌症學名藥的韌性這個會牽涉到有關於 |
| transcript.whisperx[460].start |
11871.595 |
| transcript.whisperx[460].end |
11892.723 |
| transcript.whisperx[460].text |
帶品韌性一個很重要的部分那我一直都很關心癌症病友他們在接受醫療過程裡面有沒有好的這個完整的配套那其實也很謝謝我們在健保署在113年7月份就啟動了生物相似性的藥品的鼓勵示範計畫那這個示範計畫到現在為止看起來的確從112年的這個生育 |
| transcript.whisperx[461].start |
11899.44 |
| transcript.whisperx[461].end |
11911.109 |
| transcript.whisperx[461].text |
相似藥的一定量是有明顯的上升那謝謝部長跟署長這段時間真的很用心的去讓達到這個三贏的這個可能性從原來的113年的7.38% |
| transcript.whisperx[462].start |
11913.291 |
| transcript.whisperx[462].end |
11920.133 |
| transcript.whisperx[462].text |
提升到11.9%所以根據這麼良好的示範計畫的成果就從生物相試藥又把它擴大到所謂的化學 |
| transcript.whisperx[463].start |
11935.436 |
| transcript.whisperx[463].end |
11956.461 |
| transcript.whisperx[463].text |
治療學名藥這個有點繞口啦因為到底這個癌症用藥對民眾來講就是抗癌用藥所以他比較難了解什麼是生物相似藥什麼是學名藥等一下還有標靶還有免疫用藥等等那我們也知道這個其實是一個非常好的方向 |
| transcript.whisperx[464].start |
11957.025 |
| transcript.whisperx[464].end |
11985.982 |
| transcript.whisperx[464].text |
那也透過這些止血的方式尤其是獎勵措施的確能夠發揮的這個臨床的這個引導作用那如果說把這個化學藥用進來以後其實他就會有所謂的口服跟增劑一般來講生物相似藥都是增劑那如果針對這個化學一般說的那個化療的化學藥物的玄尼藥的話他可能會有口服又有增劑那這個部分 |
| transcript.whisperx[465].start |
11986.738 |
| transcript.whisperx[465].end |
12013.164 |
| transcript.whisperx[465].text |
到目前為止差不多半年左右針對於每一個處方口服針劑的獎勵點數的這些部分不曉得有沒有初步的成果可以讓我們知悉你剛剛說有從7.38%已經到17%那這個化學治療學名藥部分不知道有沒有初步的成果有有有跟委員說明那個生物相似藥那個實施的比較早那是113年就開始實施了 |
| transcript.whisperx[466].start |
12013.684 |
| transcript.whisperx[466].end |
12032.232 |
| transcript.whisperx[466].text |
那現在已經到17% 16.9% 17%所以成效很好那去年開始的大概是下半年才開始所以大概半年的時間我們的這15個項目癌症的化學藥的學名藥的使用率也從43成長到53了也增加了10% |
| transcript.whisperx[467].start |
12035.794 |
| transcript.whisperx[467].end |
12054.635 |
| transcript.whisperx[467].text |
所以成效也不錯所以我們下一步就是像委員提到的我們越來越多的癌症的標靶藥都要準備要過專利期所以接下來會有越多的學名藥所以我們打算從化療藥其實我們現在癌症的治療 |
| transcript.whisperx[468].start |
12057.077 |
| transcript.whisperx[468].end |
12080.037 |
| transcript.whisperx[468].text |
這個標靶藥物我們核准的品項是多於化學治療的藥物啦所以我們要把一些錢省下來用更多的新藥所以我們下一步大概今年第二季嘛第二季我們就會擴大到所有的癌症治療藥物的學名藥都會納入這個獎勵的項目所以不管是口服的不管是針劑的都適用那麼每一個處方都有獎勵的點數是這樣 |
| transcript.whisperx[469].start |
12081.858 |
| transcript.whisperx[469].end |
12091.658 |
| transcript.whisperx[469].text |
所以意思就是說原先希望能夠到達70%的學民用藥的部分透過更全面的真的學民藥來提供獎勵的話這個能夠達 |
| transcript.whisperx[470].start |
12094.212 |
| transcript.whisperx[470].end |
12114.862 |
| transcript.whisperx[470].text |
到這個目標的機會就更為有他的可行性跟他對對對我們的獎勵就是兩個方式一個是醫師在處方每一個這個學名要處方下來都有一百五十點的獎勵然後整個年度如果因為你轉換了這個藥物之後那麼你的這個這個支出啊藥費支出下降 |
| transcript.whisperx[471].start |
12115.342 |
| transcript.whisperx[471].end |
12129.055 |
| transcript.whisperx[471].text |
下降那個額度我們還是回饋到你的醫院總額不會讓你下降那你就可以拿去用更多的專利期內的新藥的採購或者用在其他的醫療服務點數 |
| transcript.whisperx[472].start |
12130.496 |
| transcript.whisperx[472].end |
12153.179 |
| transcript.whisperx[472].text |
所以預計從第二劑開始就針對於所有的用藥包括癌症用藥的學名藥包括是標靶跟免疫都有機會那當然他需要符合一些要件嘛就是要有原開發廠專利到期同時具有原廠藥跟學名藥而且具有價差或者是部分價差都可以把它原液進來當作一個可以 |
| transcript.whisperx[473].start |
12153.699 |
| transcript.whisperx[473].end |
12175.069 |
| transcript.whisperx[473].text |
透過這個處方開立獎勵的清單是那這個部分在執行的過程裡面有沒有需要透過共理會的核准還是說還是要還是需要還是有個程序是是那因為你是第二季所以是不是三月的共理會三月的共理會會把它讓為一個重要議題來做討論好那就非常謝謝讓這個民眾在用藥 |
| transcript.whisperx[474].start |
12177.83 |
| transcript.whisperx[474].end |
12197.859 |
| transcript.whisperx[474].text |
好的服務品質的過程裡面也能夠讓這個三贏的政策可以持續的來推動這樣不僅我們這個可以這個供藥的韌性多元用藥供藥的韌性更好那也可以為健保省一些錢之後我們可以進更多的新藥是好謝謝謝謝那這個署長先請回座來 |
| transcript.whisperx[475].start |
12201.36 |
| transcript.whisperx[475].end |
12218.162 |
| transcript.whisperx[475].text |
跟部長再討論一下醫事人員繼續教育積分任內公使的部分我相信所有的醫事人員都會努力的來從事所謂的繼續教育因為繼續教育後面可以對自己的本質學能有更好的一個成長 |
| transcript.whisperx[476].start |
12218.843 |
| transcript.whisperx[476].end |
12242.561 |
| transcript.whisperx[476].text |
那更重要就是能夠維持這個好的醫療品質所以基本上呢根據這個醫事人員職業登記跟繼續教育辦法裡面每六年就必須要修滿一定的繼續教育的積分才能夠辦理職業執照的更新這個是一方面維持這個好的品質一方面又能夠讓所有的從業人員醫療的部分有更好的這個 |
| transcript.whisperx[477].start |
12244.323 |
| transcript.whisperx[477].end |
12255.881 |
| transcript.whisperx[477].text |
相關的這個能力這個是非常好的部分那可是這個過程裡面到底是在接受教育訓練的過程裡面是因還是要得到 |
| transcript.whisperx[478].start |
12256.724 |
| transcript.whisperx[478].end |
12281.506 |
| transcript.whisperx[478].text |
可以將這個積蓄交流學問列為公教或納入公使這個對一般的同仁來講有時候他很努力的付出的過程裡面那如何同時也能夠兼顧他的工作還有他這個有關於公使的部分那這部分好像部長那個時候也在114年10月23跟這個護理團體他們有做意見交流的會議上面 |
| transcript.whisperx[479].start |
12281.986 |
| transcript.whisperx[479].end |
12309.896 |
| transcript.whisperx[479].text |
有做一些處理那也希望應該僱主將這個所有所有人員在六年內所需要完成的120點就是每年20點的訓練時數能夠給予工價或納入工時可是在後來114年12月26日這個衛生福利部就出了公函給這個護理跟健康照護師結果我們看到的這個內容就是說有關醫事人員接受繼續教育 |
| transcript.whisperx[480].start |
12311.825 |
| transcript.whisperx[480].end |
12330.411 |
| transcript.whisperx[480].text |
醫療機構得 或得於每年20小時的範圍內餘工價這個譬如說 大家在煩惱這個到底是願還是得好 跟委員說明這個勞動部在去年的10月有一個函示就是對於雇主要求這個員工應受的這個在職訓練因 |
| transcript.whisperx[481].start |
12334.392 |
| transcript.whisperx[481].end |
12363.572 |
| transcript.whisperx[481].text |
那為公時所以我們現在未來的做法是這樣這個醫事人員的基本的積蓄消費基金6年120個小時的部分是因所以我們會再重新解釋說每年20或6年120個小時這個範圍內這個是醫事人員被法規所要求你要繼續執行業務要完備的所以要視為雇主要求你的員工要完成的這個要因 |
| transcript.whisperx[482].start |
12364.552 |
| transcript.whisperx[482].end |
12380.01 |
| transcript.whisperx[482].text |
但是超出的部分你要鼓勵這個員工去進修什麼那這個就是得啦讓他有一個彈性120個小時6年120個小時每年20個小時以內這個是因超出的部分是得了解用這樣 |
| transcript.whisperx[483].start |
12380.891 |
| transcript.whisperx[483].end |
12395.775 |
| transcript.whisperx[483].text |
公務人員也是嘛包括我們其他的這個復活勞動的朋友這些相關的這個醫事人員都算是是是謝謝所以看起來今年在1月20號再發一個函式讓他離清楚 |
| transcript.whisperx[484].start |
12396.115 |
| transcript.whisperx[484].end |
12425.07 |
| transcript.whisperx[484].text |
好好好因為這個部分也真的需要部長透過好的方式來來示意包括說是無論上課的形式跟地點都應該納為公式因為我們知道有一些是透過視訊啊有一些是到實體的部分那另外用下班的時間去上課的話就是說我下班之後我又有這個訓練的需求我再去上課的話那這一部分呢可不可以納為加班 |
| transcript.whisperx[485].start |
12426.19 |
| transcript.whisperx[485].end |
12453.465 |
| transcript.whisperx[485].text |
就是說我如果利用時間我已經下班了我去上這個繼續教育的課那有完成的話那可不可以算是加班再過來就是單位主管是不是針對這個列為繼續教育課程的內容還要不要再審查就是說好像這個既然都已經是屬於正式的這個教育課程的話有的朋友說我為什麼知道我同意不同意 |
| transcript.whisperx[486].start |
12454.065 |
| transcript.whisperx[486].end |
12478.919 |
| transcript.whisperx[486].text |
的這個課程是屬於繼續教育如果已經得到認可的話還需不需要經過這個審查的程序這個部分可能也要馬上部長利用在說明的時候或者是這些韓文的時候能夠把這些的部分當然也能夠讓所有這個議事同仁都能夠很確定的了解好我們在下一個韓的時候我們把它釐清那當然這個 |
| transcript.whisperx[487].start |
12481.2 |
| transcript.whisperx[487].end |
12505.245 |
| transcript.whisperx[487].text |
很簡單的做法反正你就是一年有20個小時的繼續教育的時數是認列在公司這是最簡單嘛這樣子的做法是最容易的醫事人員他們會自己衡量你只有20個小時嘛那你只有20個小時去報出來的不是被認列在未來繼續教育那個是醫政 |
| transcript.whisperx[488].start |
12505.965 |
| transcript.whisperx[488].end |
12522.072 |
| transcript.whisperx[488].text |
主管機關就是衛生局要認列的那個不在那個裡面那裡當然就必須額外去付出嘛好 那個就沒有問題還有一個部分就是上班時間如果同時上線去修這個課程的話公司要怎麼計算可能到時候也要麻煩保證員額外訴求一下 |
| transcript.whisperx[489].start |
12526.831 |
| transcript.whisperx[489].end |
12537.678 |
| transcript.whisperx[489].text |
這個確實有這種情形譬如說我們會有一些Meeting那個Meeting就在你的上班時間那個Meeting又去報繼續教育的有這種狀況 |
| transcript.whisperx[490].start |
12539.879 |
| transcript.whisperx[490].end |
12563.823 |
| transcript.whisperx[490].text |
這樣委員知道我們在醫院morning meeting 經常報學分嘛那個也在你的工時裡面那所以這個其實就是已經在你的工時裡面已經符合規定了這個就沒有額外再報那講的是說額外的你上班時間以外的那應該視為工假或者是工時就把它算進去算在總工時啦當天是在你的工作時間內參加的活動 |
| transcript.whisperx[491].start |
12566.844 |
| transcript.whisperx[491].end |
12586.333 |
| transcript.whisperx[491].text |
你本來就是在Meeting然後報了學分那這個好像就沒有額外報了但是你額外的這個不在今天的工時額外的那應該要認列在你的每月的總工時裡面好好如果有一些疑惑的話用QA的方式來呈現再麻煩部長好謝謝謝謝謝謝王振旭委員發言接下來請鍾嘉斌委員發言 |
| transcript.whisperx[492].start |
12606.052 |
| transcript.whisperx[492].end |
12620.788 |
| transcript.whisperx[492].text |
好 主席 在場委員先進列席政務機關所長 官員會長 工作夥伴媒體記者 女士先生好 我們就有請部長了 部長迫不及待了來 那麼也還要同時請我們看事負稅署好了蔡專門委員還有我們的保險司的張司長 |
| transcript.whisperx[493].start |
12625.39 |
| transcript.whisperx[493].end |
12649.335 |
| transcript.whisperx[493].text |
周委員好部長好剛剛我在外交國防因為是僑委員會對於台商跟僑民的一些關心跟照顧那我這裡呢也很肯定啊過去在你擔任部長之前您也多次造訪很多包括東南亞國家印象深刻的那時候在薛瑞元部長的時候我們曾經就衛武部的叫做通訊診察 |
| transcript.whisperx[494].start |
12650.775 |
| transcript.whisperx[494].end |
12662.507 |
| transcript.whisperx[494].text |
治療辦法我們要擴大試用了對不對對你還記得吧這個越南台商也拜託過也是您的督促下我們把它完成了好那我剛剛在那邊詢問的就是說會不會未來會持續的跟僑委會合作 |
| transcript.whisperx[495].start |
12666.05 |
| transcript.whisperx[495].end |
12694.686 |
| transcript.whisperx[495].text |
不過只有越南馬來西亞聽說下個月要去菲律賓未來會繼續擴大包括亞利桑那美國鳳凰城都可以試用吧我們逐步逐步規劃那當時我要求的是說除了國外之外我們國內的矯正機關有很多的受刑人因為高齡化他們年事偏高慢性病心血感激病多那麼過去如果要借戶送醫遇到這種情況很耗費人力未來如果說法務部有 |
| transcript.whisperx[496].start |
12695.626 |
| transcript.whisperx[496].end |
12712.332 |
| transcript.whisperx[496].text |
拜託有要出經費你們可以協助他把這樣的一個通訊診療方辦法擴大因為本來裡面就有矯正機關嘛那過去比較少用好像只有兩個只有精神科跟皮膚科那如果未來法務部有這個需求你們願意協助嗎 |
| transcript.whisperx[497].start |
12713.012 |
| transcript.whisperx[497].end |
12738.139 |
| transcript.whisperx[497].text |
我們去年8月就放寬矯正機關都可以可是目前只有兩個在示範如果有這個需要因為我們健保還給付這個比台商還好在境內的好來請趕快兩個科別在去年在部長在署長任內最後一個月我們已經所有的科別都可以不只這兩個科別所有的科別都適用 |
| transcript.whisperx[498].start |
12739.079 |
| transcript.whisperx[498].end |
12765.668 |
| transcript.whisperx[498].text |
但是呢因為矯正機關裡面內部的設備可能比較不夠而且呢事實上如果有他原來就是慢性病原來的醫療機構在幫他照顧健康的可以持續的照顧部長支持吧支持好那今天我們本的本題啊是我談國民年金法其實我們很很欣慰因為總統跟卓院長都有宣誓宣布啊要讓台灣好生活台灣好生活當中的國民年金 |
| transcript.whisperx[499].start |
12766.488 |
| transcript.whisperx[499].end |
12792.031 |
| transcript.whisperx[499].text |
老農津貼調高為一萬之後我們行政院也支持衛護部把我們的國民年金調高從四千拉高到基本五千那我們再往下看所以過去國民年金保障不足假如醫院低有這些問題包括幾乎過低調整太慢排污過嚴而且對於高齡者跟生長者的保障不足對不對所以往下來看那我們多次本席也多次 |
| transcript.whisperx[500].start |
12793.072 |
| transcript.whisperx[500].end |
12807.906 |
| transcript.whisperx[500].text |
呼籲調高國民年金不過因為受到憲法的要求75條以及包括預算法跟財政紀律法我們立法委員立法院不能違增加政府支出這決定因此那時候我就推了一個345億用財務法當中的一個 |
| transcript.whisperx[501].start |
12810.729 |
| transcript.whisperx[501].end |
12826.077 |
| transcript.whisperx[501].text |
留下來的一筆用途不明的金額來做部長還有印象吧有有有那時候我就主張要調到8000啦因為有345億可以用嘛但是呢如果只有345億也只能做不到一年現在呢我們他納入體制還是要修法但是這個目標部長未來會不會繼續支持 |
| transcript.whisperx[502].start |
12828.741 |
| transcript.whisperx[502].end |
12855.808 |
| transcript.whisperx[502].text |
我們幾乎提高機制調整對我們是整個財務的情況我們來提高所以這一次行政院的版本就已經一樣都調升23.5%那包含這個身障的會達到6715很好這都很正面那往下看所以你們現在幾乎提高了你們修正了牌幅這很重要過去在我們非都地區往往他一個人他住的是什麼留下來的老舊房子甚至在農業區可是 |
| transcript.whisperx[503].start |
12857.668 |
| transcript.whisperx[503].end |
12865.838 |
| transcript.whisperx[503].text |
房屋房地產估計限值被調高之後他就沒有辦法得到了那CPI的指數呢你們也調了那還可以做得更好嗎我們有沒有還可以繼續做強化的地方 部長 |
| transcript.whisperx[504].start |
12871.499 |
| transcript.whisperx[504].end |
12887.779 |
| transcript.whisperx[504].text |
我往下看比如說你們第一個金額增加所以我剛剛期待說未來還是有一個8000的目標因為目前縣市的最低生活會14000那如果按照A4跟B4去算其實目前只有5000的這個樓地板還是太低部長會不會覺得 |
| transcript.whisperx[505].start |
12888.92 |
| transcript.whisperx[505].end |
12914.652 |
| transcript.whisperx[505].text |
你要繼續努力其實我們這個五千的部分是基本對他是屬於國民年金的保險對象他還會屬於他的繳費年資還是會對所以說我提的這個八千九千這個部分部長可不可以來努力好不好有機會啦有機會那這裡面要問一下但是我所知道的目前財政部昨天前上週釋出一個消息過上個月啦應該去年啦我們好像 |
| transcript.whisperx[506].start |
12916.553 |
| transcript.whisperx[506].end |
12929.579 |
| transcript.whisperx[506].text |
稅收比預期的少了好像算算少了500億因為貨物稅 關稅等等還有一個地顏的支出是不是這樣子這位是負稅署 是嗎簡單講好不好 時間已經過來去年的情況是不是比我們預期的稍微不足 |
| transcript.whisperx[507].start |
12930.495 |
| transcript.whisperx[507].end |
12951.828 |
| transcript.whisperx[507].text |
有這個情況嗎還是你忘記了是是這樣那是就好了我很怕你說不是但是我們希望在台美對等貿易能夠協定確認之後確保台灣對外的經濟成長能夠繼續成長好像是上升到8%了對不對所以我們希望在未來稅收充裕的情況之下 |
| transcript.whisperx[508].start |
12952.762 |
| transcript.whisperx[508].end |
12979.013 |
| transcript.whisperx[508].text |
行政院來支持衛福部把這個目標來努力好不好在財政有增加的情況之下這樣可以吧可以可以喔 往下第二個就是這次我們修法的本題36條我們認為在財務法修改之後這全部的860億通通由中央政府來負擔這不對啊你同不同意未來財務法現在修改之後地方也不少地方有錢啊是不是我們的36條您覺得因為你們這次都沒有講到36條你們一直沒講到36條你們只要講到那三個事情 |
| transcript.whisperx[509].start |
12982.655 |
| transcript.whisperx[509].end |
12986.432 |
| transcript.whisperx[509].text |
但是我们期望呢行政委员之外36条部分你们会不会考虑 |
| transcript.whisperx[510].start |
12987.921 |
| transcript.whisperx[510].end |
13014.73 |
| transcript.whisperx[510].text |
這一次我們的修法沒有涉及到這個中央跟地方的分攤因為行政院另外有提出一個這個新的才化法的這個修正所以我們是希望按照行政院的才化法的新的版本按照新的版本在那個新的版本之下中央跟地方的分配較為均衡所以這種情況之下或許未來中央跟地方共同分攤國民年金的 |
| transcript.whisperx[511].start |
13016.171 |
| transcript.whisperx[511].end |
13029.984 |
| transcript.whisperx[511].text |
幾戶的這個部分你們可以看再來討論好那也不勉強往下看好那這次呢這些我們也提到了有沒有幫助這次呢過去欠費無力繳納想要回流的本金加利息的這個部分你們有沒有幫助回流欠費無力 |
| transcript.whisperx[512].start |
13034.421 |
| transcript.whisperx[512].end |
13057.445 |
| transcript.whisperx[512].text |
來 哪一個要回答我們還是會協助啦就是真的沒有能力的因為像低收入戶我們就本來就政府就補助了嘛那如果是有這個困難的我們還是有這個分期繳款的這個方式那修正後兩年內補繳這個保費跟利息的時候利息減半徵收負稅組的看法怎麼樣也是沒有準備到這一題 |
| transcript.whisperx[513].start |
13062.145 |
| transcript.whisperx[513].end |
13077.163 |
| transcript.whisperx[513].text |
好啦沒關係啦好啦這一題我們讓你回去再惡補一下啦再往下看好來接下來呢在我們的老農津貼國民年金都有所調整的情況之下衛護主管的有六大攝護津貼嘛保險師知道哪六大吧 |
| transcript.whisperx[514].start |
13078.083 |
| transcript.whisperx[514].end |
13094.515 |
| transcript.whisperx[514].text |
知道了我不用考你都寫出來了那這個未來有沒有考慮要一併做調整我們這個六大津貼裡面有三項是屬於低收入戶另外有三項是屬於邊緣戶就是中低收入戶或者是福利對象這個目前都已經有覆案了會經行政院同意之後我們會盡快宣布 |
| transcript.whisperx[515].start |
13103.562 |
| transcript.whisperx[515].end |
13132.307 |
| transcript.whisperx[515].text |
我是覺得如果真的對人民福國利民的要趕快講讓人民知道而且呢前提是是在我們國家財政可以負擔的情況之下所以我希望財政部密切的跟衛福部合作透過足跡總署在這樣的一個國家資源調度上當我們國家人民的經濟成長我們的打拼有這樣成果的時候不管是透過稅收來表達應該優先來照顧弱勢者部長你同意嗎同意我說優先照顧弱勢者就不是要去照顧那些 |
| transcript.whisperx[516].start |
13133.608 |
| transcript.whisperx[516].end |
13157.327 |
| transcript.whisperx[516].text |
優勢的退休後很有錢的那種好最後的結論了所以三個第一國民年金給付金額增加勢在必行未來希望有這個8000的目標希望行政院來努力好不好那至於中央跟地方的分擔的部分還有鼓勵民眾回流的部分這個三個方向是不是繼續來努力對對對那最後呢六大福利今天一併天了好不好好謝謝部長謝謝市長好謝謝總委員 |
| transcript.whisperx[517].start |
13166.587 |
| transcript.whisperx[517].end |
13169.988 |
| transcript.whisperx[517].text |
好謝謝鍾嘉賓委員發言接下來請鄭天才委員發言好主席各位委員有請部長請時部長 |
| transcript.whisperx[518].start |
13195.098 |
| transcript.whisperx[518].end |
13211.155 |
| transcript.whisperx[518].text |
好 部長辛苦了今天談的國民聯軍法本席也有提案禮拜五會復委到時候在主條審查的時候我們再討論希望也能夠支持 |
| transcript.whisperx[519].start |
13213.103 |
| transcript.whisperx[519].end |
13241.634 |
| transcript.whisperx[519].text |
那我們看這個國民現在另外講一個議題國民年金法53條原住民年滿55歲特別有這樣的一個規定因為有這個規定後來公務人員退休之前撫恤法原住民也可以降為55歲然後這個公立學校教職員退休之前撫恤條例原住民也可以降為55歲 |
| transcript.whisperx[520].start |
13244.656 |
| transcript.whisperx[520].end |
13271.069 |
| transcript.whisperx[520].text |
那現在就是問題出這個老人福利法仍然維持65歲原住民沒有降低為55歲那這個延伸的就很多的問題我們看這個衛福部在早期針對原住民的長者裝飾假牙也是55歲然後長照也是原住民也是55歲 |
| transcript.whisperx[521].start |
13273.643 |
| transcript.whisperx[521].end |
13298.503 |
| transcript.whisperx[521].text |
這個部長以前的前任的部長現在政務委員當初在納入優先接種疫苗的時候演出名也是55歲相關的台南的老倫健保也是55歲新北的這個健保也是55歲尤其是這個敬老悠遊卡很多縣市都是55歲 |
| transcript.whisperx[522].start |
13302.959 |
| transcript.whisperx[522].end |
13328.049 |
| transcript.whisperx[522].text |
現在重點在哪裡呢 他們拿了這個敬老悠遊卡坐公車 他們的公司公車可以然後坐捷運可以結果去坐台鐵的七間車就不行了就產生這個 怎麼一國兩制同樣的一個台北台中市的七億 新北市的七億這樣的狀況 |
| transcript.whisperx[523].start |
13331.469 |
| transcript.whisperx[523].end |
13357.232 |
| transcript.whisperx[523].text |
就變成是這樣所以這個部分要怎麼樣能夠一致怎麼樣能夠一致事實上這個前任的院長蘇貞昌院長基於敬老以及嚴重於移民比較所以有降低那就一個標準現在是不同的標準他不必雙重標準 |
| transcript.whisperx[524].start |
13359.789 |
| transcript.whisperx[524].end |
13363.604 |
| transcript.whisperx[524].text |
蘇貞昌前院長他也認同本席的 |
| transcript.whisperx[525].start |
13364.802 |
| transcript.whisperx[525].end |
13391.117 |
| transcript.whisperx[525].text |
因為這個對一個老人家來講我坐公車可以,坐捷運可以,去坐火車就不行了因為常常那個七間車在同一個縣市的時候他坐七間車就不行,鐵路的當然高鐵就是另外一個層面,比較少會有這樣的一個狀況最主要就是鐵路的那個部分 |
| transcript.whisperx[526].start |
13392.317 |
| transcript.whisperx[526].end |
13417.148 |
| transcript.whisperx[526].text |
所以這個部分其實相關的支出也不會很多事實上怎麼樣能夠把它一致所以希望衛福部這邊也能夠檢討老人福利法那條條文能夠做修正跟委員說明就是說老人的定義 |
| transcript.whisperx[527].start |
13420.389 |
| transcript.whisperx[527].end |
13435.397 |
| transcript.whisperx[527].text |
國際上都有共同的定義啦就是這個年紀啦所以我們去調整這個老人的定義這個問題比較大不過呢在福利身份上應該要調整所以當時候因為就是考慮到 |
| transcript.whisperx[528].start |
13436.437 |
| transcript.whisperx[528].end |
13463.348 |
| transcript.whisperx[528].text |
原住民跟我們國人一般的愚民有大概10歲的落差所以才將各種的福利身份下降10歲所以從65到55但是隨著我們現在不斷地在努力改善這個差距也在縮短現在大概在8歲7點多這個年紀但是我們也沒有去調整它所以是不是要用用定義上把它完全 |
| transcript.whisperx[529].start |
13464.588 |
| transcript.whisperx[529].end |
13479.197 |
| transcript.whisperx[529].text |
固定下來還是說隨著福利身份上去調整我覺得我是比較favor後面的做法就是按照福利身份讓他不一樣可是老人的定義就是全世界大家都一樣這樣定我就建議了這個 |
| transcript.whisperx[530].start |
13484.165 |
| transcript.whisperx[530].end |
13494.034 |
| transcript.whisperx[530].text |
你們不修老人福利法但是你們可不可以去協調交通部我們來協調希望他參照我們的福利的標準參照其他的 |
| transcript.whisperx[531].start |
13505.465 |
| transcript.whisperx[531].end |
13514.833 |
| transcript.whisperx[531].text |
因為其他的福利的都是都是用55對好的好謝謝我們用年金的方式來對好謝謝好謝謝謝謝謝謝鄭天才委員發言接下來請黃秀芳委員發言謝謝主席我們請部長又請石部長 |
| transcript.whisperx[532].start |
13536.46 |
| transcript.whisperx[532].end |
13543.692 |
| transcript.whisperx[532].text |
報告員好 部長好 剛剛中委員有特別提到就是說我們現在老農年金已經提高到一萬 |
| transcript.whisperx[533].start |
13545.529 |
| transcript.whisperx[533].end |
13572.878 |
| transcript.whisperx[533].text |
老農我說老農那當然就是很多民眾期待就是說我們國民年金的部分也能夠比照老農那當然就是說我們這個如果是加入國民年金原本他可能就是沒有就是沒有從事這個沒有加入勞保那全部都是加入這個國民年金所以我們會覺得說有點這個有加入 |
| transcript.whisperx[534].start |
13574.098 |
| transcript.whisperx[534].end |
13592.33 |
| transcript.whisperx[534].text |
領國民年金的這些民眾其實在這所有的這個保險當中應該是領得最少的啦領得最少的那有沒有可能現在我那天看到我們行政院已經有拍板就是說目前就是提高到5000那是不是可以再往上 |
| transcript.whisperx[535].start |
13593.431 |
| transcript.whisperx[535].end |
13616.673 |
| transcript.whisperx[535].text |
其實現在整個我們物價上漲其實如果每個月五千其實還是非常的少那是不是可以請部長針對這部分你有什麼樣的想法跟委員報告 當然我們有各種不同的社會保險跟年金制度所以大家的起跳也都不是完全一致 |
| transcript.whisperx[536].start |
13617.453 |
| transcript.whisperx[536].end |
13644.523 |
| transcript.whisperx[536].text |
所以我們這一次行政院版的這個國民年金的修法主要是也參考了老農年金的調整幅度所以23.5%的調整所以我們在這個基本的老人年金跟這個身障這邊都把它等比例的用23.5%把它調升這樣整個會讓政府整年的支出大概會增加到一兩百億啦那這個我們認為在財務上因為 |
| transcript.whisperx[537].start |
13647.985 |
| transcript.whisperx[537].end |
13667.315 |
| transcript.whisperx[537].text |
這個年金還是要能夠我們這個是國民年金啦這個基金還是希望能夠永續的發展那以我們現在的收支還可以的情形之下那政府有多餘因為我們現在增加的部分都是政府用公務預算預租我們一年真正從收的保費出去的也不過300多億 |
| transcript.whisperx[538].start |
13668.916 |
| transcript.whisperx[538].end |
13684.207 |
| transcript.whisperx[538].text |
那多數都是政府補助進來我們一年已經發到這個相關的國民年金出去的大概1000億左右了所以政府已經負擔了600多億未來會增加到800億左右所以一直在增加所以我們來努力 |
| transcript.whisperx[539].start |
13698.897 |
| transcript.whisperx[539].end |
13722.2 |
| transcript.whisperx[539].text |
所以我也認為就是說政府應該要照顧這個最需要被照顧的人所以我希望就是說部長針對這一部分我們再去思考一下那接下來我想請教部長就是說我們在這幾天看到就是印度的這個例白病毒因為我記得在我們這個COVID-19那時候也是 |
| transcript.whisperx[540].start |
13722.961 |
| transcript.whisperx[540].end |
13736.778 |
| transcript.whisperx[540].text |
在春節期間就整個春節期間然後之後就大爆發那我想請教就是說立百病毒在印度或者是在印度周邊的這個國家其實他們都有一些警戒 |
| transcript.whisperx[541].start |
13737.679 |
| transcript.whisperx[541].end |
13761.362 |
| transcript.whisperx[541].text |
那我不知道說針對我們台灣的部分因為再來就是這個寒假然後出國出國的人也很多尤其是這個過年期間這個到其他國家去旅遊的人或到東南亞或南亞這個旅遊的人也非常的多那我想請教部長針對這個立百病毒我們國家未來會有什麼樣的防範 |
| transcript.whisperx[542].start |
13762.703 |
| transcript.whisperx[542].end |
13789.554 |
| transcript.whisperx[542].text |
是不是可以先請部長做一個回應跟委員說明他這個立法並不得傳播主要是兩個方式一個是這個動物傳人主要是果福那第二個就是人傳人那所以目前在這個印度的這個案例中間有一部分個案是人傳人特別是醫護人員因為照顧這個病人的時候而得到感染 |
| transcript.whisperx[543].start |
13790.114 |
| transcript.whisperx[543].end |
13809.567 |
| transcript.whisperx[543].text |
那它在社區大傳播的機會不大是因為它的R0值低大概在0.2到0.7左右所以它會下降但是致死率很高所以我們才會提高警戒那除了我們要把它已經有醫界的通告 |
| transcript.whisperx[544].start |
13810.167 |
| transcript.whisperx[544].end |
13838.325 |
| transcript.whisperx[544].text |
給所有的醫師提高警覺如果有不明原因的這個有旅遊史同時有不明原因的這些神經症狀就是有腦炎的可能性的話那麼需要通報未來我們現在在預告中會納為第五類的傳染病強制通報那這個我們就可以提高這個警示那另外我們也跟農委會合作所以其實一直定期有在採檢因為剛剛提到果福台灣還是有也會有定期看有沒有這個 |
| transcript.whisperx[545].start |
13839.566 |
| transcript.whisperx[545].end |
13861.393 |
| transcript.whisperx[545].text |
驗出來到目前為止的檢體還沒有驗出任何一個所以台灣相對的目前的風險是可控那再加上近期看到過去這個立百病毒雖然這個致死率很高但是在全球呢並沒有產生區域性大流行都還是單一的爆發點像曾經一九 |
| transcript.whisperx[546].start |
13863.414 |
| transcript.whisperx[546].end |
13881.829 |
| transcript.whisperx[546].text |
1988年的時候這是馬來西亞有一次主要都是在印度跟孟加拉這個地區所以還沒有到整個區域性的流行過所以我們是提高警覺就是我們不要鬆懈但是目前大概風險上還是可控 |
| transcript.whisperx[547].start |
13882.946 |
| transcript.whisperx[547].end |
13901.563 |
| transcript.whisperx[547].text |
風險上還是可能那我也想請教就是說因為這個過年期間可能旅遊旺季那有可能東南亞或是到其他國家那像泰國的話他們在那個路徑有做一些監測那不知道說國內會不會有這樣的一個措施 |
| transcript.whisperx[548].start |
13902.484 |
| transcript.whisperx[548].end |
13928.262 |
| transcript.whisperx[548].text |
我們國內是這樣第一個我們在邊境那個發燒篩檢還是沒有拿掉所以進來有發燒的還是會被我們這個防疫人員察覺第二個還是會有這個警示卡就是你這個應該要注意哪一些未來如果有發生什麼症狀你要儘速就醫同時要表明旅遊史我們現在先從旅遊史這邊來強化臨床端的話提高警覺 |
| transcript.whisperx[549].start |
13929.883 |
| transcript.whisperx[549].end |
13951.212 |
| transcript.whisperx[549].text |
接下來我想請部長,就是說我接到民眾陳情就是說這個北榮,這個民眾他是在北榮的這個眼科就是住院,那他就發現他的病房上面就是針對就是鏡頭病房裡面有那個監視器,那是對著病床 |
| transcript.whisperx[550].start |
13952.052 |
| transcript.whisperx[550].end |
13981.4 |
| transcript.whisperx[550].text |
那他有跟醫院這邊做反應那也有打電話可能很多單位他都有陳情那也打到我們辦公室來做陳情那我們確實我們辦公室也有打電話到北榮去詢問因為我們覺得說病房裡面會有監視器那是不太可思議的事情那後來北榮也確定就是也確定就是說確實有這樣的一個監視器在這個病房裡面那是因為當時就是疫情期間可能就是負壓病房 |
| transcript.whisperx[551].start |
13981.88 |
| transcript.whisperx[551].end |
14004.178 |
| transcript.whisperx[551].text |
然後這個監視器就沒有移除這個監視器沒有移除那北榮他的說法是說他這個已經電源拔掉了就是說沒有做那個錄影的這樣的一個動作可是這個患者他會覺得我住在這裡面我怎麼知道你到底有沒有用是不是有錄影 |
| transcript.whisperx[552].start |
14007.32 |
| transcript.whisperx[552].end |
14029.648 |
| transcript.whisperx[552].text |
他會覺得說那我的隱私可能就全部都被錄了我想請教部長就是說除了北榮有這樣的一個狀況之外那全臺灣曾經在疫情期間作為這個負壓隔離病房可能也許他裡面都有這樣的一個監視器那全臺灣是不是也有這樣的類似的一個狀況 |
| transcript.whisperx[553].start |
14030.748 |
| transcript.whisperx[553].end |
14058.831 |
| transcript.whisperx[553].text |
跟委員說明就是過去我們這個基本上的這一些攝錄影主要都是在公共空間在私領域的話是不裝設的所以病房裡面是不裝設公共空間走廊這個護理站這個公共空間裝設私領域是不裝設除非有特殊情形像有一些精神病人那麼他會有智商傷人的情形那他在這個保護室裡面他是有裝攝影機免得他又智商傷人 |
| transcript.whisperx[554].start |
14059.511 |
| transcript.whisperx[554].end |
14076.939 |
| transcript.whisperx[554].text |
有這個狀況沒有錯那這個是一般病房一般病房原則上是不裝所以我們會來提醒那可能是當時候因為有那個這個專責病房的關係醫護人員都盡量減少進入到房間裡面所以就透過這個攝錄影來其實 |
| transcript.whisperx[555].start |
14080.18 |
| transcript.whisperx[555].end |
14094.146 |
| transcript.whisperx[555].text |
反應萬一有狀況的時候可以及時的處理那我們會發個函請大家再檢視一下原則上這些攝錄影以公共空間公共空間為主那不在私營域裡面裝設大家再檢視一次 |
| transcript.whisperx[556].start |
14096.007 |
| transcript.whisperx[556].end |
14118.258 |
| transcript.whisperx[556].text |
部長其實我們那時候打電話給北榮的時候我們會覺得說這個應該是很容易是不是把這個鏡頭就先暫時拔掉嗎以後如果有貼起來就對啊或者是以後還需要變成專責病房的時候你再把它裝上去就好對啊有這麼困難嗎我覺得是最簡單就是把它貼起來就好啦是啊是啊所以所以我 |
| transcript.whisperx[557].start |
14118.958 |
| transcript.whisperx[557].end |
14140.133 |
| transcript.whisperx[557].text |
透過這樣的我會覺得說那其他全國各個醫院曾經當成專責病房的時候是不是也有類似的一個狀況所以我們希望就是說衛福部這邊針對這一部分可能要再做一個檢視那當然我們也希望白龍其實這個是很容易的事情就剛剛部長講的就把它打開就好了謝謝委員的提醒病人的隱私我們還是要保護嘛 |
| transcript.whisperx[558].start |
14146.957 |
| transcript.whisperx[558].end |
14173.102 |
| transcript.whisperx[558].text |
他有這樣的疑慮你就趕快把這個不是整層樓每一間都這樣子當然是因為疫情的關係當時有這個需要可是疫情已經過了這麼久了那這個應該可以很容易就把它先把它移除掉嗎以後如果有需要的話再把它裝上去就好了啊好對啊好不好好謝謝委員的提醒我們來進行這個跟議員發函好所有的議員謝謝黃秀芳委員發言接下來請陳冠廷委員發言 |
| transcript.whisperx[559].start |
14187.216 |
| transcript.whisperx[559].end |
14211.069 |
| transcript.whisperx[559].text |
您好我們請部長 又請石部長陳委員好 部長好部長我們現在有一些第一線在執行公費疫苗接種時那他們這些護理師還要接種資料跟接種時的確認那很多時候他們是要依賴人工查核只要資料不完整或者是紀錄有誤就會有風險那我們聽到 |
| transcript.whisperx[560].start |
14213.53 |
| transcript.whisperx[560].end |
14233.153 |
| transcript.whisperx[560].text |
很多第一線的醫護人員然後包含我們辦公室的同仁他的母親就是第一線的護理師他跟我們說他某些疫苗是公費補助他醫生一次但是因為接種紀錄錯誤或查核這個疏忽會讓第一線人員讓民眾來重複接種那我們意思是說現在的這個我們不管是健保卡等等它已經是全面數位化了 |
| transcript.whisperx[561].start |
14233.553 |
| transcript.whisperx[561].end |
14261.981 |
| transcript.whisperx[561].text |
理論上在公費接種的時候他應該要電子化智慧化也就是說他不用說我在這邊算這個間隔多久有沒有慢性病然後自己做人工上面的查核他應該是要直接顯示出這一個人適不適合可不可以來去做接種我想請教一下部長目前的這個狀況有沒有什麼其他方式來給他改善我們目前是公費接種紀錄應該都有都在雲端這是有的 |
| transcript.whisperx[562].start |
14262.481 |
| transcript.whisperx[562].end |
14283.406 |
| transcript.whisperx[562].text |
那自費的部分有可能不完整有的人會自己打自費疫苗所以我們會去強化請醫院把這個自費接種的也上傳免得重複啦因為我們的公費政策也會改變嘛那有的可能你已經打過就不要再打了所以我們會強化那個自費疫苗的這個上傳雲端 |
| transcript.whisperx[563].start |
14284.406 |
| transcript.whisperx[563].end |
14305.906 |
| transcript.whisperx[563].text |
那公費的部分現在都已經OK了那現在是我了解委員在提的因為有一些是要多次接種比如他完成接種可能要兩個度子或三個度子他要間隔所以他那個間隔的提醒是不是間隔時間OK或者是還不到 |
| transcript.whisperx[564].start |
14307.047 |
| transcript.whisperx[564].end |
14334.627 |
| transcript.whisperx[564].text |
那這個比較屬於智慧化的提醒那麼或者是有沒有什麼禁忌不能打還是什麼我請CDC研究看看好就是說讓它儘快智慧化就不用讓它再經過因為每次的人工的審核就是多一份風險那如果自動可以把它做數位化之後就可以避免這些風險謝謝部長那第二個部分針對外籍在研究 |
| transcript.whisperx[565].start |
14334.867 |
| transcript.whisperx[565].end |
14356.379 |
| transcript.whisperx[565].text |
外籍戶左的部分那衛福部最近有宣布說為了要去填補護理能力的缺口他們預計在2026年4、5月就會開放醫院來引進外籍戶左那我們看到這個消息我們有點擔心怕他是在躲避一些問題就是說我們醫院缺人所以補人這個是很 |
| transcript.whisperx[566].start |
14357.219 |
| transcript.whisperx[566].end |
14377.708 |
| transcript.whisperx[566].text |
很簡化問題的一個方式因為現在很多只有護理執照真正的問題是工作薪資的條件或者是他薪資的結構讓人家不願意留在醫院那如果未來你說把外籍護所把他招募進來之後我請問說這個以後的這個行政的管理難道要交給護理師來做行政管理那這樣有達成行政減量的工作嗎 |
| transcript.whisperx[567].start |
14378.288 |
| transcript.whisperx[567].end |
14401.243 |
| transcript.whisperx[567].text |
那或者是說你要做這些事情的話你要給護理師行政加擠嘛那才有效的一方面提高他們的薪資改變他們的結構同時又有人能夠進來協助護理師來把這些問題解決我想請問一下部長你認為這個護理人口的這種缺口的主要解方真的可以這樣子用這種少一個補一個這樣的方式來去解決嗎 |
| transcript.whisperx[568].start |
14402.304 |
| transcript.whisperx[568].end |
14418.783 |
| transcript.whisperx[568].text |
跟委員說明這個我們現在所提到的不是叫做護佐是叫做造福員那麼這個造福員不會去替代護理的人力這個是兩件事情那這個主要的考慮是因為我們在過去這兩年有推動 |
| transcript.whisperx[569].start |
14419.444 |
| transcript.whisperx[569].end |
14441.875 |
| transcript.whisperx[569].text |
叫做住院整合性照顧因為現在的高齡化很多住院的長者呢需要生活協助他可能在家裡面有長照來協助到醫院裡面沒有那這個工作有時候就會落到護理人員的身上所以我們才會開始有這個用共聘的方式那麼共同聘請這個生活的 |
| transcript.whisperx[570].start |
14442.695 |
| transcript.whisperx[570].end |
14468.045 |
| transcript.whisperx[570].text |
輔助就是照服員來協助一些生活照顧也減輕護理人員的負擔那我們這個成效很好民眾的反應度很高他可以減輕他自己要聘這個看護的費用那同時醫院的管理也比較好因為由醫院統一來調度那麼他的一些訓練也都能夠符合規定那這樣我們去年是全國參加這個計畫的是5000床左右 |
| transcript.whisperx[571].start |
14470.906 |
| transcript.whisperx[571].end |
14481.052 |
| transcript.whisperx[571].text |
大概一年花了五億我們有補助所以這個民眾的負擔是下降的那我們未來希望更多做到一半的病床大概要做到三萬床 |
| transcript.whisperx[572].start |
14482.256 |
| transcript.whisperx[572].end |
14500.764 |
| transcript.whisperx[572].text |
所以他需要更多的造福人所以造福源我們才會說有一定的比例不是全部不能多於本地的這個造福源那開放讓這個外籍具有這個語言能力要有一定的基本的語言能力才可以而且也要取得 |
| transcript.whisperx[573].start |
14501.204 |
| transcript.whisperx[573].end |
14513.728 |
| transcript.whisperx[573].text |
造服務員的資格才能夠算進這個服務方案裡頭所以這個大概跟您說明一下那護理的部分我們會持續的去推升好 謝謝好 謝謝委員好 謝謝陳冠廷委員發言接下來請葉元之委員發言 |
| transcript.whisperx[574].start |
14539.83 |
| transcript.whisperx[574].end |
14562.843 |
| transcript.whisperx[574].text |
主席好 麻煩請部長謝謝 麻煩請石部長好 月圓好部長好 您現在就是為了要那個紓解像類似去年過年期間急診室的用色狀況嘛現在有一個做法是說希望診所可以多開嘛那我現在就您的了解 現在門診在診所願意開的那個意願高嘛 |
| transcript.whisperx[575].start |
14563.821 |
| transcript.whisperx[575].end |
14590.252 |
| transcript.whisperx[575].text |
到我們統計的去年最低的時候大概是在初一初二初三這三天大概都不到5%2到4%的開診率那我們今年就弄了這些方案然後現在在一直在登記當中現在初三的開診率已經可以超過10%初一初二我們還在努力那醫院的部分大概開診率過去初一初二也都是休息的 |
| transcript.whisperx[576].start |
14590.612 |
| transcript.whisperx[576].end |
14608.46 |
| transcript.whisperx[576].text |
現在也有開診所以開診率大概也到7成我現在先針對那個門診部分跟您討論因為我當然也有去了解一下其實大家其實意願也不是太高啦為什麼誘因不足因為現在衛福部你們提出來的誘因是讓他的診查費可以兩倍嘛對不對兩倍嘛 |
| transcript.whisperx[577].start |
14610.621 |
| transcript.whisperx[577].end |
14630.668 |
| transcript.whisperx[577].text |
但是他在春節開診像初一初二初三開診的話成本也會提高為什麼呢因為不可能醫師自己來開診嘛你總是有護理師嘛阿爸號員啊藥師啊那通通常這些相關的工作人員他的薪水門診的院長就是診所院長也要給他們大概兩到三倍啊 |
| transcript.whisperx[578].start |
14631.829 |
| transcript.whisperx[578].end |
14643.187 |
| transcript.whisperx[578].text |
所以他們會有一個低門檻的成本那如果你在過年期間開業然後結果病人沒有到大概平均30個以上的話實際上他還會虧本 |
| transcript.whisperx[579].start |
14646.451 |
| transcript.whisperx[579].end |
14668.578 |
| transcript.whisperx[579].text |
所以大家可能就會覺得誘因不足那乾脆去放假也不用拗那些護理師春節來加班所以我覺得當然我覺得部長你們想到這個方法希望門診可以多開去紓解大醫院的急診的量我覺得不錯可是在執行面上會有這樣的問題所以我其實再給你一個建議其實你就可以直接把 |
| transcript.whisperx[580].start |
14669.238 |
| transcript.whisperx[580].end |
14697.447 |
| transcript.whisperx[580].text |
他們可能延伸的固定成本直接給他們舉例來講你今天如果願意開業的話一整了一整就給他們一萬塊那你現在全國的門診全國的診所大概多少個一萬間一萬兩千間一萬兩千間嘛你今天如果有兩成兩成的人願意在春節假設啦很良好的狀況兩成的人願意在春節開診的話一個診大概如果一萬塊大概就兩千萬就是大概兩千萬 |
| transcript.whisperx[581].start |
14698.067 |
| transcript.whisperx[581].end |
14725.184 |
| transcript.whisperx[581].text |
那如果多幾天一兩億就可以解決了你現在是說變多少錢要來解決這個春節紓解狀況因為我們是根據就醫量大概16億但是他包含住院他包含住院所以增加一點點你就可以讓門診願意開業的這個意願會高很多你研究看看好我們研究看看你研究看看 |
| transcript.whisperx[582].start |
14726.284 |
| transcript.whisperx[582].end |
14744.293 |
| transcript.whisperx[582].text |
這個用同胞制啦這個跟委員講說現在這個UCC我們那個假日期就是用這個概念我們直接付那個終點費啦幾個小時多少錢這個概念跟您講的是一致的我現在就把我們因為我也希望說春節的時候 |
| transcript.whisperx[583].start |
14744.893 |
| transcript.whisperx[583].end |
14761.739 |
| transcript.whisperx[583].text |
我們比如說鄉親們啊都在看醫生不要遇到這種不舒服擁擠的狀況啊對不對那大家能夠去就近去診所看我也是樂觀其成啊但我的了解的狀況意願就是我把剛剛可能你聽不到的東西講給你聽了啦 |
| transcript.whisperx[584].start |
14763.16 |
| transcript.whisperx[584].end |
14779.085 |
| transcript.whisperx[584].text |
那現在就看您願不願意做嘛你提高一點點的工作獎金讓大家覺得說至少可以支付我固定成本那就不會他們就不會考慮說好我願意配合初一開開業啊大家都來啦負三倍薪水啊然後然後可能沒有什麼 |
| transcript.whisperx[585].start |
14779.725 |
| transcript.whisperx[585].end |
14807.846 |
| transcript.whisperx[585].text |
沒有什麼病人那一天等於就沒有收入嘛然後而且支出變多嘛啊你就讓醫生護理師再再從過年而已啊好好對不對你這個你這個研議一下好你你覺得這個可能性高嗎我們會有一個調整的就是先開啦到時候如果不夠沒有那麼多了但是你開了我們再來看看怎麼補給你對補給他啦對也可以或者是說你直接如果你超了已經超出的那超出就可以啊你用這個承諾也很好如果用一個後續的 |
| transcript.whisperx[586].start |
14809.527 |
| transcript.whisperx[586].end |
14833.475 |
| transcript.whisperx[586].text |
因為病人沒有出來我們預算已經框在這裡了我們就去回田我覺得你今天能夠做出這樣承諾也很好啊至少那一些願意開業的醫生大家都沒有生病沒有用到最好嘛那我最好嘛那但是我們預算他開了嘛對不對然後他會有成本嗎你就補給他嘛可以可以好不好就朝這個方向啦對我相信大家願意開的那個意願可能就更高了啦是 |
| transcript.whisperx[587].start |
14833.755 |
| transcript.whisperx[587].end |
14851.545 |
| transcript.whisperx[587].text |
然後第二個問題同樣也是醫療資源問題因為我們我是板橋我們板橋55萬人口但我們只有一間大型醫院就是亞東醫院所以有時候有病人的話都要往別區跑跑雙河或者是跑其他的地方 |
| transcript.whisperx[588].start |
14852.438 |
| transcript.whisperx[588].end |
14873.36 |
| transcript.whisperx[588].text |
那本來我們新北市政府是有規劃一個板橋的醫療園區這個部長您應該很清楚我也清楚之前流標了嘛流標原因我也覺得非常奇怪因為當時三年前新北市政府就跟衛福部申請了大概要開499床衛福部也同意了然後結果呢 |
| transcript.whisperx[589].start |
14874.321 |
| transcript.whisperx[589].end |
14893.056 |
| transcript.whisperx[589].text |
準備要蓋的時候都規劃好要蓋的時候然後要上網招標健保署忽然有一個新的規定出來就是說新的如果新設醫院大概一年只給兩億對吧所以有這個新的規定沒有這是假消息是不是沒有沒有沒有這個規定沒有這個規定那為什麼那為什麼之前 |
| transcript.whisperx[590].start |
14893.997 |
| transcript.whisperx[590].end |
14908.586 |
| transcript.whisperx[590].text |
所以你用這個機會澄清我覺得也是好事因為他們現在要重新招標沒有這個規定啦那當初是什麼是怎麼講的我不知道這個消息完全不知道因為那時候就是傳出來說要總額控管嘛 |
| transcript.whisperx[591].start |
14909.707 |
| transcript.whisperx[591].end |
14933.955 |
| transcript.whisperx[591].text |
總和控管各大型醫院都已經分配好了量了然後如果說有新設醫院的話就2億那當然就沒有人要來投標本來有一家醫院投標後來就聽到這個消息之後不投標這過程你很清楚然後你很清楚因為2億的話大概就是一般的門一個門診怎麼可能是499床結果那所以你可以澄清一下因為我們要鼓勵 |
| transcript.whisperx[592].start |
14935.555 |
| transcript.whisperx[592].end |
14957.103 |
| transcript.whisperx[592].text |
優質的醫院來投標跟委員說明就是說第一個我們鼓勵當然這個雖然醫院是一家大型的可是診所還是很多所以要新開的這一家絕對是以急重症優先不是在看一般的門診這是第一個第二個我看最近這個新北市也在做了一些調整那個調整的方向我是蠻支持的 |
| transcript.whisperx[593].start |
14959.386 |
| transcript.whisperx[593].end |
14973.044 |
| transcript.whisperx[593].text |
調整的方向就是第一個配合衛福部嘛所以他還有100個長照的床嘛對不對 然後就針對長輩嘛區域是缺乏的對啊 但關鍵是關鍵就是說我覺得為什麼我覺得你們 |
| transcript.whisperx[594].start |
14974.306 |
| transcript.whisperx[594].end |
14988.468 |
| transcript.whisperx[594].text |
要了解為什麼一開始有一家大型醫院要投標後來他要撤標就是因為健保總額管制嘛當初是傳兩億那你可能不是兩億那是多少對不對因為你總額的量會讓那些醫院 |
| transcript.whisperx[595].start |
14989.489 |
| transcript.whisperx[595].end |
15008.177 |
| transcript.whisperx[595].text |
提高也是剛剛一樣提高誘因如果你今天是給30億30億那當然他意願就會高兩億就不高新北市政府為什麼會做調整他是等於是降低的醫院來投標的成本委員我跟您說明這個事實上是每個醫院的總額會一個區一個固定的總額 |
| transcript.whisperx[596].start |
15008.897 |
| transcript.whisperx[596].end |
15034.812 |
| transcript.whisperx[596].text |
所以那個2億的傳聞是來自那個區的醫院共管自己的協商不是來自我們衛福部或署本部的核定那消息傳出來之後我們跟部長還有我還有跟我們新北市衛生局一直有溝通所以目前呢最新的方案是新北市會預註9.1億在硬體上面那它在病房急性病房是299床長照床是100床這是最新的版本那目前 |
| transcript.whisperx[597].start |
15035.472 |
| transcript.whisperx[597].end |
15059.129 |
| transcript.whisperx[597].text |
就我知道已經蠻多醫院這個我都知道但關鍵就是大家的顧慮還是在於健保署會不會有一個總額控管然後那個總額控管的量會不會很小所以不等大概啦因為2億是控管會議的決定但是不是衛福部的決定嘛對吧那衛福部你們認為像這種大型的醫院大概可以到多少你覺得合理 |
| transcript.whisperx[598].start |
15059.549 |
| transcript.whisperx[598].end |
15083.766 |
| transcript.whisperx[598].text |
因為要這麼說這個一定會影響到地方的資源的重分配啦因為人口就這麼多啦也沒有增加啦所以一定是這邊有新的就有的地方會替代過來所以我們才會說這每年以100到150場的規模然後我們核給的這個額度就是跟它一樣規模的醫院一年是多少 |
| transcript.whisperx[599].start |
15084.786 |
| transcript.whisperx[599].end |
15107.604 |
| transcript.whisperx[599].text |
大概多少那就要看他是那一個層級的醫院所以不會有一個像類似講的什麼先把那個額度框出來那我重新這個詮釋一下你的意思大概就是說像這樣的一個大型的醫院他應該多少就可以拿到多少就是他的同等級醫院這麼多床大概是多少所以就是多少所以就跟 |
| transcript.whisperx[600].start |
15108.524 |
| transcript.whisperx[600].end |
15122.995 |
| transcript.whisperx[600].text |
這個全國的各大型的醫院講說不用擔心就放心來投標請大家拿出你的用品質服務的品質來這邊但是新的案子還是比以前的好我知道這為什麼是就是因為 |
| transcript.whisperx[601].start |
15124.44 |
| transcript.whisperx[601].end |
15140.7 |
| transcript.whisperx[601].text |
之前傳出個消息出來嘛大家不願意來投嘛覺得怕虧本嘛所以市府後來就編了很多公務預算進去嘛對不對包括停車場都市府自己興建嘛所以看得出來市府真的很想促成這件事情啦所以也希望說中央也可以在旁邊協助因為這個對板橋來說如果 |
| transcript.whisperx[602].start |
15142.702 |
| transcript.whisperx[602].end |
15163.397 |
| transcript.whisperx[602].text |
我們在板橋五十五萬人口如果有多一家大型醫院一定可以紓解很多我們的鄉親看病的醫療可以增加醫療資源啦所以希望衛福部可以站在協助促成的立場好不好好這案子比較OK啦這案子不OK好謝謝業源支委員發言接下來請劉建國委員發言 |
| transcript.whisperx[603].start |
15171.966 |
| transcript.whisperx[603].end |
15188.493 |
| transcript.whisperx[603].text |
請劉昭偉謝謝謝謝昭偉,有請石部長請石部長劉委員好部長好社保師有來?有 |
| transcript.whisperx[604].start |
15201.889 |
| transcript.whisperx[604].end |
15214.714 |
| transcript.whisperx[604].text |
然後社家署沒有來社家署沒有好部長行政院在上週二十二日通過國民年輕法的不問條文修正草案就像現行的 |
| transcript.whisperx[605].start |
15215.703 |
| transcript.whisperx[605].end |
15242.77 |
| transcript.whisperx[605].text |
每個月4049要提高到包含這個移屬年金及原名的企務上調為每月5000嘛沒有錯嘛然後身心障礙年金從每月的5437調高到6715漲幅將近23.5這是行政院的一個圖卡就公民年金企務再提高保險津貼都調整是這樣那簡單的算數 |
| transcript.whisperx[606].start |
15244.37 |
| transcript.whisperx[606].end |
15263.435 |
| transcript.whisperx[606].text |
有算過這樣一年要增加多少嗎?就是從原有老年金、一屬年金及原民的幾乎五千然後如果減四零四九所以要增加九百五十一嘛,對不對?那身障年金是六七一五減原有的五四三七所以要增加到一二七八所以估計要多少預算? |
| transcript.whisperx[607].start |
15263.975 |
| transcript.whisperx[607].end |
15278.45 |
| transcript.whisperx[607].text |
跟委員報這裡三塊一個是這個基本年金的部分這裡一調整大概會需要多增加156.3億那另外一個是排富因為我們把那個門檻 |
| transcript.whisperx[608].start |
15280.652 |
| transcript.whisperx[608].end |
15306.763 |
| transcript.whisperx[608].text |
把它拉高啦所以等於放寬排富啦放寬排富之後呢會多受益的人數就會增加大概2萬多人這邊會多增加13.5億那如果我們再根據CPI去調超過3%我們又再調一次那這邊又會再多受益176萬人所以大概會再增加25.1億所以整個合起來大概會增加194億 |
| transcript.whisperx[609].start |
15310.909 |
| transcript.whisperx[609].end |
15314.353 |
| transcript.whisperx[609].text |
就這兩大項加起來每年要再增加194億對沒有錯嘛對對對 |
| transcript.whisperx[610].start |
15319.161 |
| transcript.whisperx[610].end |
15345.035 |
| transcript.whisperx[610].text |
那因為我們現在要將國民年金的企務再提高那基本上我本人也有提案絕對是雙手雙腳漲成因為物價的指數一直在飆高嘛對不對但是部長的思考的範疇裡面就只有針對國民年金跟身障的年金其他的牽涉到大四五津貼沒有一併做通盤檢討然後給行政院做具體的建議 |
| transcript.whisperx[611].start |
15346.209 |
| transcript.whisperx[611].end |
15354.465 |
| transcript.whisperx[611].text |
因為你一旦動到國民年金基本上這之前我們就跟先生有提醒過我們希望趕快將國民年金的這樣的一個 |
| transcript.whisperx[612].start |
15355.772 |
| transcript.whisperx[612].end |
15380.749 |
| transcript.whisperx[612].text |
幾乎可以提高但是我們必須要很坦誠的只要提高國民銀金那相對的八大社會津貼你通通必須一併思考考量甚至你通通要往上提高是有嗎有有有另外還有我們一共是八大您提到的有八大福利津貼那還有六個沒有調整這個調完之後調了兩個了那還有六個沒有調整 |
| transcript.whisperx[613].start |
15381.269 |
| transcript.whisperx[613].end |
15403.041 |
| transcript.whisperx[613].text |
那六個裡面有三個是屬於低收入戶的包含他的這個家庭生活補助包含他的這個兒童補助還有這個就學的補助這個還有三個那另外還有兩個是屬於中低收入戶一個是屬於弱勢而少的那我們也一併提了建議案那麼在行政院很快就會有 |
| transcript.whisperx[614].start |
15403.881 |
| transcript.whisperx[614].end |
15422.954 |
| transcript.whisperx[614].text |
會有決定下來所以有一併都提到行政院讓行政院去做參考有有有一併這時間上會陸陸續續那個我有中低勞嘛中低產嘛對不對那還有低收入各款嘛對還有就學的嘛還有包含這個家庭的嘛包含兒童的嘛還有特勤的嘛 |
| transcript.whisperx[615].start |
15424.336 |
| transcript.whisperx[615].end |
15433.172 |
| transcript.whisperx[615].text |
對全部通通有提供給好那如果全部要一併8到15現在應該叫8加1啦全部如果全部調整的話扣掉這169 |
| transcript.whisperx[616].start |
15435.918 |
| transcript.whisperx[616].end |
15463.376 |
| transcript.whisperx[616].text |
19多那其他還要多少這邊194對 這邊194嘛將近200億了啦對那還要增加到多少那個等行政院拍板才知道那個金額是多少沒有 這怎麼需要等到行政院拍板是衛生部本身就要盤整然後把這個相關的一個預算規模都抓出來給行政院去做最後一個裁定才對啊怎麼會變成行政院在幫你們抓預算有方案會影響到那個這個 |
| transcript.whisperx[617].start |
15465.838 |
| transcript.whisperx[617].end |
15486.038 |
| transcript.whisperx[617].text |
預算的規模啦所以您問我預算會影響到多少這個還沒有辦法拍板因為是根據那個方案才決定那個預算規模假設以現在的國民年金跟現在的津貼你已經基本上調高將近23.5那其他的如果依照這樣 |
| transcript.whisperx[618].start |
15488.22 |
| transcript.whisperx[618].end |
15503.146 |
| transcript.whisperx[618].text |
不只這樣那以最低這樣來講嘛更高當然是最好啊那大致上是多少你應該讓委員會知道一下因為這個原本我們也在之前有具體建議過也希望一併來全面思考8加1的社會津貼該條就該條了 |
| transcript.whisperx[619].start |
15511.158 |
| transcript.whisperx[619].end |
15517.025 |
| transcript.whisperx[619].text |
幾百億啦沒有那個叫幾百億的然後預算怎麼講確實那等於說醫療是你的專業啦但是因為你當了部長這一塊你還是要惡補要趕快惡補你怎麼可以回答委員會回答我說是幾百億 |
| transcript.whisperx[620].start |
15525.414 |
| transcript.whisperx[620].end |
15532.718 |
| transcript.whisperx[620].text |
這個一定要行政院拍板之後我知道啦 我知道 現在是說他們報行政議員來的議程規模才有多少嘛我不是說 現在已經有拍板定案了嘛你總是要給我知道多少多少嘛 要給社會大眾知道多少嘛政府要過來兌變價值 他們說 等到多少嘛這兩個看下去 要跟他們拍板嘛 除了還有6加1嘛那民運總統加起來可能要達700至800億 還是800到1000億嘛 |
| transcript.whisperx[621].start |
15552.828 |
| transcript.whisperx[621].end |
15568.493 |
| transcript.whisperx[621].text |
我想給社會大眾知道這個事情非常的正確也應該讓大家知道行政院衛部有這樣的決心要針對8加1的社會基金的對象要好好提升照顧啊但是你現在回答我幾百億這個很奇怪這也不算你的個性現在都精準醫療啊大約啦 大約大概在300億左右不只啦 |
| transcript.whisperx[622].start |
15578.416 |
| transcript.whisperx[622].end |
15589.282 |
| transcript.whisperx[622].text |
新增 我說的是新增預算喔新增預算不是全部喔那你這兩項 這裡新增是差不多194億嘛這兩項的新增就194億的其他還有 我就講8加1嘛8加2是9嘛 9擴掉這兩項 還有7嘛你算6也沒關係嘛 那怎麼可能才300多億 |
| transcript.whisperx[623].start |
15601.708 |
| transcript.whisperx[623].end |
15611.544 |
| transcript.whisperx[623].text |
6的人數因為他有一部分是低收入戶當然啦一部分是中低收入戶然後再加上的是弱勢而少啦人數沒有這麼多這邊是176萬人 |
| transcript.whisperx[624].start |
15613.424 |
| transcript.whisperx[624].end |
15633.938 |
| transcript.whisperx[624].text |
好啦我姑且相信你啦好不好你要不要把那個你們評估起來相關的預算的大概啦給委員會給我做參考啦可不可以好不好嘿不要落差太大啦你有沒有漏氣喔好然後跟部長要請教的是500減4049所以增加9516715減5437增加1278你覺得這樣合理嗎 |
| transcript.whisperx[625].start |
15642.679 |
| transcript.whisperx[625].end |
15645.63 |
| transcript.whisperx[625].text |
你換句話說 周遭的屏東店 請走一個屏東人一百塊 |
| transcript.whisperx[626].start |
15650.885 |
| transcript.whisperx[626].end |
15674.204 |
| transcript.whisperx[626].text |
不覺得這樣合理嗎?因為國民年金還是需要永續我們現在新增的部分都是由中央政府直接撥補的預算這個也受到財化法的影響所以我們希望未來行政院版本的財化法如果修正之後我們再繼續檢討 |
| transcript.whisperx[627].start |
15676.025 |
| transcript.whisperx[627].end |
15682.43 |
| transcript.whisperx[627].text |
我是建議部長啦好不好就是越弱勢的我們更應該照顧嘛所以當然不能說所有的每一項的津貼都等同時嘛但是朝向一個最大的一個一個大家可接受的一個調漲然後來保障照顧這些最弱勢的對象我想部長有起這個責任啦所以這個預算應該提高到什麼程度如果說你經過有詳細的一個盤整盤算 |
| transcript.whisperx[628].start |
15701.73 |
| transcript.whisperx[628].end |
15719.882 |
| transcript.whisperx[628].text |
我想今天應該你打呼我就會很肯定嘛那甚至於我們還可以大家一起共同努力來跟行政院來做這個反應也讓全國的針對這8加1的社會津貼的對象都有感在行政院在衛福部的主政之下對這些對象有特別的這樣的一個 |
| transcript.whisperx[629].start |
15720.522 |
| transcript.whisperx[629].end |
15748.946 |
| transcript.whisperx[629].text |
因應現在的經濟狀況物價指數的情形然後有所對他們更高的這樣的一個協助跟支持我想這樣會讓人民感受到政府的溫度也感受到這樣溫暖所以還是要提醒一個星期內應該可以把這些資料給我們可以啦好不管怎麼樣我今天是要提醒就是我們我們很少這樣包含老紅津貼包含津貼料照牌的公民年金很少我們需要去調整到 |
| transcript.whisperx[630].start |
15749.906 |
| transcript.whisperx[630].end |
15770.458 |
| transcript.whisperx[630].text |
這個提高整個津貼的這樣的一個金額的時候我們的總預算還沒有通過啦大家都非常清楚這個新增預算新興項目延續性的新增預算基本上總預算沒有過就是即便法律通過了也通通不可以動之的所以我們是希望努力的可以來跟 |
| transcript.whisperx[631].start |
15771.518 |
| transcript.whisperx[631].end |
15793.53 |
| transcript.whisperx[631].text |
在兩位委員溝通我們竟然把法案都排進來了然後行政院也表示了這樣的一個正面的正向的態度那我想總預算真的是要快速的來審查不然今天我們在這邊討論包含老農今天也好包含前兩天通過了農民儲金也好要由公部門來負擔比例提高基本上總預算沒有過這些法律過通通還是沒有辦法去執行了 |
| transcript.whisperx[632].start |
15795.911 |
| transcript.whisperx[632].end |
15821.386 |
| transcript.whisperx[632].text |
所以這是一個非常非常非常矛盾也非常現實的一個狀況我在這邊也公開的再度來做呼籲那第二件事情我是很厲害的時間比較快我的主持都比較快這個印度發生立百病毒的疫情部長知道嗎知道好已經引起周邊國家警戒亞洲多個國際機場都已經加強的篩檢台灣有嗎 |
| transcript.whisperx[633].start |
15825.536 |
| transcript.whisperx[633].end |
15835.281 |
| transcript.whisperx[633].text |
篩檢沒有啦 我們主要台灣沒有嘛亞洲很多的國際機場都已經篩檢了台灣沒有台灣沒有是台灣覺得還好沒有這麼重要這個應該是講不是什麼篩檢就是發燒篩檢戰啦那因為我們的機場從來沒有測過我們一直其他的機場他們測掉了可是台灣的機場這個發燒篩檢啊 |
| transcript.whisperx[634].start |
15849.599 |
| transcript.whisperx[634].end |
15855.64 |
| transcript.whisperx[634].text |
這個是強調圖為泰國蘇納萬府的機場嘛他們是加強篩檢他下標是這樣嗎?因為我們台灣的發燒篩檢站從來沒有撤離過啦所以等同吃就對了因為立百病毒的RO值低於1不會大流行 |
| transcript.whisperx[635].start |
15873.684 |
| transcript.whisperx[635].end |
15899.693 |
| transcript.whisperx[635].text |
應該是說它目前的數據R0是0.2到0.7啦就是說一個人傳染下一個的人數是0.2個到0.7所以它不會擴大像過去我們那個都是5啊6啊一個人傳好多人的那這個R0值是低於1但是因為雖然它傳播力沒有那麼強可是它的致死率很高才會引發大家的關注 |
| transcript.whisperx[636].start |
15900.68 |
| transcript.whisperx[636].end |
15913.614 |
| transcript.whisperx[636].text |
但是部長知道1998年在馬來西亞經歷了那個立百仙村當時的災難發生什麼事情嘛我知道對不對它是造成三個國家將近300人感染的病例其中100多人死亡耶對然後 |
| transcript.whisperx[637].start |
15914.861 |
| transcript.whisperx[637].end |
15922.049 |
| transcript.whisperx[637].text |
然後還在什麼埃西亞進900個豬場90多萬隻豬頭被捕殺這樣算嚴重嗎?嚴重啊第三下嚴重對人的性命、胖腱、肋骨也不算輕所以它不只是可以人傳人還可以豬傳人還可以豬傳豬的 |
| transcript.whisperx[638].start |
15934.563 |
| transcript.whisperx[638].end |
15951.432 |
| transcript.whisperx[638].text |
這個比我們在要防治非洲疫情的情況之下應該是大家要提高更高的警覺才對吧所以對人而言但是對產業而言我想那個落差值非常非常大 |
| transcript.whisperx[639].start |
15952.842 |
| transcript.whisperx[639].end |
15980.035 |
| transcript.whisperx[639].text |
是不是要請部長 不能大意沒有剩下的本錢 不能因為病毒 脖子低我們就掉個清心嘛對 我們已經提高那個警戒程度了包含從機場的部分 除了發燒篩檢會注意之外也提醒旅客出現相關的症狀要去就醫 要表明他的旅遊史然後我們也發了醫界通函提醒這些可能的症狀是什麼 |
| transcript.whisperx[640].start |
15983.398 |
| transcript.whisperx[640].end |
15999.533 |
| transcript.whisperx[640].text |
我今天會提醒這個事情因為農曆春節快到了反國的鄉親你還能預估嘛所以我們要加強警戒我們可能整個篩檢什麼都要再提高所以變態比較辛苦是不是你可以直接就連結農業部看這個事情要怎麼應應對付 |
| transcript.whisperx[641].start |
16005.198 |
| transcript.whisperx[641].end |
16023.653 |
| transcript.whisperx[641].text |
我覺得這有其不一樣一週內提供給我們做你們要怎麼提升的這樣一個處理的方式最後一項WHO也是讓上週22號川普大帝已經宣布了退出WHO |
| transcript.whisperx[642].start |
16025.034 |
| transcript.whisperx[642].end |
16028.877 |
| transcript.whisperx[642].text |
這個世界衛生組織昨天我原本想要發表一些看法其實這個世界衛生組織是世界最不衛生組織的 |
| transcript.whisperx[643].start |
16036.718 |
| transcript.whisperx[643].end |
16058.107 |
| transcript.whisperx[643].text |
現在美國已經退出了那理由很簡單2019年台灣早就對新型的冠狀病毒發生事情但WHO卻假裝台灣不存在錯失了防疫的先機我們原本有觀察員身份後來被他們取消掉年年好幾年要扣關要申請一個觀察員的身份通通不給我們 |
| transcript.whisperx[644].start |
16059.267 |
| transcript.whisperx[644].end |
16076.039 |
| transcript.whisperx[644].text |
然後我們提出這麼嚴重相信已經算是有人類原始以來造成最大的人員死傷的新冠病毒COVID-19台灣2019就已經提出來WHO視而不見所以它叫做世界最不衛生組織現在 |
| transcript.whisperx[645].start |
16078.891 |
| transcript.whisperx[645].end |
16085.475 |
| transcript.whisperx[645].text |
全世界第一強國 美國就已經退出了台灣的態度是什麼 明年還在扣關嗎 會長這個跟委員說明 這個確實這個美國退出WHO我相信對WHO的衝擊影響比對台灣還要大 |
| transcript.whisperx[646].start |
16098.142 |
| transcript.whisperx[646].end |
16123.192 |
| transcript.whisperx[646].text |
所以我們會密切的觀察後續WHO它的影響會多大但是在目前而言WHO還是全球最主要的衛生醫療平台公共衛生醫療平台所以我們還是會持續的有意義的參與當然未來如果美國有成立新的平台的時候當然我們也會積極爭取去參與 |
| transcript.whisperx[647].start |
16124.993 |
| transcript.whisperx[647].end |
16150.46 |
| transcript.whisperx[647].text |
我覺得有時候是借力使力啦借機發揮啦讓台灣的整個對世界衛生的貢獻醫療的這樣的一個付出真的是你要趁這個機會順勢而為啦我想今天在兩年前AI國際台北AI國際電腦展可以辦了這麼大的盛會這是全世界級的 |
| transcript.whisperx[648].start |
16151.46 |
| transcript.whisperx[648].end |
16172.077 |
| transcript.whisperx[648].text |
雖然名稱叫台北但是他還是一個世界級的那今天川普已經宣布就是退出WHO那其實也跟世界衛生組織宣戰嘛你們這個就是不公平嘛你們這個就是不公正嘛你們這個還在引力嘛然後針對這麼嚴重的事情台灣提出這麼嚴重的事情你還敢視而不見嘛 |
| transcript.whisperx[649].start |
16173.078 |
| transcript.whisperx[649].end |
16187.577 |
| transcript.whisperx[649].text |
那其實因為部長我為什麼希望今天用這個會期最後一次委員會再用多一點的時間來提醒部長因為部長在衛生醫療這個單位公共部門已經滿久的時間 |
| transcript.whisperx[650].start |
16189.666 |
| transcript.whisperx[650].end |
16207.594 |
| transcript.whisperx[650].text |
當AI的國際展台北AI國際展可以辦到如此的盛大那台灣整體的醫療台灣整體的衛生的維護台灣整體的很多的這樣的一個面向的一個整體提升醫療環境衛生環境我們努力貢獻是不是也可以趁這個機會 |
| transcript.whisperx[651].start |
16209.355 |
| transcript.whisperx[651].end |
16235.695 |
| transcript.whisperx[651].text |
可以達到某種程度的一個渲染然後一個一個一個一個一個一個發揚我們更精準的這樣的一個作為就好比台北醫療電腦廠的告理一樣那甚至也可以邀請美國一起來共同來研辦這件事情那AI醫療現在已經都不用再介紹了那AI的機器人 醫療的機器人其實基本上這個都是台灣應該要走在世界的前端 |
| transcript.whisperx[652].start |
16240.513 |
| transcript.whisperx[652].end |
16249.828 |
| transcript.whisperx[652].text |
趁這個機會啊應該部長有你的能耐跟你的經驗嘛而且這速度要快嘛對不對有沒有機會上半年度我們就可以 |
| transcript.whisperx[653].start |
16251.004 |
| transcript.whisperx[653].end |
16278.917 |
| transcript.whisperx[653].text |
搞一個比世界衛生組織開會更具有效果的然後提出前瞻預警性的相關的對醫療對衛生環境有所有所示警全世界還是建置什麼樣的一個模範讓全世界可以來了解到對台灣對這樣的一個互出貢獻確實有達到某種程度的效益還有智慧我快要哭了你怎麼想說第一趕快來思考 |
| transcript.whisperx[654].start |
16280.441 |
| transcript.whisperx[654].end |
16294.235 |
| transcript.whisperx[654].text |
這真的可以做啦,現在你要趁這個機會啦,其實我感覺川普你大舞台給你啦,真的啦,他沒機會大舞台給總統,因為總統外交管理,他要去發表什麼要給某個程度,你們要保證在這個時間是可以很充分的典型,台灣的醫療,台灣的環境衛生, |
| transcript.whisperx[655].start |
16303.304 |
| transcript.whisperx[655].end |
16327.104 |
| transcript.whisperx[655].text |
很多制度 基本上是可以跟世界 早就走在世界前面然後今天又有這樣的一個情勢發生真的請部長展示智慧啦 好不好好好讓我們台灣可以再持續讓台灣可以做世界的台灣啦讓台灣的整個衛生醫療可以在世界再度的躍升這個舞台 好不好好啦 請各位來電 好不好好 謝謝 |
| transcript.whisperx[656].start |
16329.206 |
| transcript.whisperx[656].end |
16334.349 |
| transcript.whisperx[656].text |
好 謝謝趙偉 謝謝好 謝謝劉建國 趙偉接下來最後一位請陳英委員發言這個很辛苦喔 剛到了 剛下飛機好 謝謝趙偉的佛心齁那 嗯對 體諒我們東部班機實在是沒有很優好 那麻煩請我們石部長有請石部長 |
| transcript.whisperx[657].start |
16358.248 |
| transcript.whisperx[657].end |
16386.81 |
| transcript.whisperx[657].text |
三位也辛苦了謝謝部長好我們年關將近所以我們今天打算就春節期間醫療人力調度跟急重症分級醫療政策執行成效要跟部長請教幾個問題首先就是在春節期間我們民眾面臨的急重症大概有哪些大概屬於是哪些科別的醫療人力會短缺還是所有的科別的人力都會短缺 |
| transcript.whisperx[658].start |
16387.87 |
| transcript.whisperx[658].end |
16414.675 |
| transcript.whisperx[658].text |
跟委員說明大概我們看過去的資料這個過年期間的這個急診人次大概是一般我們大概1.5到1.7倍啦多增加了很大一部分就是呼吸道還有腸胃道還有一些小外傷啦所以最多的還是呼吸道疾病是最多那又會剛好每年都碰到那個流感劑的高峰剛好都在過年期間 |
| transcript.whisperx[659].start |
16415.495 |
| transcript.whisperx[659].end |
16435.346 |
| transcript.whisperx[659].text |
所以今年我們就提早因應了那這樣我們過去在微服部有沒有利用健保資料庫去統計分析春節期間民眾的就醫需求那是不是也跟平日有比較顯著的這個差異那這些差異呢是不是有這個跟這個地區別 |
| transcript.whisperx[660].start |
16436.667 |
| transcript.whisperx[660].end |
16447.196 |
| transcript.whisperx[660].text |
有這個不同的規模或者跟應該是說有沒有跟這個地區別或者有沒有跟這個不同規模的醫療院所或者是不同專業課別有關呢 |
| transcript.whisperx[661].start |
16449.529 |
| transcript.whisperx[661].end |
16476.774 |
| transcript.whisperx[661].text |
就是整體的我們大概都有掌握不過委員提醒我們這個地區差異我們來特別看一下好那就是你們都是有利用健保資料庫去統計那如果說衛福部有掌握這些差異性的分布那是不是我們今天討論的這個醫療人力不足就可以很清楚的掌握大約因為年假的關係哪些區域 |
| transcript.whisperx[662].start |
16477.574 |
| transcript.whisperx[662].end |
16501.603 |
| transcript.whisperx[662].text |
好的哪些醫院可能會短缺什麼樣的這個科別的醫療人力而且短缺多少也可以根據經驗提早掌握因應了那舉例而言在我們台東縣在過年期間有沒有醫療人力不足的問題那他的醫療資源有限那分級醫療更是困難所以衛福部你們的掌握到的狀況是怎麼樣大概 |
| transcript.whisperx[663].start |
16503.645 |
| transcript.whisperx[663].end |
16527.723 |
| transcript.whisperx[663].text |
以台東本來資源就比較缺乏啦那這個醫院的話都是會開診那大概我們過去的資料是初一初二初三開診率是最低的所以我們今年才會有那個加成獎勵百分之百加成在這幾天就是這樣那麼這個診所的開診率比較低我們現在再繼續給他努力 |
| transcript.whisperx[664].start |
16528.723 |
| transcript.whisperx[664].end |
16551.29 |
| transcript.whisperx[664].text |
就是當年初一到初三這三天對對對這幾天是比較低那所以我們這樣目前醫療人力的調度啊那個衛福部有沒有就是你們的具體做法是怎麼樣就是說是不是限制休假啦那這些加班的人力啊有沒有根據這個勞基法國定假日薪資增加2.67倍同時可以補休 |
| transcript.whisperx[665].start |
16554.191 |
| transcript.whisperx[665].end |
16576.304 |
| transcript.whisperx[665].text |
那目前這些需要調整的醫療人力的醫療院所衛福部有什麼職權你們可以來要求加強調整我們的做法是兩塊一個是說門診的部分分流所以從基層的去鼓勵那麼在醫院的部分重症的收治還是重要 |
| transcript.whisperx[666].start |
16576.684 |
| transcript.whisperx[666].end |
16597.478 |
| transcript.whisperx[666].text |
因為過去會關床 大家要休假所以我們現在請醫院調整一下大家的休假前後段把這個住院的量也叫去年給它提升所以住院的部分的病床也會比去年增加那麼至於獎勵的部分 |
| transcript.whisperx[667].start |
16599.42 |
| transcript.whisperx[667].end |
16622.202 |
| transcript.whisperx[667].text |
80%都一定要給人員不是拿去做醫院的其他用的對 就80%一定都給上班的人員去使用大概是目前是用這樣的有一個問題你沒有回答到就是說當然有一些部分是依據勞基法的部分因為我們除了醫師之外都是勞基法 |
| transcript.whisperx[668].start |
16624.451 |
| transcript.whisperx[668].end |
16648.667 |
| transcript.whisperx[668].text |
因為我們除了醫師之外其他都是適用勞基法人員對對對那我是說他落實的狀況如何這樣子落實的狀況對因為有就是說畢竟是這個過年過年加班他的這個薪資增加計算的方式倍數比較多嘛就這個部分你們可能要留意一下我們再提醒好對好 |
| transcript.whisperx[669].start |
16649.187 |
| transcript.whisperx[669].end |
16663.523 |
| transcript.whisperx[669].text |
那在過去曾經像譬如說在COVID的期間那政府有做了很多的提醒衛福部也有一個很強大的這個APP然後來提醒民眾這個很多的該注意的事情 |
| transcript.whisperx[670].start |
16664.144 |
| transcript.whisperx[670].end |
16693.308 |
| transcript.whisperx[670].text |
大概是像過年期間其實我們好像沒有聽過說衛福部是有發布新聞稿啦或者有做什麼來提醒民眾要注意身體健康要注意保暖或腸胃消化系統的不是那就是說同時可能也因為面臨這個人力吃緊的問題我們就是說可以做哪些配合或者是說我們應該可以從這個源頭來提醒民眾備藥啦或者是有一些 |
| transcript.whisperx[671].start |
16694.689 |
| transcript.whisperx[671].end |
16707.827 |
| transcript.whisperx[671].text |
狀況我們是可以在家裡自行處理的不要就是說大家一窩蜂全部都往醫院擠畢竟那個診所應該這個時候是大部分都不會有人所以這個部分 |
| transcript.whisperx[672].start |
16709.75 |
| transcript.whisperx[672].end |
16731.069 |
| transcript.whisperx[672].text |
就是說是不是我們做可以在今年做這樣子的準備跟提醒不曉得部長是不是這個同意本席的建議然後讓民眾知道就是說我們哪些集中症可能會發生要怎麼預防如果不幸需要緊急就醫那哪些醫療院所可以提供這個比較完善的照顧 |
| transcript.whisperx[673].start |
16731.67 |
| transcript.whisperx[673].end |
16753.719 |
| transcript.whisperx[673].text |
好那個謝謝委員提醒確實我們現在是朝向提供就醫資訊我們這個APP上都會去強化就醫資訊但是對民眾自我照顧的提升特別提醒的是這樣不要生病過年期間也不要這個熬夜打牌太久然後暴飲暴食這個也不好 |
| transcript.whisperx[674].start |
16754.739 |
| transcript.whisperx[674].end |
16766.358 |
| transcript.whisperx[674].text |
那我們來強化一下這個自我照顧本來就有慢性病的更要注意嘛勸大家都不要打牌那個時候應該很困難不要打太久啦 |
| transcript.whisperx[675].start |
16767.776 |
| transcript.whisperx[675].end |
16786.075 |
| transcript.whisperx[675].text |
好這個就看你們宣導的功力了那我們最後想請教就是這個急重症分級醫療實施的成效我想在這個分級醫療是維持我們健康品質的一個手段而不是一個目的那平常的這個醫療我們的這個分級醫療 |
| transcript.whisperx[676].start |
16790.299 |
| transcript.whisperx[676].end |
16801.668 |
| transcript.whisperx[676].text |
有真的落實那春節的就可以很順利的執行所以要請部長說明一下在分級醫療目前執行上有沒有什麼困難那我們真的有落實嗎 |
| transcript.whisperx[677].start |
16802.691 |
| transcript.whisperx[677].end |
16825.16 |
| transcript.whisperx[677].text |
我看了一些我們最近的這個分析這分級醫療有在改善就是各層級醫院他的輕症比例是在下降那麼包含醫學中心他現在所謂的輕症大概是就醫佔整個醫院的大概收入的38%然後到區域級醫院大概是50%然後到地區醫院是65% |
| transcript.whisperx[678].start |
16826.34 |
| transcript.whisperx[678].end |
16851.805 |
| transcript.whisperx[678].text |
你可以看得到這個三個層級是不一樣醫學中心還是看得比較多的重大傷病這個是可以看得出來那另外一個就是慢性病在基層就醫的比例也在提高也就是說慢性病拿這個長期處方籤的也在提升所以分級醫療有在進步但是呢還是有更多努力的空間這我們會持續用各種的方式來推動這樣 |
| transcript.whisperx[679].start |
16853.646 |
| transcript.whisperx[679].end |
16877.447 |
| transcript.whisperx[679].text |
好我接下来问一个比较严肃的问题就是说有没有医学中心或区域医院拒绝转送还是说协调这个后送要花很长的时间去协调安排那这些需要转送的病人是急诊的病人居多还是重症患者治疗一段时间了然后才决定后送的 |
| transcript.whisperx[680].start |
16877.95 |
| transcript.whisperx[680].end |
16892.404 |
| transcript.whisperx[680].text |
因為這些大概都攸關整個成效的指標那衛福部有沒有專責的單位在做統計分析不然你們要怎麼知道說你們做的分級醫療政策確實是有效的呢 |
| transcript.whisperx[681].start |
16893.089 |
| transcript.whisperx[681].end |
16910.412 |
| transcript.whisperx[681].text |
就是急診的轉診率這個我們有有在monitor啦但是您提的是說住院了一段時間在轉診我想這個我們健保資料是有辦法分析那我們來分析看看有沒有這些異常的情形發生 |
| transcript.whisperx[682].start |
16911.333 |
| transcript.whisperx[682].end |
16925.25 |
| transcript.whisperx[682].text |
因為有些是需要轉送的病人就是說那到底急診的多還是說重症患者好這些你們可能都要對就是住院之後又轉診的這部分就再特別留意看一下 |
| transcript.whisperx[683].start |
16926.431 |
| transcript.whisperx[683].end |
16944.491 |
| transcript.whisperx[683].text |
因為部長你是真的非常難得就是從一位醫師然後從這個轉任常務文官然後又有擔任這個政務官的這個人才所以我想我們在這麼長的歲月的共識當中 |
| transcript.whisperx[684].start |
16946.96 |
| transcript.whisperx[684].end |
16970.891 |
| transcript.whisperx[684].text |
我們像部長就是也不僅承認這個醫事司長那時候我也有在那健保署署長跟次長我都有在歷練非常的完整所以呢希望在這麼豐富的這個培養之下呢部長應該是最有能力跟經驗來解決今天討論的難題所以也希望 |
| transcript.whisperx[685].start |
16972.572 |
| transcript.whisperx[685].end |
16998.364 |
| transcript.whisperx[685].text |
衛福部可以善用健保資料庫可以多考慮經濟誘因來取代強制性的管理跟管制所以我想如果是這樣的話一定是可以解決醫療人力短缺的問題不管是在平日或者是春節假日我想這個才是我們民眾的福氣是我們國家的福氣謝謝謝謝委員的鼓勵我們要繼續努力 |
| transcript.whisperx[686].start |
17002.725 |
| transcript.whisperx[686].end |
17020.987 |
| transcript.whisperx[686].text |
好謝謝陳英委員發言那本日會議詢答全部結束那委員徐欣穎所提書面質詢列入紀錄刊登公報現在做以下決定及決議第一報告說明及詢答完畢 |
| transcript.whisperx[687].start |
17021.909 |
| transcript.whisperx[687].end |
17044.334 |
| transcript.whisperx[687].text |
二委員質詢未及答覆或請補充資料者請相關機關於二週內以書面答覆委員另要求期限者從期鎖定三國民年金法部分條文修正草案等19案另則期繼續審查本次會議到此結束現在散會 |
| transcript.whisperx[688].start |
17050.306 |
| transcript.whisperx[688].end |
17051.467 |
| transcript.whisperx[688].text |
謝謝張委員 謝謝 謝謝新年快樂好 |
| transcript.whisperx[689].start |
17066.074 |
| transcript.whisperx[689].end |
17066.094 |
| transcript.whisperx[689].text |
謝謝你們 |