{"id":152067,"url":"https://ivod.ly.gov.tw/Play/Clip/1M/152067","video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/6f015fe8e6787db112d6bf9574cbb056d575e50b9cd8685a55be169921a0a7173c866e876d24eab55ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"王正旭","委員發言時間":"10:58:14 - 11:08:49","影片長度":"00:10:35","會議時間":"2024-05-02T09:00:00+08:00","會議名稱":"立法院第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議（事由：審查\n一、委員王育敏等19人擬具「全民健康保險法第六十二條條文修正草案」案。\n二、委員蘇清泉等28人擬具「全民健康保險法第六十二條條文修正草案」案。\n三、國民黨黨團擬具「全民健康保險法第六十二條條文修正草案」案。\n【以上議案，如經復議則不予審查】）","date":"2024-05-02","meet":{"tmpMeeting":null,"title":"第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議","term":11,"type":"委員會","sessionPeriod":1,"sessionTimes":14,"committees":[26],"id":"委員會-11-1-26-14"},"duration":635,"end_time":"2024-05-02T11:08:49+08:00","start_time":"2024-05-02T10:58:14+08:00","features":["ai-transcript","gazette"],"type":"Clip","gazette":{"lineno":601,"blocks":[["王委員正旭：（10時58分）謝謝主席。麻煩薛部長，還有石署長。"],["主席：請薛部長、石署長。"],["薛部長瑞元：委員好。"],["王委員正旭：部長好、署長好。經過剛剛很熱烈的討論，我們知道這個真的非常、非常重要，期待透過很好的討論，讓社會大眾共同來面對這個問題，能夠有效解決問題。未來如果有機會，下個禮拜一的公聽會經過大家努力討論以後，希望能夠有一個解決的方向或者是方案出來。我們也知道，健保真的是一個保護全民健康的制度，達到好的滿意度的同時，也得到社會跟全球的肯定。我在這邊想要跟部長討論的是，除了高度滿意以外，基本上就是提升了醫療的可近性，讓民眾在就醫的時候可以很方便，而且可以及時得到疾病的照護，也促進國人的健康。過去這20年來，總額支付制度執行下來，除了控管以外，其實也真的能夠讓健保的資源得到有效利用。當然它造成的影響，尤其是疫情之後造成的影響讓我們整體醫療的韌性受到很大的考驗，對於醫療的從業人員，剛剛提到很多次，包括部長、署長、現場蘇委員、還有我本身都是來自醫界，我們非常非常認同健保制度有這麼好的優點，可是還是需要做一些調整、做一些改革，透過這個改革除了繼續照顧民眾健康，同時也希望能夠建立一個友善的醫療環境，讓所有從事醫療的同仁都能夠得到該有的保障，這個是我們非常非常期待的。","我們可以了解，剛剛也提過很多關於新政府賴總統當選人他未來希望能夠對於健保部分做哪一些調整、哪一些改革，他也允諾健保點值不應該低於0.9元，並且要朝著1點1元的方向來努力，當然這個需要透過健保的改革來改善點值的不足，如果現階段可以不修法就能夠達到這個目標的話，其實在對社會各方面的影響最低的同時也希望能夠讓整個醫療環境可以更為方便、更為改善，所以他也希望未來行政團隊衛福部需要針對挹注財源跟促進健保的永續目標提出一些研議跟完整的規劃策略。","我們可以從下一張圖卡看到，如果賴總統的政見允諾要能夠實現的話，其實在上個禮拜六健康台灣論壇裡面就有提出一些財務策略的方向來做為改革大方向的依據，這邊羅列了六點，請問部長，這六點未來我們能夠快速執行的部分有哪一些？有哪些部分可能還需要經過調整或是做一些修正？這部分可不可以請部長先讓我們知道大方向可行的部分？"],["薛部長瑞元：這部分的話，一是解釋的變更，那是在施行細則裡面，這個不必修法就可以做得到；二的部分就必須要修法；三的部分是另立癌藥基金，這個就必須要有公務預算來支撐，目前的規劃可能是100億。至於部分總額項目改用公務預算支應，就現在舉出來的這一些，total大概從100億到200億之間，所以再加上剛剛那個癌藥基金，如果是離開健保再另外去做的話，大概100億，這樣加起來大概可以騰出差不多300億到400億之間。","然後個人補充保費的部分要修法，這沒有辦法不修法；調整補充保費的費率也必須要修法。所以如果不修法的話大概是我剛剛算的，可能有200億到300億可以騰出來，就是改由公務預算來支應，但是跟我們今天所提的，如果是0.95元的話要700億、如果是1點1元的話要1,150億，還有很大的一個差距。"],["王委員正旭：是，所以部長意思是如果透過這些健保財務策略的改善方向來看，未來還是有機會去增加整體的醫療資源，這個是可以肯定的？"],["薛部長瑞元：這都是一樣啦，公務預算放到健保裡面去挹注或者是公務預算另外去支應這一些計畫，其實都是公務預算，就是有機會可以去做調整的，如果主計總處能夠容許我們把這個預算編列出來，那麼這部分是可以的，就不用修法，但是這裡差不多可能只能支應到二、三百億。"],["王委員正旭：是，至少可以預先編列好類似的概算，將來在執行的時候不會出問題、出狀況。"],["薛部長瑞元：對。"],["王委員正旭：好，謝謝。下一頁我們可以看到總額制度的改革最重要的目標就是希望能夠穩定醫療的服務點值，包括這幾大項，這部分除了部長來說明以外，署長可不可以來補充說明？未來針對於彈性總額制度、總額目標制等等，如何能夠讓民眾或是整個醫療團隊、醫療團體對於我們如何穩定醫療服務點值更有信心。"],["薛部長瑞元：這部分的話，第一個我們再做討論；第二個其實現在都已經在做了，包括偏鄉保障1點1元或者是給付加成，這個現在都在做。至於DRG的部分其實是可以持續再做推動，這個也應該是可以做得到。而關於高價、具集中性之醫療服務要獨立在總額之外，其實目前都是先用專款在做處理，嚴格來講也是屬於在總額之外，所以問題點是出在第一個所謂的彈性總額制度，這邊寫的是總額目標制，總額目標制的定義必須要清楚，假設我們今年預定的總額是9,000億，最後超出了，那要怎麼處理？如果堅持1點1元，就幾乎可以說是沒有總額了，那個目標是假的，超出還是1點1元嘛！0.95元也是一樣。所以如果是要目標制的話，就是超出總額之外的必須要打折，問題是要打幾折？現在是打0折啦，就是超出了就通通不付，那以後要打幾折？這個大家要講清楚，如果要去推所謂的總額目標制的話。"],["王委員正旭：的確我們的改革真的是要執行、要進行，要怎麼做會是最適當。我們可以看下一張圖卡，其實健保法第六十二條就是在規範總額制度之下點值調整的要求。我們再往下看會知道，如果真的把這個點值做一個下限的要求的話，那未來的實質運作還算是……目前我們看到還是希望在總額制度之下來運行，這個是可以理解的，而且是透過公務預算來遂行這部分的總額制度未來不受到太大的衝擊。","我們再往下看，其實我們知道我們所擔心或者是未來在執行上要更為注意的就是會不會回到論量計酬制，這種實質上是一個總額，可是執行上會變成是一個論量計酬制。我們再往下看，論量計酬制事實上一開始就是採取這樣的制度，後來因為整體的醫療費用快速成長，在很快就要調保費的情形下，後來在2002年全面實施總額支付制，我們也看到總額支付制真的達到了階段性的成就，如何在現有的基礎上再做一些適度的調控來改善支付基準的這些改革，讓全民都了解、讓醫界也共同了解我們希望建構一個良善的、好的醫療環境，讓所有的醫療同仁持續來照顧全民的健康，同時又能夠讓這個支付達到一個更好的、合理的分配、合理醫療資源的提供，我相信這個大家一定要共同來努力，也期待部長在未來的時間裡持續往這個方向一起來貢獻您的力量。"],["薛部長瑞元：好，謝謝。"],["王委員正旭：謝謝部長。"],["主席：謝謝王正旭委員。","接下來請蘇清泉委員質詢。"]],"agenda":{"page_end":242,"meet_id":"委員會-11-1-26-14","speakers":["王育敏","蘇清泉","陳昭姿","陳菁徽","林月琴","黃秀芳","邱鎮軍","涂權吉","廖偉翔","劉建國","王正旭","林淑芬","林德福","賴士葆","李彥秀","盧縣一","楊瓊瓔","黃國昌","賴惠員","陳瑩","楊曜"],"page_start":167,"meetingDate":["2024-05-02"],"gazette_id":"1133901","agenda_lcidc_ids":["1133901_00004"],"meet_name":"立法院第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議紀錄","content":"審查一、委員王育敏等18人擬具「全民健康保險法第六十二條條文修正草案」案；二、委員蘇清\n泉等27人擬具「全民健康保險法第六十二條條文修正草案」案；三、國民黨黨團擬具「全民健康\n保險法第六十二條條文修正草案」案","agenda_id":"1133901_00003"}},"transcript":{"id":"152067","pyannote":{"name":"ronny","tool":"pyannote","data":{"url":"https://ivod.ly.gov.tw/Play/Clip/1M/152067","tool":"pyannote","id":"152067-pyannote"},"job_id":"mZMzGig7GZmGfQMt","queued_at":"2024-05-31 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\"環\"}, {\"word\": \"境\", \"start\": 614.694, \"end\": 614.714, \"score\": 0.0}, {\"word\": \"委\", \"start\": 614.714, \"end\": 614.734, \"score\": 0.0}, {\"word\": \"員\"}, {\"word\": \"會\"}, {\"word\": \"好\", \"start\": 633.77, \"end\": 633.79, \"score\": 0.005}, {\"word\": \"謝\"}, {\"word\": \"謝\"}], \"language\": \"zh\"}","srt":"1\n00:00:10,619 --> 00:00:37,290\n謝謝主席。麻煩薛部長還有石署長。好,薛部長、石署長請。國安好。部長好、石署長好。經過剛剛很熱烈的討論,我們知道其實這個真的非常非常重要。期待透過很好的討論,得到社會大家共同來面對這個問題。\n\n2\n00:00:38,752 --> 00:01:02,365\nbicyn珍珠珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍�\n\n3\n00:01:06,787 --> 00:01:27,465\n那這邊想要跟部長討論的就是下一張的翻燈片告訴我們說除了這個高度滿意以外基本上就是提升了這個醫療的可敬性讓民眾在就醫的時候可以很方便而且可以及時的得到整個疾病的照護那也促進了國人的健康\n\n4\n00:01:28,266 --> 00:01:48,864\n那過去這20年來總額支付制度執行下來其實也真的能夠讓這個健保的資源除了控管以外也得到有效的利用那當然它的造成的影響尤其是疫情之後造成的影響讓我們整體的這個醫療的韌性受到很大的考驗\n\n5\n00:01:49,945 --> 00:02:08,353\n對於醫療我從業人員剛剛提到很多次包括部長、署長還有現場數位員還有我本身都是來自醫界我們非常非常的認同健保制度有這麼好的優點可是還是需要做一些調整做一些改革\n\n6\n00:02:09,153 --> 00:02:32,949\n二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次\n\n7\n00:02:39,013 --> 00:02:40,054\nbicyn蘇清泉\n\n8\n00:02:56,716 --> 00:02:58,337\nbicylman\n\n9\n00:03:27,236 --> 00:03:49,814\n則,我們可以從下一張看到如果這個賴總統的政見要允諾能夠呈現實現的話那其實在上個禮拜六健康台灣的論壇裡面就有提出了一些財務策略的方向來作為改革的一個大的方向的依據那這邊就羅列了六點那這六點請問部長未來我們\n\n10\n00:03:54,838 --> 00:03:55,078\n議員王育敏等19人擬具\n\n11\n00:04:13,612 --> 00:04:35,204\n這部分的話,一的話,那是一個解釋的一個變更,那是在實現細則裡面,那這個不必修法就可以做得到。二的部分的話,就必須要修法。那三的部分的話,另立癌藥基金,那這個就必須要有空汙預算來支撐。目前的規劃可能是在一百億。\n\n12\n00:04:36,064 --> 00:05:04,247\n�那部分總額的項目改用公費預算來支援的部分的話就剛現在舉出來的這一些的話大概TOTAL從一百億到兩百億之間所以再加上剛剛那個癌藥基金的如果是離開健保再另外去做的話大概一百億這樣加起來大概可以就是說騰出騰出這個差不多在三百億到四百億之間\n\n13\n00:05:05,228 --> 00:05:22,186\n然後個人補充保費的這部分的話這要修法這沒有辦法說不修法那調整補充保費的費率這也必須要修法所以如果不修法的話大概我剛剛算的可能在200億到300億可以騰出來\n\n14\n00:05:24,008 --> 00:05:50,931\nbicyn則是改由公務預算來支援。但是跟我們今天所提的如果是0.95的話要700億那如果是1.1億的話1151億還有很大的一個差距。是所以部長意思是說如果透過這些健保財務策略的這個改善方向來看的話未來還是有機會去增加整體的醫療資源這個是可以肯定的\n\n15\n00:05:52,899 --> 00:06:11,539\n這都是一樣啦,就是說公務預算放到這個健保裡面去移住,或者是公務預算另外去支援這一些計畫,其實都是公務預算。就是有機會可以去做調整的,如果說主席總書這邊的話,\n\n16\n00:06:13,221 --> 00:06:15,122\nadequard\n\n17\n00:06:37,657 --> 00:07:06,274\n那針對於下一頁我們可以看到的就是總和制度的改革其實最重要的目標就是希望能夠穩定醫療的服務點值那就包括這幾大項那這部分除了部長來說明以外那署長也可以來補充說明未來針對於這個彈性總和制度總和目標制等等的話如何能夠讓民眾或者是整個醫療團隊醫療團體對於我們如何穩定醫療服務點值是更有信心\n\n18\n00:07:08,200 --> 00:07:27,697\n這個部分的話,第一個我們在座討論。第二個部分的話,其實都已經現在是在做了。包括這些偏鄉的保障一點議員,或者是他的給付加成,這個現在都在做。DRG的部分的話,其實是可以持續在座推動,這個也應該是可以做得到。\n\n19\n00:07:28,337 --> 00:07:56,183\n那高價集中性的這些醫療服務獨立在總額之外其實目前都是先用專款在做處理它嚴格來講也是屬於說在總額之外所以問題點是出在第一個所謂的彈性總額制度這邊寫的是總額目標制總額目標制的定義必須要清楚假設說我們今年預定的總額是九千億\n\n20\n00:07:57,591 --> 00:08:03,579\n那最後超出了,要怎麼處理?你如果堅持是1.1元的話,這幾乎可以說是沒有總額的。\n\n21\n00:08:09,517 --> 00:08:29,549\nadequ目標是假的,因為超出你還是一點議員嘛。零點九五也是一樣。所以如果是要目標制的話,就是超出總額之外的話必須要打折。那問題就是要打幾折。以現在是打零折啦。就是通通超出了就不付啦。那以後的話,要打幾折?\n\n22\n00:08:30,780 --> 00:08:49,017\nuggage要講清楚。如果說所謂的總額目標制要去推這個的話。的確我們的改革真的是要執行、要進行。那來怎麼做會是最適當我們可以看下一張。其實健保法六十二條就是在規範這個總額制度之下這個電子的調整的這個\n\n23\n00:09:14,049 --> 00:09:39,567\n�其實我們也知道我們所擔心或者是未來在執行上要更為注意的就是那會不會回到論量計酬制的這種實質上它是一個總和可是執行上會變成是一個論量計酬制我們再往下看那這個論量計酬制事實上一開始就是採取這樣的制度後來因為整體的這個醫療費用快速的成長\n\n24\n00:10:03,387 --> 00:10:14,734\n二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．立法院第11屆第12會期社會福利及衛生環境委員會第12條條文修正草案．立法院第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會\n\n25\n00:10:33,770 --> 00:10:33,790\n好謝謝\n\n","tsv":"start\tend\ttext\n10619\t37290\t謝謝主席。麻煩薛部長還有石署長。好,薛部長、石署長請。國安好。部長好、石署長好。經過剛剛很熱烈的討論,我們知道其實這個真的非常非常重要。期待透過很好的討論,得到社會大家共同來面對這個問題。\n38752\t62365\tbicyn 珍珠珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍�\n66787\t87465\t那這邊想要跟部長討論的就是下一張的翻燈片告訴我們說除了這個高度滿意以外基本上就是提升了這個醫療的可敬性讓民眾在就醫的時候可以很方便而且可以及時的得到整個疾病的照護那也促進了國人的健康\n88266\t108864\t那過去這20年來總額支付制度執行下來其實也真的能夠讓這個健保的資源除了控管以外也得到有效的利用那當然它的造成的影響尤其是疫情之後造成的影響讓我們整體的這個醫療的韌性受到很大的考驗\n109945\t128353\t對於醫療我從業人員剛剛提到很多次包括部長、署長還有現場數位員還有我本身都是來自醫界我們非常非常的認同健保制度有這麼好的優點可是還是需要做一些調整做一些改革\n129153\t152949\t二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次\n159013\t160054\tbicyn 蘇清泉\n176716\t178337\tbicylman\n207236\t229814\t則,我們可以從下一張看到如果這個賴總統的政見要允諾能夠呈現實現的話那其實在上個禮拜六健康台灣的論壇裡面就有提出了一些財務策略的方向來作為改革的一個大的方向的依據那這邊就羅列了六點那這六點請問部長未來我們\n234838\t235078\t議員王育敏等19人擬具\n253612\t275204\t這部分的話,一的話,那是一個解釋的一個變更,那是在實現細則裡面,那這個不必修法就可以做得到。二的部分的話,就必須要修法。那三的部分的話,另立癌藥基金,那這個就必須要有空汙預算來支撐。目前的規劃可能是在一百億。\n276064\t304247\t�那部分總額的項目改用公費預算來支援的部分的話就剛現在舉出來的這一些的話大概TOTAL從一百億到兩百億之間所以再加上剛剛那個癌藥基金的如果是離開健保再另外去做的話大概一百億這樣加起來大概可以就是說騰出騰出這個差不多在三百億到四百億之間\n305228\t322186\t然後個人補充保費的這部分的話這要修法這沒有辦法說不修法那調整補充保費的費率這也必須要修法所以如果不修法的話大概我剛剛算的可能在200億到300億可以騰出來\n324008\t350931\tbicyn 則是改由公務預算來支援。但是跟我們今天所提的如果是0.95的話要700億那如果是1.1億的話1151億還有很大的一個差距。是 所以部長意思是說如果透過這些健保財務策略的這個改善方向來看的話未來還是有機會去增加整體的醫療資源這個是可以肯定的\n352899\t371539\t這都是一樣啦,就是說公務預算放到這個健保裡面去移住,或者是公務預算另外去支援這一些計畫,其實都是公務預算。就是有機會可以去做調整的,如果說主席總書這邊的話,\n373221\t375122\tadequard\n397657\t426274\t那針對於下一頁我們可以看到的就是總和制度的改革其實最重要的目標就是希望能夠穩定醫療的服務點值那就包括這幾大項那這部分除了部長來說明以外那署長也可以來補充說明未來針對於這個彈性總和制度總和目標制等等的話如何能夠讓民眾或者是整個醫療團隊醫療團體對於我們如何穩定醫療服務點值是更有信心\n428200\t447697\t這個部分的話,第一個我們在座討論。第二個部分的話,其實都已經現在是在做了。包括這些偏鄉的保障一點議員,或者是他的給付加成,這個現在都在做。DRG的部分的話,其實是可以持續在座推動,這個也應該是可以做得到。\n448337\t476183\t那高價集中性的這些醫療服務獨立在總額之外其實目前都是先用專款在做處理它嚴格來講也是屬於說在總額之外所以問題點是出在第一個所謂的彈性總額制度這邊寫的是總額目標制總額目標制的定義必須要清楚假設說我們今年預定的總額是九千億\n477591\t483579\t那最後超出了,要怎麼處理?你如果堅持是1.1元的話,這幾乎可以說是沒有總額的。\n489517\t509549\tadequ目標是假的,因為超出你還是一點議員嘛。零點九五也是一樣。所以如果是要目標制的話,就是超出總額之外的話必須要打折。那問題就是要打幾折。以現在是打零折啦。就是通通超出了就不付啦。那以後的話,要打幾折?\n510780\t529017\tuggage要講清楚。如果說所謂的總額目標制要去推這個的話。的確我們的改革真的是要執行、要進行。那來怎麼做會是最適當我們可以看下一張。其實健保法六十二條就是在規範這個總額制度之下這個電子的調整的這個\n529838\t553729\t​​​​​​​​​​\n554049\t579567\t� 其實我們也知道我們所擔心或者是未來在執行上要更為注意的就是那會不會回到論量計酬制的這種實質上它是一個總和可是執行上會變成是一個論量計酬制我們再往下看那這個論量計酬制事實上一開始就是採取這樣的制度後來因為整體的這個醫療費用快速的成長\n580828\t603387\t​​​​​​​​​​​​\n603387\t614734\t二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．立法院第11屆第12會期社會福利及衛生環境委員會第12條條文修正草案．立法院第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會\n633770\t633790\t好謝謝\n","txt":"謝謝主席。麻煩薛部長還有石署長。好,薛部長、石署長請。國安好。部長好、石署長好。經過剛剛很熱烈的討論,我們知道其實這個真的非常非常重要。期待透過很好的討論,得到社會大家共同來面對這個問題。\nbicyn 珍珠珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍�\n那這邊想要跟部長討論的就是下一張的翻燈片告訴我們說除了這個高度滿意以外基本上就是提升了這個醫療的可敬性讓民眾在就醫的時候可以很方便而且可以及時的得到整個疾病的照護那也促進了國人的健康\n那過去這20年來總額支付制度執行下來其實也真的能夠讓這個健保的資源除了控管以外也得到有效的利用那當然它的造成的影響尤其是疫情之後造成的影響讓我們整體的這個醫療的韌性受到很大的考驗\n對於醫療我從業人員剛剛提到很多次包括部長、署長還有現場數位員還有我本身都是來自醫界我們非常非常的認同健保制度有這麼好的優點可是還是需要做一些調整做一些改革\n二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次\nbicyn 蘇清泉\nbicylman\n則,我們可以從下一張看到如果這個賴總統的政見要允諾能夠呈現實現的話那其實在上個禮拜六健康台灣的論壇裡面就有提出了一些財務策略的方向來作為改革的一個大的方向的依據那這邊就羅列了六點那這六點請問部長未來我們\n議員王育敏等19人擬具\n這部分的話,一的話,那是一個解釋的一個變更,那是在實現細則裡面,那這個不必修法就可以做得到。二的部分的話,就必須要修法。那三的部分的話,另立癌藥基金,那這個就必須要有空汙預算來支撐。目前的規劃可能是在一百億。\n�那部分總額的項目改用公費預算來支援的部分的話就剛現在舉出來的這一些的話大概TOTAL從一百億到兩百億之間所以再加上剛剛那個癌藥基金的如果是離開健保再另外去做的話大概一百億這樣加起來大概可以就是說騰出騰出這個差不多在三百億到四百億之間\n然後個人補充保費的這部分的話這要修法這沒有辦法說不修法那調整補充保費的費率這也必須要修法所以如果不修法的話大概我剛剛算的可能在200億到300億可以騰出來\nbicyn 則是改由公務預算來支援。但是跟我們今天所提的如果是0.95的話要700億那如果是1.1億的話1151億還有很大的一個差距。是 所以部長意思是說如果透過這些健保財務策略的這個改善方向來看的話未來還是有機會去增加整體的醫療資源這個是可以肯定的\n這都是一樣啦,就是說公務預算放到這個健保裡面去移住,或者是公務預算另外去支援這一些計畫,其實都是公務預算。就是有機會可以去做調整的,如果說主席總書這邊的話,\nadequard\n那針對於下一頁我們可以看到的就是總和制度的改革其實最重要的目標就是希望能夠穩定醫療的服務點值那就包括這幾大項那這部分除了部長來說明以外那署長也可以來補充說明未來針對於這個彈性總和制度總和目標制等等的話如何能夠讓民眾或者是整個醫療團隊醫療團體對於我們如何穩定醫療服務點值是更有信心\n這個部分的話,第一個我們在座討論。第二個部分的話,其實都已經現在是在做了。包括這些偏鄉的保障一點議員,或者是他的給付加成,這個現在都在做。DRG的部分的話,其實是可以持續在座推動,這個也應該是可以做得到。\n那高價集中性的這些醫療服務獨立在總額之外其實目前都是先用專款在做處理它嚴格來講也是屬於說在總額之外所以問題點是出在第一個所謂的彈性總額制度這邊寫的是總額目標制總額目標制的定義必須要清楚假設說我們今年預定的總額是九千億\n那最後超出了,要怎麼處理?你如果堅持是1.1元的話,這幾乎可以說是沒有總額的。\nadequ目標是假的,因為超出你還是一點議員嘛。零點九五也是一樣。所以如果是要目標制的話,就是超出總額之外的話必須要打折。那問題就是要打幾折。以現在是打零折啦。就是通通超出了就不付啦。那以後的話,要打幾折?\nuggage要講清楚。如果說所謂的總額目標制要去推這個的話。的確我們的改革真的是要執行、要進行。那來怎麼做會是最適當我們可以看下一張。其實健保法六十二條就是在規範這個總額制度之下這個電子的調整的這個\n​​​​​​​​​​\n� 其實我們也知道我們所擔心或者是未來在執行上要更為注意的就是那會不會回到論量計酬制的這種實質上它是一個總和可是執行上會變成是一個論量計酬制我們再往下看那這個論量計酬制事實上一開始就是採取這樣的制度後來因為整體的這個醫療費用快速的成長\n​​​​​​​​​​​​\n二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．立法院第11屆第12會期社會福利及衛生環境委員會第12條條文修正草案．立法院第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會\n好謝謝\n","vtt":"WEBVTT\n\n00:10.619 --> 00:37.290\n謝謝主席。麻煩薛部長還有石署長。好,薛部長、石署長請。國安好。部長好、石署長好。經過剛剛很熱烈的討論,我們知道其實這個真的非常非常重要。期待透過很好的討論,得到社會大家共同來面對這個問題。\n\n00:38.752 --> 01:02.365\nbicyn珍珠珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍�\n\n01:06.787 --> 01:27.465\n那這邊想要跟部長討論的就是下一張的翻燈片告訴我們說除了這個高度滿意以外基本上就是提升了這個醫療的可敬性讓民眾在就醫的時候可以很方便而且可以及時的得到整個疾病的照護那也促進了國人的健康\n\n01:28.266 --> 01:48.864\n那過去這20年來總額支付制度執行下來其實也真的能夠讓這個健保的資源除了控管以外也得到有效的利用那當然它的造成的影響尤其是疫情之後造成的影響讓我們整體的這個醫療的韌性受到很大的考驗\n\n01:49.945 --> 02:08.353\n對於醫療我從業人員剛剛提到很多次包括部長、署長還有現場數位員還有我本身都是來自醫界我們非常非常的認同健保制度有這麼好的優點可是還是需要做一些調整做一些改革\n\n02:09.153 --> 02:32.949\n二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次\n\n02:39.013 --> 02:40.054\nbicyn蘇清泉\n\n02:56.716 --> 02:58.337\nbicylman\n\n03:27.236 --> 03:49.814\n則,我們可以從下一張看到如果這個賴總統的政見要允諾能夠呈現實現的話那其實在上個禮拜六健康台灣的論壇裡面就有提出了一些財務策略的方向來作為改革的一個大的方向的依據那這邊就羅列了六點那這六點請問部長未來我們\n\n03:54.838 --> 03:55.078\n議員王育敏等19人擬具\n\n04:13.612 --> 04:35.204\n這部分的話,一的話,那是一個解釋的一個變更,那是在實現細則裡面,那這個不必修法就可以做得到。二的部分的話,就必須要修法。那三的部分的話,另立癌藥基金,那這個就必須要有空汙預算來支撐。目前的規劃可能是在一百億。\n\n04:36.064 --> 05:04.247\n�那部分總額的項目改用公費預算來支援的部分的話就剛現在舉出來的這一些的話大概TOTAL從一百億到兩百億之間所以再加上剛剛那個癌藥基金的如果是離開健保再另外去做的話大概一百億這樣加起來大概可以就是說騰出騰出這個差不多在三百億到四百億之間\n\n05:05.228 --> 05:22.186\n然後個人補充保費的這部分的話這要修法這沒有辦法說不修法那調整補充保費的費率這也必須要修法所以如果不修法的話大概我剛剛算的可能在200億到300億可以騰出來\n\n05:24.008 --> 05:50.931\nbicyn則是改由公務預算來支援。但是跟我們今天所提的如果是0.95的話要700億那如果是1.1億的話1151億還有很大的一個差距。是所以部長意思是說如果透過這些健保財務策略的這個改善方向來看的話未來還是有機會去增加整體的醫療資源這個是可以肯定的\n\n05:52.899 --> 06:11.539\n這都是一樣啦,就是說公務預算放到這個健保裡面去移住,或者是公務預算另外去支援這一些計畫,其實都是公務預算。就是有機會可以去做調整的,如果說主席總書這邊的話,\n\n06:13.221 --> 06:15.122\nadequard\n\n06:37.657 --> 07:06.274\n那針對於下一頁我們可以看到的就是總和制度的改革其實最重要的目標就是希望能夠穩定醫療的服務點值那就包括這幾大項那這部分除了部長來說明以外那署長也可以來補充說明未來針對於這個彈性總和制度總和目標制等等的話如何能夠讓民眾或者是整個醫療團隊醫療團體對於我們如何穩定醫療服務點值是更有信心\n\n07:08.200 --> 07:27.697\n這個部分的話,第一個我們在座討論。第二個部分的話,其實都已經現在是在做了。包括這些偏鄉的保障一點議員,或者是他的給付加成,這個現在都在做。DRG的部分的話,其實是可以持續在座推動,這個也應該是可以做得到。\n\n07:28.337 --> 07:56.183\n那高價集中性的這些醫療服務獨立在總額之外其實目前都是先用專款在做處理它嚴格來講也是屬於說在總額之外所以問題點是出在第一個所謂的彈性總額制度這邊寫的是總額目標制總額目標制的定義必須要清楚假設說我們今年預定的總額是九千億\n\n07:57.591 --> 08:03.579\n那最後超出了,要怎麼處理?你如果堅持是1.1元的話,這幾乎可以說是沒有總額的。\n\n08:09.517 --> 08:29.549\nadequ目標是假的,因為超出你還是一點議員嘛。零點九五也是一樣。所以如果是要目標制的話,就是超出總額之外的話必須要打折。那問題就是要打幾折。以現在是打零折啦。就是通通超出了就不付啦。那以後的話,要打幾折?\n\n08:30.780 --> 08:49.017\nuggage要講清楚。如果說所謂的總額目標制要去推這個的話。的確我們的改革真的是要執行、要進行。那來怎麼做會是最適當我們可以看下一張。其實健保法六十二條就是在規範這個總額制度之下這個電子的調整的這個\n\n09:14.049 --> 09:39.567\n�其實我們也知道我們所擔心或者是未來在執行上要更為注意的就是那會不會回到論量計酬制的這種實質上它是一個總和可是執行上會變成是一個論量計酬制我們再往下看那這個論量計酬制事實上一開始就是採取這樣的制度後來因為整體的這個醫療費用快速的成長\n\n10:03.387 --> 10:14.734\n二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．立法院第11屆第12會期社會福利及衛生環境委員會第12條條文修正草案．立法院第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會\n\n10:33.770 --> 10:33.790\n好謝謝\n\n","segments":[{"start":10.619,"end":37.29,"text":"謝謝主席。麻煩薛部長還有石署長。好,薛部長、石署長請。國安好。部長好、石署長好。經過剛剛很熱烈的討論,我們知道其實這個真的非常非常重要。期待透過很好的討論,得到社會大家共同來面對這個問題。"},{"start":38.752,"end":62.365,"text":" bicyn 珍珠珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍珍�"},{"start":66.787,"end":87.465,"text":"那這邊想要跟部長討論的就是下一張的翻燈片告訴我們說除了這個高度滿意以外基本上就是提升了這個醫療的可敬性讓民眾在就醫的時候可以很方便而且可以及時的得到整個疾病的照護那也促進了國人的健康"},{"start":88.266,"end":108.864,"text":"那過去這20年來總額支付制度執行下來其實也真的能夠讓這個健保的資源除了控管以外也得到有效的利用那當然它的造成的影響尤其是疫情之後造成的影響讓我們整體的這個醫療的韌性受到很大的考驗"},{"start":109.945,"end":128.353,"text":"對於醫療我從業人員剛剛提到很多次包括部長、署長還有現場數位員還有我本身都是來自醫界我們非常非常的認同健保制度有這麼好的優點可是還是需要做一些調整做一些改革"},{"start":129.153,"end":152.949,"text":"二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次"},{"start":159.013,"end":160.054,"text":" bicyn 蘇清泉"},{"start":176.716,"end":178.337,"text":" bicylman"},{"start":207.236,"end":229.814,"text":"則,我們可以從下一張看到如果這個賴總統的政見要允諾能夠呈現實現的話那其實在上個禮拜六健康台灣的論壇裡面就有提出了一些財務策略的方向來作為改革的一個大的方向的依據那這邊就羅列了六點那這六點請問部長未來我們"},{"start":234.838,"end":235.078,"text":"議員王育敏等19人擬具"},{"start":253.612,"end":275.204,"text":"這部分的話,一的話,那是一個解釋的一個變更,那是在實現細則裡面,那這個不必修法就可以做得到。二的部分的話,就必須要修法。那三的部分的話,另立癌藥基金,那這個就必須要有空汙預算來支撐。目前的規劃可能是在一百億。"},{"start":276.064,"end":304.247,"text":"�那部分總額的項目改用公費預算來支援的部分的話就剛現在舉出來的這一些的話大概TOTAL從一百億到兩百億之間所以再加上剛剛那個癌藥基金的如果是離開健保再另外去做的話大概一百億這樣加起來大概可以就是說騰出騰出這個差不多在三百億到四百億之間"},{"start":305.228,"end":322.186,"text":"然後個人補充保費的這部分的話這要修法這沒有辦法說不修法那調整補充保費的費率這也必須要修法所以如果不修法的話大概我剛剛算的可能在200億到300億可以騰出來"},{"start":324.008,"end":350.931,"text":" bicyn 則是改由公務預算來支援。但是跟我們今天所提的如果是0.95的話要700億那如果是1.1億的話1151億還有很大的一個差距。是 所以部長意思是說如果透過這些健保財務策略的這個改善方向來看的話未來還是有機會去增加整體的醫療資源這個是可以肯定的"},{"start":352.899,"end":371.539,"text":"這都是一樣啦,就是說公務預算放到這個健保裡面去移住,或者是公務預算另外去支援這一些計畫,其實都是公務預算。就是有機會可以去做調整的,如果說主席總書這邊的話,"},{"start":373.221,"end":375.122,"text":"adequard"},{"start":397.657,"end":426.274,"text":"那針對於下一頁我們可以看到的就是總和制度的改革其實最重要的目標就是希望能夠穩定醫療的服務點值那就包括這幾大項那這部分除了部長來說明以外那署長也可以來補充說明未來針對於這個彈性總和制度總和目標制等等的話如何能夠讓民眾或者是整個醫療團隊醫療團體對於我們如何穩定醫療服務點值是更有信心"},{"start":428.2,"end":447.697,"text":"這個部分的話,第一個我們在座討論。第二個部分的話,其實都已經現在是在做了。包括這些偏鄉的保障一點議員,或者是他的給付加成,這個現在都在做。DRG的部分的話,其實是可以持續在座推動,這個也應該是可以做得到。"},{"start":448.337,"end":476.183,"text":"那高價集中性的這些醫療服務獨立在總額之外其實目前都是先用專款在做處理它嚴格來講也是屬於說在總額之外所以問題點是出在第一個所謂的彈性總額制度這邊寫的是總額目標制總額目標制的定義必須要清楚假設說我們今年預定的總額是九千億"},{"start":477.591,"end":483.579,"text":"那最後超出了,要怎麼處理?你如果堅持是1.1元的話,這幾乎可以說是沒有總額的。"},{"start":489.517,"end":509.549,"text":"adequ目標是假的,因為超出你還是一點議員嘛。零點九五也是一樣。所以如果是要目標制的話,就是超出總額之外的話必須要打折。那問題就是要打幾折。以現在是打零折啦。就是通通超出了就不付啦。那以後的話,要打幾折?"},{"start":510.78,"end":529.017,"text":"uggage要講清楚。如果說所謂的總額目標制要去推這個的話。的確我們的改革真的是要執行、要進行。那來怎麼做會是最適當我們可以看下一張。其實健保法六十二條就是在規範這個總額制度之下這個電子的調整的這個"},{"start":529.838,"end":553.729,"text":"​​​​​​​​​​"},{"start":554.049,"end":579.567,"text":"� 其實我們也知道我們所擔心或者是未來在執行上要更為注意的就是那會不會回到論量計酬制的這種實質上它是一個總和可是執行上會變成是一個論量計酬制我們再往下看那這個論量計酬制事實上一開始就是採取這樣的制度後來因為整體的這個醫療費用快速的成長"},{"start":580.828,"end":603.387,"text":"​​​​​​​​​​​​"},{"start":603.387,"end":614.734,"text":"二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．立法院第11屆第12會期社會福利及衛生環境委員會第12條條文修正草案．立法院第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會"},{"start":633.77,"end":633.79,"text":"好謝謝"}]}}}}