{"id":153614,"url":"https://ivod.ly.gov.tw/Play/Clip/1M/153614","video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/18e54f584c581c98926954fe4100889d84a12a82c262ca1011da973c502cee621aae88de4fb15d3e5ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"廖偉翔","委員發言時間":"11:25:12 - 11:38:10","影片長度":"00:12:58","會議時間":"2024-06-05T09:00:00+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20次全體委員會議（事由：邀請衛生福利部部長、外交部就「2024年我國參與世界衛生大會（WHA）之經過、檢討與展望」進行專題報告，並備質詢。\n【6月5日及6日二天一次會】）","type":"Clip","date":"2024-06-05","start_time":"2024-06-05T11:25:12+08:00","end_time":"2024-06-05T11:38:10+08:00","duration":778,"meet":{"tmpMeeting":null,"title":"第11屆第1會期社會福利及衛生環境委員會第20次全體委員會議","term":11,"type":"委員會","sessionPeriod":1,"sessionTimes":20,"committees":[26],"id":"委員會-11-1-26-20"},"features":["ai-transcript","gazette"],"gazette":{"lineno":574,"blocks":[["廖委員偉翔：（11時25分）謝謝主席，有請我們的邱部長。"],["主席：請邱部長。"],["邱部長泰源：委員好。"],["廖委員偉翔：部長好，首先謝謝辛苦歸國。"],["邱部長泰源：謝謝。"],["廖委員偉翔：感謝大家，現在我們國家在國際上的外交不容易，所以也特別肯定，也特別辛苦，加油！"],["邱部長泰源：謝謝。"],["廖委員偉翔：部長，再來就是我想要問一下，這幾年因為要控制我們的藥費增加，所以有許多新藥是被限縮給付。限縮的範圍當然包含療程、給付用藥時間等等，造成被限縮給付的藥品並不符合國際上的臨床指引，所以病人很困擾。常見的狀況是，病人用藥一段時間之後，健保就不給付，也只能自費。醫生也很困擾，因為醫生知道可以開某個適合病人的藥，可是因為健保不給付了，所以成本也變高了，病人可能負擔不起，就改用其他藥，我想部長應該知道這個狀況。"],["邱部長泰源：是。"],["廖委員偉翔：現在問題也一一浮現，包括原廠開發，在我國也找不到合格的病人做臨床試驗，所以臺灣也已經在國際的新藥開發市場中逐漸被忽略了，被忽視了；未來有許多新藥研發也將不會有我國的Data；醫師也無法爭取發表研究。我覺得這個部分也將會使我國整體的醫療發展停滯，再來就是剝奪病患爭取成為新藥開發的試驗對象，因為有許多疾病也是現行藥物沒辦法治療的，只能夠在新藥開發的時候爭取成為臨床試驗的對象，而且藥廠會支付全額，全部支付這個病人的費用。","所以請教部長，限縮給付雖然省錢，但是也造成剛剛所提到的問題。部長，我想您自己也是台大醫院家醫科的教授，相信您也很清楚。我想問部長，會不會考慮將這個用藥給付條件調整至和國際醫療指引一樣，跟這個指引一致，想要問部長的態度，當然我們知道這個問題也受限於經費有限，所以有點難，但除了經費之外，我們應該還是要以病人為中心，對吧！"],["邱部長泰源：對。"],["廖委員偉翔：同時也要考量到我們醫療科技的發展，所以想要問部長，你對於這個部分有什麼想法？你是否願意去評估，去推動這個新藥國際醫療指引全給付？"],["邱部長泰源：是，真的非常敬佩我們委員，廖委員能夠這麼了解醫療的需求跟現在的狀況，甚至連臨床試驗這件事情這麼重要都能夠了解，真的非常敬佩。我想您提的，能夠給我們臺灣的病人，完全符合國際醫療指引的治療，跟給他給付，這絕對是國家應該做的方向，而且我們也的確在做，像今年在新藥各方面就比去年又多一倍……"],["廖委員偉翔：所以你們會盡量的去……"],["邱部長泰源：我們未來希望爭取全民認可，能夠有更多的健康投資，希望能夠達到這樣一個國際的標準，我想是未來重要的目標。"],["廖委員偉翔：謝謝部長。另外，為了鼓勵用藥後，蒐集真實世界的數據，並且發展成真實世界的證據，我也想問，我們健保制度上是否也應該去評估，怎麼樣去支持跟鼓勵？"],["邱部長泰源：這個部分我們請署長幫忙回答。"],["石署長崇良：跟委員報告，確實有些新藥受限於它的個案或者是臨床的突破性，在臨床二期就取得藥證，所以我們需要更多的真實世界資料來佐證。我們在去年開始也導入了暫時性支付的概念，就是對於這些病人有臨床上需求，但是臨床證據還有一些不足的，我們先讓它到健保來給付，但是在兩年到三年的時間內，我們來蒐集真實世界資料，做為兩年之後的這個決定。我們在今年1月1號也成立了HTA的專責單位，就是醫療科技評估的專責單位，來協助做真實世界資料的蒐集跟後續的分析。"],["廖委員偉翔：了解，所以這個部分你們還是會持續的去思考，怎麼去支持跟獎勵和吸引他們，對不對？"],["石署長崇良：是。"],["廖委員偉翔：OK！沒問題，謝謝。再來就是下一個問題，部長，這一、兩年有許多醫院都面臨關床的困境，有區域醫院已經關了三成的病床。當然也有人的說法是急缺護理師，所以有病床卻開不得，導致很多病人都塞在急診室。但衛福部卻說，根據今年的統計，跟去年5月同期相比，你們的護理人員增加，總病床數也增加。所以我想要問一下，衛福部的意思是說，沒有媒體描述的這個關床潮嗎？"],["邱部長泰源：這個我先回答一下。我想我們統計的數據是整個床數，跟實際上的real world，大家也知道我整天在醫院混……"],["廖委員偉翔：對。"],["邱部長泰源：每天我都會看到這些你現在照出來的景象，每天都會感受到當天的狀況。以臺大醫院來講，我昨天跟院長也討論很久，臺大醫院是不至於有關床的現象，但是中南部我相信可能會有需要床開少一點的。如果真的有這種情況，應該照顧的病人受到影響，這個都是我們政府一定要去改善、去瞭解的。"],["廖委員偉翔：對，請問這部分有解嗎？因為這幾年的狀況都是這樣，地區醫院也是。"],["邱部長泰源：我們來瞭解原因，到底是護理人力不足，還是因為點值，如果做太多，點值是不是會有影響等等的，其實我們要去瞭解到這個因素。"],["廖委員偉翔：是，所以這部分的原因，是不是可以請部長盡速的找出來，然後要怎麼解，因為我要告訴您的是，全國都知道因為缺護理師，這可能也是其中之一的原因，您剛剛有提到，對不對？"],["邱部長泰源：是。"],["廖委員偉翔：所以導致關床，但是照護司長卻反問關床的醫院是哪幾家，我是覺得這個回應不太恰當。"],["邱部長泰源：其實我們並沒有否認關床，而是說整個統計數據，我們後來自己再檢討，這樣的數據是沒辦法代表實際上大家所關心的事情，所以在這邊跟大家抱歉，我們只呈現我們所擁有的資料。因為各個醫院關床不會去跟衛生主管報告，如果它知道你關這麼多……"],["廖委員偉翔：好，部長，沒關係……"],["邱部長泰源：之後就會給你減少……"],["廖委員偉翔：對，我知道，所以我跟你講，這就是有數據佐證，你們剛剛說總執登人數有增加，但為何地區醫院以上的護理師人力卻還是一再的流失？所以實際上這是不是其中的原因，要拜託衛福部趕快去了解清楚並改善，因為這有關於我們一般民眾就醫的權益。","我們來看一下這個數據，我們是從貴部的網站上下載這份資料，我也挑了比較有資源、有能力的醫學中心層級去比較。從這個比較表其實可以看出來，疫情前108年，醫中的占床率平均接近八成五，但是疫後111年的資料，已經掉到七成五，112年跟113年更慘，恐怕有七成都有困難，連醫學中心都這麼慘，更不要說區域醫院和地區醫院。所以後來我也把108年、109年，還有111年跟112年，每個年度第一季（Q1）的占床率去比較，可以清楚看出來，這個數據平均從七成和六成，掉到112年的四成八，平均掉了22%耶！這就是實務上會認為說，關床有達到三成的原因。我要告訴部長，這個數據明明也清清楚楚的，為什麼你們就不願意面對，看要怎麼解決呢？歸結這個原因，當然你剛剛都有提到……"],["邱部長泰源：報告委員，我覺得一定要面對……"],["廖委員偉翔：對！"],["邱部長泰源：一定要面對，我第一次的回答只是一個數據的呈現，未來我相信衛福部會針對問題來解決，譬如說在人工輸液的時候，我也請全國醫療院所、醫師公會去調查所有的醫療院所到底缺了多少，一樣的，我們現在會跟相關的團體來密切的結合，才能真正了解到，不管是醫中、區域、地區醫院，到底情況是怎麼樣，我們要一個一個分別來解決。"],["廖委員偉翔：部長可不可以告訴我們，因為這個數據還蠻明顯的，我們知道在做管理的時候，總是要有一個目標，我們希望你們了解情況之後可以真實的了解這樣的占床率，那你們未來希望這個數據怎麼改善？"],["邱部長泰源：因為我也當過醫學中心的部主任，常常每個禮拜都在那邊檢討各科的占床率，所以我對占床率是非常敏感的。像臺大醫院差不多都九十幾%，可能……"],["廖委員偉翔：但這是平均啦！我給你的數據也是你們的資料啊！這都是平均。"],["邱部長泰源：對啦！有的可能是一般急性病房或特殊病房，特殊病房有時候占床率也變化蠻大的，所以可能也要分。我們要更犀利的來分析，可能才有辦法針對問題來解決，但是護理人力需要充實，我想這是最急迫要做的事情。"],["廖委員偉翔：是，部長，雖然你也剛上任，但是這個問題也好幾年了，我想部長是不是可以到時候也把這個資料研究清楚，提供你們打算怎麼解決的方案給本席好嗎？"],["邱部長泰源：好，一定。"],["廖委員偉翔：再來我趕快再問一題，我知道時間到。部長，其實賴總統在2021年的時候有出席健保的國是論壇，剛剛講到有關於病床的癥結點，其實也有部分可能跟健保點值有關。2021年時任副總統、現在的賴總統說，這二十幾年來不諱言，健保制度也存在很多問題。去年賴總統說要召開健保國是會議，想請問部長，什麼時候要召開？"],["邱部長泰源：其實健保國是會議，我的認知，已經包含在過去六場健康臺灣全國大論壇，裡面已經提出了很多具體的短期、中期、長期我們要解決的一些健保改革。這個部分因為今天也沒有時間，我們從公務預算不能用在健保裡面等等的這些處理，這個就可以提出一些經費，是不是研議相關的……"],["廖委員偉翔：部長，因為這個研議真的是相當的研議，研議了非常的久……"],["邱部長泰源：這次的研議是很具體啦！"],["廖委員偉翔：所以可不可以請部長到時候儘速的提出，到底你們的願景要怎麼改？因為願景講得都很美好，但始終是願景，看起來問題就是存在，我們一直不面對、一直不改善，這個東西也拖好久了。"],["邱部長泰源：這個一定要解決……"],["廖委員偉翔：所以部長您任內一定會強力的推動解決對不對？"],["邱部長泰源：我過去十年就每天在解決這個問題，未來一定更加努力。"],["廖委員偉翔：好，謝謝部長。"],["邱部長泰源：謝謝委員。"],["主席：謝謝廖偉翔委員。現在處理臨時提案，總共有兩案，請一併宣讀。","一、","衛生福利部於2024年5月15日預告「醫院設立或擴充許可辦法第六條附表修正草案」調整醫療區域劃分，將石門、三芝、淡水、八里共四個行政區於臺北二級醫療區域中新增淡海次醫療區域，此更動主要考量淡海新市鎮移入人口近年大量移入，然而醫療院所主要集中在士林、北投地區，以至於淡海新市鎮地區民眾就醫不便，其立意良善，衛生福利部應協助凝聚共識，加速推動該醫療區域劃分之調整；另，淡水、三芝、石門現況僅有淡水馬偕紀念醫院為醫學中心，無區域醫院、地區醫院僅有泓安醫院、北新醫院、台安醫院等三所精神專科醫院，其餘均為基層診所，致民眾遇急重症醫療需求，需負擔較高額的門診費用，為落實衛生福利部分級醫療之推動，建請衛生福利部研議於新增次醫療區域後，評估部立醫院、或協請新北市衛生局加入該次醫療區域成立區域醫院，以健全北海岸地區分級醫療網絡。","提案人：蘇巧慧　　黃秀芳　　王正旭　　劉建國","二、","為落實家庭暴力防治工作，家庭暴力防治中心對於危機家庭須立即提供多項保護性服務措施，且依家庭暴力防治法規定，該中心得與性侵害防治中心合併設立，使中心工作業務相當繁重。經查，於縣（市）政府，其中心主任多為縣（市）長兼任，未必能有專業性協助社工同仁面對處理高風險、多重問題複雜個案及跨網絡合作；另查，直轄市政府，其組長職務列等僅7職等，相較高級社會工作師7-8職等低，職等未反映其職責程度，且為避免產生領導統御問題，爰由高級社會工作師兼任組長，以致於考試院銓敘部歷年審查修編案，均表示單位主管重要職務及一人一職之原則，請其審酌將兼任組長改為專任，然而實務上並不可行，而中心僅設置1名9-10職等主任及1名9職等副主任，綜理涉及人身安全之保護性業務，業務量並不亞於工程機關、勞動機關等規模相當單位，其首長職等可列為11職等，且設有幕僚長協助處理內部繁雜事務。綜上，為能全面性推動保護性業務，回應其業務性質及組織規模，建請衛生福利部就家庭暴力防治中心（家庭暴力暨性侵害防治中心）研議調整其定位，包含對其編制進行通案檢視與盤整，並協助建立相關基準，作為考試院銓敘部審查該中心編修案之參考依據。","提案人：蘇巧慧　　黃秀芳　　王正旭　　劉建國"],["主席：請問第一案行政單位有沒有意見？"],["邱部長泰源：沒有。"],["主席：沒有，那就照案通過。第二案行政單位有沒有意見？"],["邱部長泰源：遵照辦理。"],["主席：那就照案通過。我們這個臨時提案全部處理完畢。接下來請洪孟楷委員發言。"]],"agenda":{"page_end":130,"meet_id":"委員會-11-1-26-20","speakers":["黃秀芳","林月琴","陳昭姿","蘇清泉","陳菁徽","邱鎮軍","涂權吉","王育敏","王正旭","陳培瑜","盧縣一","廖偉翔","洪孟楷","楊瓊瓔","林淑芬","劉建國","洪申翰","楊曜","陳瑩","張智倫","陳冠廷"],"page_start":61,"meetingDate":["2024-06-05"],"gazette_id":"1136001","agenda_lcidc_ids":["1136001_00003"],"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20次全體委員會議紀錄","content":"邀請衛生福利部部長、外交部就「2024年我國參與世界衛生大會（WHA）之經過、檢討與展望」\n進行專題報告，並備質詢","agenda_id":"1136001_00002"}},"transcript":{"id":"153614","pyannote":{"name":"ronny","tool":"pyannote","data":{"url":"https://ivod.ly.gov.tw/Play/Clip/1M/153614","tool":"pyannote","id":"153614-pyannote"},"job_id":"2UlbtCk1tULo6gPN","queued_at":"2024-06-05 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\"score\": 0.939}, {\"word\": \"員\"}, {\"word\": \"現\"}, {\"word\": \"在\", \"start\": 776.827, \"end\": 777.207, \"score\": 0.937}, {\"word\": \"處\"}, {\"word\": \"理\", \"start\": 777.207, \"end\": 777.788, \"score\": 0.916}, {\"word\": \"臨\"}, {\"word\": \"時\"}, {\"word\": \"提\", \"start\": 777.788, \"end\": 777.948, \"score\": 0.993}, {\"word\": \"案\", \"start\": 777.948, \"end\": 777.968, \"score\": 0.96}], \"language\": \"zh\"}","srt":"1\n00:00:08,644 --> 00:00:30,472\n謝謝主席。那有請我們的邱部長。請邱部長。委員好。部長好。首先謝謝辛苦歸國。感謝大家現在我們國家在國際上的這個外交不容易。所以也特別肯定特別辛苦。那加油。謝謝。那再來就是部長。\n\n2\n00:00:31,533 --> 00:00:48,722\n我想要問一下因為這幾年因為要控制我們的藥費增加所以有許多新藥是被限縮給付那限縮的範圍當然包含這個療程、給付用藥時間等等那造成這個被限縮給付的藥品並不符合國際上的臨床指引\n\n3\n00:01:13,540 --> 00:01:39,794\n現在問題也一一浮現包括原廠開發在我國也找不到合格的病人做臨床實驗所以台灣也已經在國際的新藥開發市場中逐漸被忽視了未來有許多新藥研發也將不會有我國的data醫師也無法爭取發表研究我覺得這部分也會將使我們我國整體的醫療發展停滯再來就是剝奪病患爭取成為新藥開發的試驗對象\n\n4\n00:01:42,489 --> 00:02:05,808\n那因為有許多疾病也是現行藥物沒辦法治療的只能夠爭取在新藥開發的時候爭取成為臨床試驗的對象而且並且藥廠會支付全部支付這個病人的費用所以請教部長限縮給付雖然省錢但是也造成剛剛所提到的問題那部長我想您自己也是臺大這個醫院家醫科的教授相信您也很清楚\n\n5\n00:02:06,508 --> 00:02:25,787\n那想要問說部長會不會考慮將這個用藥給付條件調整制和國際醫療指引一樣這個跟這個指引一致的這個部分因為想要問部長的態度喔因為這個問題當然我們知道他也受限於經費有限所以有點難\n\n6\n00:02:26,688 --> 00:02:39,757\n但除了經費之外我們應該還是要以病人為中心嘛對吧同時也要考量到我們的醫療科技的發展所以想要問部長就是說你對於這個部分你有什麼想法那你是否願意去評估去推動這個新藥國際醫療指引全體付\n\n7\n00:02:42,583 --> 00:03:04,731\n是,真的非常敬佩我們廖委員能夠這麼瞭解到這個醫療的需求跟現在的狀況以及像甚至臨床試驗這些事情這麼重要都能夠瞭解,真的非常敬佩那我想您提的能夠給我們的給臺灣的病人完全符合國際醫療指引\n\n8\n00:03:07,725 --> 00:03:35,961\n的一個治療跟給他幾戶這是絕對是國家應該做的方向而且我們也的確在做像今年就在新藥各方面的就比去年又多一倍所以你們會盡量的去我們未來希望爭取全民認可能夠有更多的健康投資希望能夠來達到這樣一個國際的標準我想是未來重要的目標好謝謝部長\n\n9\n00:03:36,821 --> 00:03:52,864\n另外就是為了鼓勵用藥後收集真實世界的數據並且發展成真實世界的證據這個部分我也想問說我們健保制度上是否也應該去評估怎麼樣去支持跟鼓勵\n\n10\n00:03:55,955 --> 00:04:16,273\n這個沒關係,我們署長您幫忙跟委員報告,確實這個有些新藥那麼受限於它的個案或者是臨床的突破性有的在臨床二期就取得藥證所以我們需要更多的真實世界資料來做佐證所以我們在去年開始也導入了暫時性支付的概念\n\n11\n00:04:16,713 --> 00:04:38,610\n就是對於這些病人有臨床上需求但是臨床證據還有一些不足的我們先讓他到健保來給付但是在兩年到三年的時間內我們來收集真實世界資料來作為最後那麼兩年之後過了之後的這個決定所以我們在今年1月1號也成立了\n\n12\n00:04:39,931 --> 00:04:47,198\n的專責單位,就是醫療科技評估的專責單位來協助做真實世界資料的收集跟後續的分析。\n\n13\n00:04:56,409 --> 00:05:14,057\n再來就是下一個問題部長這一兩年有許多醫院都面臨關床的困境有區域醫院已經關了三成的病床當然有人說的說法就是急缺護理師所以有病床卻開不得導致很多病人都塞在急診室\n\n14\n00:05:15,177 --> 00:05:33,306\n但衛福部卻說根據今年的統計5月跟去年5月同期相比你們的護理人員增加總病床數也增加所以我想要問一下衛福部的意思是說沒有媒體描述的這個關床潮嗎?這個我先回答一下\n\n15\n00:05:34,929 --> 00:05:54,344\n我想我們統計的是整個床數那跟實際上的realWorld大家也知道我整天在這個醫院混每天我就看到這些你現在照出來的景象你每天可以感受到當天的狀況\n\n16\n00:05:55,825 --> 00:06:21,722\n那以台大醫院來講我昨天跟院長也討論了很久台大醫院是不至於有關床的現象但是中南部或者那個我相信可能會有需要床開少一點的這個部分那他的原因這個如果真的有這種情況而影響到\n\n17\n00:06:22,603 --> 00:06:22,763\n拜訪委員\n\n18\n00:06:39,588 --> 00:07:05,409\n因為點值,如果你做太多點值是不是會有影響?等等的,其實我們要去了解到這個因素。這部分的原因是不是可以請部長盡速的找出來,然後要怎麼解喔?因為我要告訴您的是,全國都知道因為缺護理師,這也可能是其中之一的原因,您剛剛有提到嘛,對不對?是。所以導致關床,但是這個照護師長卻反問關床的醫院是哪幾家喔?師長。\n\n19\n00:07:06,650 --> 00:07:11,332\n其實我們並沒有否認關闖,而是說他整個統計數據所以這個我們後來自己在檢討說這樣的一個數據是沒辦法代表實際上大家所關心的事情所以在這邊跟大家抱歉沒有呈現一個我們只呈現我們所擁有的資料因為各個議院關闖\n\n20\n00:07:34,448 --> 00:07:58,043\n他不會去跟衛生主管報告因為如果他知道說你怪這麼多好,部長沒關係,我給你看下一頁喔50層你阿伯就跟你撿,這樣就對了對,我知道所以我跟你講這就是有數據佐證喔因為反正你們剛剛說總值登人數有增加但為何地區醫院以上的護理師人力還是卻一再的流失喔那所以實際上\n\n21\n00:07:59,878 --> 00:08:17,701\n當然這是不是其中的原因要拜託衛福不趕快去了解清楚並改善因為這有關於我們一般民眾這個就醫的權益喔那我們來看一下這個數據喔我們是從貴部的網站上去下載這份資料喔那我也挑了比較有資源有能力的醫學中心層級去比較\n\n22\n00:08:19,103 --> 00:08:36,541\n從這個比較表其實可以看出來疫情前108年醫中的戰床率平均接近8成5但是疫後這個111年的資料已經掉到7成5那112年跟113年更慘恐怕有7成都有困難\n\n23\n00:08:37,302 --> 00:09:02,640\n那連醫學中心都這麼慘更不要說這個區醫院和地區醫院所以後來我也把這108年、109年的這個Q1還有111年跟112年的每個年度的第一劑的戰床率戰床率去比較可以清楚看出來我們看到這個數據平均從7成和6成掉到112年的4成8所以平均也有掉了22%\n\n24\n00:09:04,747 --> 00:09:31,509\n所以這就是實務上會認為說關床有達到三成的原因所以我要告訴部長這個數據明明也清清楚楚的為什麼你們就不願意面對那要看要怎麼解決呢對不對規則這個原因當然你剛剛都有講我覺得一定要面對對一定要面對那我那個第一次的回答那只是一個數據的呈現未來我相信我們衛福部會針對\n\n25\n00:09:33,350 --> 00:09:59,343\n我們例如說在上次輸液的時候,人工輸液的時候我也請全國醫療院所、醫事公會去調查所有的醫療院所到底缺了多少一樣的我們現在會跟相關的團體來密切的結合來才能真正了解到不管是醫中、區域、地區醫院到底它的情況是怎麼樣我們要一個一個分別來解決\n\n26\n00:10:00,031 --> 00:10:18,450\n部長那可不可以告訴我們說因為這個數據還蠻明顯的嘛我們知道在做管理的時候你總是要有一個目標啦我們希望說你們瞭解情況之後是不是可以真實的瞭解說這樣的占床率那你們未來希望這個東西可以怎麼這個數據會怎麼改善以前是87的\n\n27\n00:10:23,166 --> 00:10:46,293\n這個因為我也當過醫學中心的部主任所以常常每個禮拜都在那邊檢討各科的戰狀律師我對戰狀律師非常敏感小台大醫院全部都90幾%都90%可能也如果但是但是這是平均我給你的數據也是你們的資料有的是可能是一般急性病房或者是特殊病房特殊病房有時候\n\n28\n00:10:47,373 --> 00:10:49,577\n但是護理人力的需要充實,我想這是\n\n29\n00:11:01,965 --> 00:11:02,545\n部長,下一頁就是\n\n30\n00:11:19,267 --> 00:11:44,253\n其實賴總統在20212021年的時候有這個健保的國事論壇那其實剛剛講到有關於病床的癥結點其實也有部分可能跟這個健保點子有關那2021年的時任副總統現在的賴總統說這個20幾年來不諱言健保制度也存在很多問題那去年賴總統說要召開健保國事會議想要請問部長什麼時候要召開其實\n\n31\n00:11:46,134 --> 00:11:59,644\n建保國事會議已經我的認知已經包含在過去五六場一個健康台灣大論前國大論壇裡面已經提出了很多具體短期、中期、長期\n\n32\n00:12:00,925 --> 00:12:28,531\n我們要解決的一些健保的改革那這個部分因為今天你沒有時間我們從公務依算歸公務就說公務依算不能用在健保裡面等等的這些處理那這個就可以提出一些經費那是不是研議相關的一些在可能是不是部長因為這個研議真的是研議相當的研議研議了非常的久這次的研議是很記題\n\n33\n00:12:29,851 --> 00:12:57,968\n對,所以可不可以請部長到時候盡速的提出到底你們的願景要怎麼改我想因為因為願景講的都很美好但始終是願景喔看起來問題就是存在那我們一直不面對一直不改善這個東西也拖了好久所以部長您任內一定會強力的推動解決對不對我過去10點就每天在解決這個問題未來一定更加努力好,謝謝部長好,謝謝委員好,謝謝廖偉翔委員現在處理臨時提案\n\n","tsv":"start\tend\ttext\n8644\t30472\t謝謝主席。那有請我們的邱部長。請邱部長。委員好。部長好。首先謝謝辛苦歸國。感謝大家現在我們國家在國際上的這個外交不容易。所以也特別肯定特別辛苦。那加油。謝謝。那再來就是部長。\n31533\t48722\t我想要問一下因為這幾年因為要控制我們的藥費增加所以有許多新藥是被限縮給付那限縮的範圍當然包含這個療程、給付用藥時間等等那造成這個被限縮給付的藥品並不符合國際上的臨床指引\n49462\t73200\t⋯⋯⋯\n73540\t99794\t現在問題也一一浮現包括原廠開發在我國也找不到合格的病人做臨床實驗所以台灣也已經在國際的新藥開發市場中逐漸被忽視了未來有許多新藥研發也將不會有我國的data醫師也無法爭取發表研究我覺得這部分也會將使我們我國整體的醫療發展停滯再來就是剝奪病患爭取成為新藥開發的試驗對象\n102489\t125808\t那因為有許多疾病也是現行藥物沒辦法治療的只能夠爭取在新藥開發的時候爭取成為臨床試驗的對象而且並且藥廠會支付全部支付這個病人的費用所以請教部長限縮給付雖然省錢但是也造成剛剛所提到的問題那部長我想您自己也是臺大這個醫院家醫科的教授相信您也很清楚\n126508\t145787\t那想要問說部長會不會考慮將這個用藥給付條件調整制和國際醫療指引一樣這個跟這個指引一致的這個部分因為想要問部長的態度喔因為這個問題當然我們知道他也受限於經費有限所以有點難\n146688\t159757\t但除了經費之外我們應該還是要以病人為中心嘛對吧同時也要考量到我們的醫療科技的發展所以想要問部長就是說你對於這個部分你有什麼想法那你是否願意去評估去推動這個新藥國際醫療指引全體付\n162583\t184731\t是,真的非常敬佩我們廖委員能夠這麼瞭解到這個醫療的需求跟現在的狀況以及像甚至臨床試驗這些事情這麼重要都能夠瞭解,真的非常敬佩那我想您提的能夠給我們的給臺灣的病人完全符合國際醫療指引\n187725\t215961\t的一個治療跟給他幾戶這是絕對是國家應該做的方向而且我們也的確在做像今年就在新藥各方面的就比去年又多一倍所以你們會盡量的去我們未來希望爭取全民認可能夠有更多的健康投資希望能夠來達到這樣一個國際的標準我想是未來重要的目標好謝謝部長\n216821\t232864\t另外就是為了鼓勵用藥後收集真實世界的數據並且發展成真實世界的證據這個部分我也想問說我們健保制度上是否也應該去評估怎麼樣去支持跟鼓勵\n235955\t256273\t這個沒關係,我們署長您幫忙跟委員報告,確實這個有些新藥那麼受限於它的個案或者是臨床的突破性有的在臨床二期就取得藥證所以我們需要更多的真實世界資料來做佐證所以我們在去年開始也導入了暫時性支付的概念\n256713\t278610\t就是對於這些病人有臨床上需求但是臨床證據還有一些不足的我們先讓他到健保來給付但是在兩年到三年的時間內我們來收集真實世界資料來作為最後那麼兩年之後過了之後的這個決定所以我們在今年1月1號也成立了\n279931\t287198\t的專責單位,就是醫療科技評估的專責單位來協助做真實世界資料的收集跟後續的分析。\n296409\t314057\t再來就是下一個問題部長這一兩年有許多醫院都面臨關床的困境有區域醫院已經關了三成的病床當然有人說的說法就是急缺護理師所以有病床卻開不得導致很多病人都塞在急診室\n315177\t333306\t但衛福部卻說根據今年的統計5月跟去年5月同期相比你們的護理人員增加總病床數也增加所以我想要問一下衛福部的意思是說沒有媒體描述的這個關床潮嗎?這個我先回答一下\n334929\t354344\t我想我們統計的是整個床數那跟實際上的real World大家也知道我整天在這個醫院混每天我就看到這些你現在照出來的景象你每天可以感受到當天的狀況\n355825\t381722\t那以台大醫院來講我昨天跟院長也討論了很久台大醫院是不至於有關床的現象但是中南部或者那個我相信可能會有需要床開少一點的這個部分那他的原因這個如果真的有這種情況而影響到\n382603\t382763\t拜訪委員\n399588\t425409\t因為點值,如果你做太多點值是不是會有影響?等等的,其實我們要去了解到這個因素。這部分的原因是不是可以請部長盡速的找出來,然後要怎麼解喔?因為我要告訴您的是,全國都知道因為缺護理師,這也可能是其中之一的原因,您剛剛有提到嘛,對不對?是。所以導致關床,但是這個照護師長卻反問關床的醫院是哪幾家喔?師長。\n426650\t431332\t其實我們並沒有否認關闖,而是說他整個統計數據所以這個我們後來自己在檢討說這樣的一個數據是沒辦法代表實際上大家所關心的事情所以在這邊跟大家抱歉沒有呈現一個我們只呈現我們所擁有的資料因為各個議院關闖\n454448\t478043\t他不會去跟衛生主管報告因為如果他知道說你怪這麼多好,部長沒關係,我給你看下一頁喔50層你阿伯就跟你撿,這樣就對了對,我知道所以我跟你講這就是有數據佐證喔因為反正你們剛剛說總值登人數有增加但為何地區醫院以上的護理師人力還是卻一再的流失喔那所以實際上\n479878\t497701\t當然這是不是其中的原因要拜託衛福不趕快去了解清楚並改善因為這有關於我們一般民眾這個就醫的權益喔那我們來看一下這個數據喔我們是從貴部的網站上去下載這份資料喔那我也挑了比較有資源有能力的醫學中心層級去比較\n499103\t516541\t從這個比較表其實可以看出來疫情前108年醫中的戰床率平均接近8成5但是疫後這個111年的資料已經掉到7成5那112年跟113年更慘恐怕有7成都有困難\n517302\t542640\t那連醫學中心都這麼慘更不要說這個區醫院和地區醫院所以後來我也把這108年、109年的這個Q1還有111年跟112年的每個年度的第一劑的戰床率戰床率去比較可以清楚看出來我們看到這個數據平均從7成和6成掉到112年的4成8所以平均也有掉了22%\n544747\t571509\t所以這就是實務上會認為說關床有達到三成的原因所以我要告訴部長這個數據明明也清清楚楚的為什麼你們就不願意面對那要看要怎麼解決呢對不對規則這個原因當然你剛剛都有講我覺得一定要面對對一定要面對那我那個第一次的回答那只是一個數據的呈現未來我相信我們衛福部會針對\n573350\t599343\t我們例如說在上次輸液的時候,人工輸液的時候我也請全國醫療院所、醫事公會去調查所有的醫療院所到底缺了多少一樣的我們現在會跟相關的團體來密切的結合來才能真正了解到不管是醫中、區域、地區醫院到底它的情況是怎麼樣我們要一個一個分別來解決\n600031\t618450\t部長那可不可以告訴我們說因為這個數據還蠻明顯的嘛我們知道在做管理的時候你總是要有一個目標啦我們希望說你們瞭解情況之後是不是可以真實的瞭解說這樣的占床率那你們未來希望這個東西可以怎麼這個數據會怎麼改善以前是87的\n623166\t646293\t這個因為我也當過醫學中心的部主任所以常常每個禮拜都在那邊檢討各科的戰狀律師我對戰狀律師非常敏感小台大醫院全部都90幾%都90%可能也如果但是但是這是平均我給你的數據也是你們的資料有的是可能是一般急性病房或者是特殊病房特殊病房有時候\n647373\t649577\t但是護理人力的需要充實,我想這是\n661965\t662545\t部長,下一頁就是\n679267\t704253\t其實賴總統在20212021年的時候有這個健保的國事論壇那其實剛剛講到有關於病床的癥結點其實也有部分可能跟這個健保點子有關那2021年的時任副總統現在的賴總統說這個20幾年來不諱言健保制度也存在很多問題那去年賴總統說要召開健保國事會議想要請問部長什麼時候要召開其實\n706134\t719644\t建保國事會議已經我的認知已經包含在過去五六場一個健康台灣大論前國大論壇裡面已經提出了很多具體短期、中期、長期\n720925\t748531\t我們要解決的一些健保的改革那這個部分因為今天你沒有時間我們從公務依算歸公務就說公務依算不能用在健保裡面等等的這些處理那這個就可以提出一些經費那是不是研議相關的一些在可能是不是部長因為這個研議真的是研議相當的研議研議了非常的久這次的研議是很記題\n749851\t777968\t對,所以可不可以請部長到時候盡速的提出到底你們的願景要怎麼改我想因為因為願景講的都很美好但始終是願景喔看起來問題就是存在那我們一直不面對一直不改善這個東西也拖了好久所以部長您任內一定會強力的推動解決對不對我過去10點就每天在解決這個問題未來一定更加努力好,謝謝部長好,謝謝委員好,謝謝廖偉翔委員現在處理臨時提案\n","txt":"謝謝主席。那有請我們的邱部長。請邱部長。委員好。部長好。首先謝謝辛苦歸國。感謝大家現在我們國家在國際上的這個外交不容易。所以也特別肯定特別辛苦。那加油。謝謝。那再來就是部長。\n我想要問一下因為這幾年因為要控制我們的藥費增加所以有許多新藥是被限縮給付那限縮的範圍當然包含這個療程、給付用藥時間等等那造成這個被限縮給付的藥品並不符合國際上的臨床指引\n⋯⋯⋯\n現在問題也一一浮現包括原廠開發在我國也找不到合格的病人做臨床實驗所以台灣也已經在國際的新藥開發市場中逐漸被忽視了未來有許多新藥研發也將不會有我國的data醫師也無法爭取發表研究我覺得這部分也會將使我們我國整體的醫療發展停滯再來就是剝奪病患爭取成為新藥開發的試驗對象\n那因為有許多疾病也是現行藥物沒辦法治療的只能夠爭取在新藥開發的時候爭取成為臨床試驗的對象而且並且藥廠會支付全部支付這個病人的費用所以請教部長限縮給付雖然省錢但是也造成剛剛所提到的問題那部長我想您自己也是臺大這個醫院家醫科的教授相信您也很清楚\n那想要問說部長會不會考慮將這個用藥給付條件調整制和國際醫療指引一樣這個跟這個指引一致的這個部分因為想要問部長的態度喔因為這個問題當然我們知道他也受限於經費有限所以有點難\n但除了經費之外我們應該還是要以病人為中心嘛對吧同時也要考量到我們的醫療科技的發展所以想要問部長就是說你對於這個部分你有什麼想法那你是否願意去評估去推動這個新藥國際醫療指引全體付\n是,真的非常敬佩我們廖委員能夠這麼瞭解到這個醫療的需求跟現在的狀況以及像甚至臨床試驗這些事情這麼重要都能夠瞭解,真的非常敬佩那我想您提的能夠給我們的給臺灣的病人完全符合國際醫療指引\n的一個治療跟給他幾戶這是絕對是國家應該做的方向而且我們也的確在做像今年就在新藥各方面的就比去年又多一倍所以你們會盡量的去我們未來希望爭取全民認可能夠有更多的健康投資希望能夠來達到這樣一個國際的標準我想是未來重要的目標好謝謝部長\n另外就是為了鼓勵用藥後收集真實世界的數據並且發展成真實世界的證據這個部分我也想問說我們健保制度上是否也應該去評估怎麼樣去支持跟鼓勵\n這個沒關係,我們署長您幫忙跟委員報告,確實這個有些新藥那麼受限於它的個案或者是臨床的突破性有的在臨床二期就取得藥證所以我們需要更多的真實世界資料來做佐證所以我們在去年開始也導入了暫時性支付的概念\n就是對於這些病人有臨床上需求但是臨床證據還有一些不足的我們先讓他到健保來給付但是在兩年到三年的時間內我們來收集真實世界資料來作為最後那麼兩年之後過了之後的這個決定所以我們在今年1月1號也成立了\n的專責單位,就是醫療科技評估的專責單位來協助做真實世界資料的收集跟後續的分析。\n再來就是下一個問題部長這一兩年有許多醫院都面臨關床的困境有區域醫院已經關了三成的病床當然有人說的說法就是急缺護理師所以有病床卻開不得導致很多病人都塞在急診室\n但衛福部卻說根據今年的統計5月跟去年5月同期相比你們的護理人員增加總病床數也增加所以我想要問一下衛福部的意思是說沒有媒體描述的這個關床潮嗎?這個我先回答一下\n我想我們統計的是整個床數那跟實際上的real World大家也知道我整天在這個醫院混每天我就看到這些你現在照出來的景象你每天可以感受到當天的狀況\n那以台大醫院來講我昨天跟院長也討論了很久台大醫院是不至於有關床的現象但是中南部或者那個我相信可能會有需要床開少一點的這個部分那他的原因這個如果真的有這種情況而影響到\n拜訪委員\n因為點值,如果你做太多點值是不是會有影響?等等的,其實我們要去了解到這個因素。這部分的原因是不是可以請部長盡速的找出來,然後要怎麼解喔?因為我要告訴您的是,全國都知道因為缺護理師,這也可能是其中之一的原因,您剛剛有提到嘛,對不對?是。所以導致關床,但是這個照護師長卻反問關床的醫院是哪幾家喔?師長。\n其實我們並沒有否認關闖,而是說他整個統計數據所以這個我們後來自己在檢討說這樣的一個數據是沒辦法代表實際上大家所關心的事情所以在這邊跟大家抱歉沒有呈現一個我們只呈現我們所擁有的資料因為各個議院關闖\n他不會去跟衛生主管報告因為如果他知道說你怪這麼多好,部長沒關係,我給你看下一頁喔50層你阿伯就跟你撿,這樣就對了對,我知道所以我跟你講這就是有數據佐證喔因為反正你們剛剛說總值登人數有增加但為何地區醫院以上的護理師人力還是卻一再的流失喔那所以實際上\n當然這是不是其中的原因要拜託衛福不趕快去了解清楚並改善因為這有關於我們一般民眾這個就醫的權益喔那我們來看一下這個數據喔我們是從貴部的網站上去下載這份資料喔那我也挑了比較有資源有能力的醫學中心層級去比較\n從這個比較表其實可以看出來疫情前108年醫中的戰床率平均接近8成5但是疫後這個111年的資料已經掉到7成5那112年跟113年更慘恐怕有7成都有困難\n那連醫學中心都這麼慘更不要說這個區醫院和地區醫院所以後來我也把這108年、109年的這個Q1還有111年跟112年的每個年度的第一劑的戰床率戰床率去比較可以清楚看出來我們看到這個數據平均從7成和6成掉到112年的4成8所以平均也有掉了22%\n所以這就是實務上會認為說關床有達到三成的原因所以我要告訴部長這個數據明明也清清楚楚的為什麼你們就不願意面對那要看要怎麼解決呢對不對規則這個原因當然你剛剛都有講我覺得一定要面對對一定要面對那我那個第一次的回答那只是一個數據的呈現未來我相信我們衛福部會針對\n我們例如說在上次輸液的時候,人工輸液的時候我也請全國醫療院所、醫事公會去調查所有的醫療院所到底缺了多少一樣的我們現在會跟相關的團體來密切的結合來才能真正了解到不管是醫中、區域、地區醫院到底它的情況是怎麼樣我們要一個一個分別來解決\n部長那可不可以告訴我們說因為這個數據還蠻明顯的嘛我們知道在做管理的時候你總是要有一個目標啦我們希望說你們瞭解情況之後是不是可以真實的瞭解說這樣的占床率那你們未來希望這個東西可以怎麼這個數據會怎麼改善以前是87的\n這個因為我也當過醫學中心的部主任所以常常每個禮拜都在那邊檢討各科的戰狀律師我對戰狀律師非常敏感小台大醫院全部都90幾%都90%可能也如果但是但是這是平均我給你的數據也是你們的資料有的是可能是一般急性病房或者是特殊病房特殊病房有時候\n但是護理人力的需要充實,我想這是\n部長,下一頁就是\n其實賴總統在20212021年的時候有這個健保的國事論壇那其實剛剛講到有關於病床的癥結點其實也有部分可能跟這個健保點子有關那2021年的時任副總統現在的賴總統說這個20幾年來不諱言健保制度也存在很多問題那去年賴總統說要召開健保國事會議想要請問部長什麼時候要召開其實\n建保國事會議已經我的認知已經包含在過去五六場一個健康台灣大論前國大論壇裡面已經提出了很多具體短期、中期、長期\n我們要解決的一些健保的改革那這個部分因為今天你沒有時間我們從公務依算歸公務就說公務依算不能用在健保裡面等等的這些處理那這個就可以提出一些經費那是不是研議相關的一些在可能是不是部長因為這個研議真的是研議相當的研議研議了非常的久這次的研議是很記題\n對,所以可不可以請部長到時候盡速的提出到底你們的願景要怎麼改我想因為因為願景講的都很美好但始終是願景喔看起來問題就是存在那我們一直不面對一直不改善這個東西也拖了好久所以部長您任內一定會強力的推動解決對不對我過去10點就每天在解決這個問題未來一定更加努力好,謝謝部長好,謝謝委員好,謝謝廖偉翔委員現在處理臨時提案\n","vtt":"WEBVTT\n\n00:08.644 --> 00:30.472\n謝謝主席。那有請我們的邱部長。請邱部長。委員好。部長好。首先謝謝辛苦歸國。感謝大家現在我們國家在國際上的這個外交不容易。所以也特別肯定特別辛苦。那加油。謝謝。那再來就是部長。\n\n00:31.533 --> 00:48.722\n我想要問一下因為這幾年因為要控制我們的藥費增加所以有許多新藥是被限縮給付那限縮的範圍當然包含這個療程、給付用藥時間等等那造成這個被限縮給付的藥品並不符合國際上的臨床指引\n\n01:13.540 --> 01:39.794\n現在問題也一一浮現包括原廠開發在我國也找不到合格的病人做臨床實驗所以台灣也已經在國際的新藥開發市場中逐漸被忽視了未來有許多新藥研發也將不會有我國的data醫師也無法爭取發表研究我覺得這部分也會將使我們我國整體的醫療發展停滯再來就是剝奪病患爭取成為新藥開發的試驗對象\n\n01:42.489 --> 02:05.808\n那因為有許多疾病也是現行藥物沒辦法治療的只能夠爭取在新藥開發的時候爭取成為臨床試驗的對象而且並且藥廠會支付全部支付這個病人的費用所以請教部長限縮給付雖然省錢但是也造成剛剛所提到的問題那部長我想您自己也是臺大這個醫院家醫科的教授相信您也很清楚\n\n02:06.508 --> 02:25.787\n那想要問說部長會不會考慮將這個用藥給付條件調整制和國際醫療指引一樣這個跟這個指引一致的這個部分因為想要問部長的態度喔因為這個問題當然我們知道他也受限於經費有限所以有點難\n\n02:26.688 --> 02:39.757\n但除了經費之外我們應該還是要以病人為中心嘛對吧同時也要考量到我們的醫療科技的發展所以想要問部長就是說你對於這個部分你有什麼想法那你是否願意去評估去推動這個新藥國際醫療指引全體付\n\n02:42.583 --> 03:04.731\n是,真的非常敬佩我們廖委員能夠這麼瞭解到這個醫療的需求跟現在的狀況以及像甚至臨床試驗這些事情這麼重要都能夠瞭解,真的非常敬佩那我想您提的能夠給我們的給臺灣的病人完全符合國際醫療指引\n\n03:07.725 --> 03:35.961\n的一個治療跟給他幾戶這是絕對是國家應該做的方向而且我們也的確在做像今年就在新藥各方面的就比去年又多一倍所以你們會盡量的去我們未來希望爭取全民認可能夠有更多的健康投資希望能夠來達到這樣一個國際的標準我想是未來重要的目標好謝謝部長\n\n03:36.821 --> 03:52.864\n另外就是為了鼓勵用藥後收集真實世界的數據並且發展成真實世界的證據這個部分我也想問說我們健保制度上是否也應該去評估怎麼樣去支持跟鼓勵\n\n03:55.955 --> 04:16.273\n這個沒關係,我們署長您幫忙跟委員報告,確實這個有些新藥那麼受限於它的個案或者是臨床的突破性有的在臨床二期就取得藥證所以我們需要更多的真實世界資料來做佐證所以我們在去年開始也導入了暫時性支付的概念\n\n04:16.713 --> 04:38.610\n就是對於這些病人有臨床上需求但是臨床證據還有一些不足的我們先讓他到健保來給付但是在兩年到三年的時間內我們來收集真實世界資料來作為最後那麼兩年之後過了之後的這個決定所以我們在今年1月1號也成立了\n\n04:39.931 --> 04:47.198\n的專責單位,就是醫療科技評估的專責單位來協助做真實世界資料的收集跟後續的分析。\n\n04:56.409 --> 05:14.057\n再來就是下一個問題部長這一兩年有許多醫院都面臨關床的困境有區域醫院已經關了三成的病床當然有人說的說法就是急缺護理師所以有病床卻開不得導致很多病人都塞在急診室\n\n05:15.177 --> 05:33.306\n但衛福部卻說根據今年的統計5月跟去年5月同期相比你們的護理人員增加總病床數也增加所以我想要問一下衛福部的意思是說沒有媒體描述的這個關床潮嗎?這個我先回答一下\n\n05:34.929 --> 05:54.344\n我想我們統計的是整個床數那跟實際上的realWorld大家也知道我整天在這個醫院混每天我就看到這些你現在照出來的景象你每天可以感受到當天的狀況\n\n05:55.825 --> 06:21.722\n那以台大醫院來講我昨天跟院長也討論了很久台大醫院是不至於有關床的現象但是中南部或者那個我相信可能會有需要床開少一點的這個部分那他的原因這個如果真的有這種情況而影響到\n\n06:22.603 --> 06:22.763\n拜訪委員\n\n06:39.588 --> 07:05.409\n因為點值,如果你做太多點值是不是會有影響?等等的,其實我們要去了解到這個因素。這部分的原因是不是可以請部長盡速的找出來,然後要怎麼解喔?因為我要告訴您的是,全國都知道因為缺護理師,這也可能是其中之一的原因,您剛剛有提到嘛,對不對?是。所以導致關床,但是這個照護師長卻反問關床的醫院是哪幾家喔?師長。\n\n07:06.650 --> 07:11.332\n其實我們並沒有否認關闖,而是說他整個統計數據所以這個我們後來自己在檢討說這樣的一個數據是沒辦法代表實際上大家所關心的事情所以在這邊跟大家抱歉沒有呈現一個我們只呈現我們所擁有的資料因為各個議院關闖\n\n07:34.448 --> 07:58.043\n他不會去跟衛生主管報告因為如果他知道說你怪這麼多好,部長沒關係,我給你看下一頁喔50層你阿伯就跟你撿,這樣就對了對,我知道所以我跟你講這就是有數據佐證喔因為反正你們剛剛說總值登人數有增加但為何地區醫院以上的護理師人力還是卻一再的流失喔那所以實際上\n\n07:59.878 --> 08:17.701\n當然這是不是其中的原因要拜託衛福不趕快去了解清楚並改善因為這有關於我們一般民眾這個就醫的權益喔那我們來看一下這個數據喔我們是從貴部的網站上去下載這份資料喔那我也挑了比較有資源有能力的醫學中心層級去比較\n\n08:19.103 --> 08:36.541\n從這個比較表其實可以看出來疫情前108年醫中的戰床率平均接近8成5但是疫後這個111年的資料已經掉到7成5那112年跟113年更慘恐怕有7成都有困難\n\n08:37.302 --> 09:02.640\n那連醫學中心都這麼慘更不要說這個區醫院和地區醫院所以後來我也把這108年、109年的這個Q1還有111年跟112年的每個年度的第一劑的戰床率戰床率去比較可以清楚看出來我們看到這個數據平均從7成和6成掉到112年的4成8所以平均也有掉了22%\n\n09:04.747 --> 09:31.509\n所以這就是實務上會認為說關床有達到三成的原因所以我要告訴部長這個數據明明也清清楚楚的為什麼你們就不願意面對那要看要怎麼解決呢對不對規則這個原因當然你剛剛都有講我覺得一定要面對對一定要面對那我那個第一次的回答那只是一個數據的呈現未來我相信我們衛福部會針對\n\n09:33.350 --> 09:59.343\n我們例如說在上次輸液的時候,人工輸液的時候我也請全國醫療院所、醫事公會去調查所有的醫療院所到底缺了多少一樣的我們現在會跟相關的團體來密切的結合來才能真正了解到不管是醫中、區域、地區醫院到底它的情況是怎麼樣我們要一個一個分別來解決\n\n10:00.031 --> 10:18.450\n部長那可不可以告訴我們說因為這個數據還蠻明顯的嘛我們知道在做管理的時候你總是要有一個目標啦我們希望說你們瞭解情況之後是不是可以真實的瞭解說這樣的占床率那你們未來希望這個東西可以怎麼這個數據會怎麼改善以前是87的\n\n10:23.166 --> 10:46.293\n這個因為我也當過醫學中心的部主任所以常常每個禮拜都在那邊檢討各科的戰狀律師我對戰狀律師非常敏感小台大醫院全部都90幾%都90%可能也如果但是但是這是平均我給你的數據也是你們的資料有的是可能是一般急性病房或者是特殊病房特殊病房有時候\n\n10:47.373 --> 10:49.577\n但是護理人力的需要充實,我想這是\n\n11:01.965 --> 11:02.545\n部長,下一頁就是\n\n11:19.267 --> 11:44.253\n其實賴總統在20212021年的時候有這個健保的國事論壇那其實剛剛講到有關於病床的癥結點其實也有部分可能跟這個健保點子有關那2021年的時任副總統現在的賴總統說這個20幾年來不諱言健保制度也存在很多問題那去年賴總統說要召開健保國事會議想要請問部長什麼時候要召開其實\n\n11:46.134 --> 11:59.644\n建保國事會議已經我的認知已經包含在過去五六場一個健康台灣大論前國大論壇裡面已經提出了很多具體短期、中期、長期\n\n12:00.925 --> 12:28.531\n我們要解決的一些健保的改革那這個部分因為今天你沒有時間我們從公務依算歸公務就說公務依算不能用在健保裡面等等的這些處理那這個就可以提出一些經費那是不是研議相關的一些在可能是不是部長因為這個研議真的是研議相當的研議研議了非常的久這次的研議是很記題\n\n12:29.851 --> 12:57.968\n對,所以可不可以請部長到時候盡速的提出到底你們的願景要怎麼改我想因為因為願景講的都很美好但始終是願景喔看起來問題就是存在那我們一直不面對一直不改善這個東西也拖了好久所以部長您任內一定會強力的推動解決對不對我過去10點就每天在解決這個問題未來一定更加努力好,謝謝部長好,謝謝委員好,謝謝廖偉翔委員現在處理臨時提案\n\n","segments":[{"start":8.644,"end":30.472,"text":"謝謝主席。那有請我們的邱部長。請邱部長。委員好。部長好。首先謝謝辛苦歸國。感謝大家現在我們國家在國際上的這個外交不容易。所以也特別肯定特別辛苦。那加油。謝謝。那再來就是部長。"},{"start":31.533,"end":48.722,"text":"我想要問一下因為這幾年因為要控制我們的藥費增加所以有許多新藥是被限縮給付那限縮的範圍當然包含這個療程、給付用藥時間等等那造成這個被限縮給付的藥品並不符合國際上的臨床指引"},{"start":49.462,"end":73.2,"text":"⋯⋯⋯"},{"start":73.54,"end":99.794,"text":"現在問題也一一浮現包括原廠開發在我國也找不到合格的病人做臨床實驗所以台灣也已經在國際的新藥開發市場中逐漸被忽視了未來有許多新藥研發也將不會有我國的data醫師也無法爭取發表研究我覺得這部分也會將使我們我國整體的醫療發展停滯再來就是剝奪病患爭取成為新藥開發的試驗對象"},{"start":102.489,"end":125.808,"text":"那因為有許多疾病也是現行藥物沒辦法治療的只能夠爭取在新藥開發的時候爭取成為臨床試驗的對象而且並且藥廠會支付全部支付這個病人的費用所以請教部長限縮給付雖然省錢但是也造成剛剛所提到的問題那部長我想您自己也是臺大這個醫院家醫科的教授相信您也很清楚"},{"start":126.508,"end":145.787,"text":"那想要問說部長會不會考慮將這個用藥給付條件調整制和國際醫療指引一樣這個跟這個指引一致的這個部分因為想要問部長的態度喔因為這個問題當然我們知道他也受限於經費有限所以有點難"},{"start":146.688,"end":159.757,"text":"但除了經費之外我們應該還是要以病人為中心嘛對吧同時也要考量到我們的醫療科技的發展所以想要問部長就是說你對於這個部分你有什麼想法那你是否願意去評估去推動這個新藥國際醫療指引全體付"},{"start":162.583,"end":184.731,"text":"是,真的非常敬佩我們廖委員能夠這麼瞭解到這個醫療的需求跟現在的狀況以及像甚至臨床試驗這些事情這麼重要都能夠瞭解,真的非常敬佩那我想您提的能夠給我們的給臺灣的病人完全符合國際醫療指引"},{"start":187.725,"end":215.961,"text":"的一個治療跟給他幾戶這是絕對是國家應該做的方向而且我們也的確在做像今年就在新藥各方面的就比去年又多一倍所以你們會盡量的去我們未來希望爭取全民認可能夠有更多的健康投資希望能夠來達到這樣一個國際的標準我想是未來重要的目標好謝謝部長"},{"start":216.821,"end":232.864,"text":"另外就是為了鼓勵用藥後收集真實世界的數據並且發展成真實世界的證據這個部分我也想問說我們健保制度上是否也應該去評估怎麼樣去支持跟鼓勵"},{"start":235.955,"end":256.273,"text":"這個沒關係,我們署長您幫忙跟委員報告,確實這個有些新藥那麼受限於它的個案或者是臨床的突破性有的在臨床二期就取得藥證所以我們需要更多的真實世界資料來做佐證所以我們在去年開始也導入了暫時性支付的概念"},{"start":256.713,"end":278.61,"text":"就是對於這些病人有臨床上需求但是臨床證據還有一些不足的我們先讓他到健保來給付但是在兩年到三年的時間內我們來收集真實世界資料來作為最後那麼兩年之後過了之後的這個決定所以我們在今年1月1號也成立了"},{"start":279.931,"end":287.198,"text":"的專責單位,就是醫療科技評估的專責單位來協助做真實世界資料的收集跟後續的分析。"},{"start":296.409,"end":314.057,"text":"再來就是下一個問題部長這一兩年有許多醫院都面臨關床的困境有區域醫院已經關了三成的病床當然有人說的說法就是急缺護理師所以有病床卻開不得導致很多病人都塞在急診室"},{"start":315.177,"end":333.306,"text":"但衛福部卻說根據今年的統計5月跟去年5月同期相比你們的護理人員增加總病床數也增加所以我想要問一下衛福部的意思是說沒有媒體描述的這個關床潮嗎?這個我先回答一下"},{"start":334.929,"end":354.344,"text":"我想我們統計的是整個床數那跟實際上的real World大家也知道我整天在這個醫院混每天我就看到這些你現在照出來的景象你每天可以感受到當天的狀況"},{"start":355.825,"end":381.722,"text":"那以台大醫院來講我昨天跟院長也討論了很久台大醫院是不至於有關床的現象但是中南部或者那個我相信可能會有需要床開少一點的這個部分那他的原因這個如果真的有這種情況而影響到"},{"start":382.603,"end":382.763,"text":"拜訪委員"},{"start":399.588,"end":425.409,"text":"因為點值,如果你做太多點值是不是會有影響?等等的,其實我們要去了解到這個因素。這部分的原因是不是可以請部長盡速的找出來,然後要怎麼解喔?因為我要告訴您的是,全國都知道因為缺護理師,這也可能是其中之一的原因,您剛剛有提到嘛,對不對?是。所以導致關床,但是這個照護師長卻反問關床的醫院是哪幾家喔?師長。"},{"start":426.65,"end":431.332,"text":"其實我們並沒有否認關闖,而是說他整個統計數據所以這個我們後來自己在檢討說這樣的一個數據是沒辦法代表實際上大家所關心的事情所以在這邊跟大家抱歉沒有呈現一個我們只呈現我們所擁有的資料因為各個議院關闖"},{"start":454.448,"end":478.043,"text":"他不會去跟衛生主管報告因為如果他知道說你怪這麼多好,部長沒關係,我給你看下一頁喔50層你阿伯就跟你撿,這樣就對了對,我知道所以我跟你講這就是有數據佐證喔因為反正你們剛剛說總值登人數有增加但為何地區醫院以上的護理師人力還是卻一再的流失喔那所以實際上"},{"start":479.878,"end":497.701,"text":"當然這是不是其中的原因要拜託衛福不趕快去了解清楚並改善因為這有關於我們一般民眾這個就醫的權益喔那我們來看一下這個數據喔我們是從貴部的網站上去下載這份資料喔那我也挑了比較有資源有能力的醫學中心層級去比較"},{"start":499.103,"end":516.541,"text":"從這個比較表其實可以看出來疫情前108年醫中的戰床率平均接近8成5但是疫後這個111年的資料已經掉到7成5那112年跟113年更慘恐怕有7成都有困難"},{"start":517.302,"end":542.64,"text":"那連醫學中心都這麼慘更不要說這個區醫院和地區醫院所以後來我也把這108年、109年的這個Q1還有111年跟112年的每個年度的第一劑的戰床率戰床率去比較可以清楚看出來我們看到這個數據平均從7成和6成掉到112年的4成8所以平均也有掉了22%"},{"start":544.747,"end":571.509,"text":"所以這就是實務上會認為說關床有達到三成的原因所以我要告訴部長這個數據明明也清清楚楚的為什麼你們就不願意面對那要看要怎麼解決呢對不對規則這個原因當然你剛剛都有講我覺得一定要面對對一定要面對那我那個第一次的回答那只是一個數據的呈現未來我相信我們衛福部會針對"},{"start":573.35,"end":599.343,"text":"我們例如說在上次輸液的時候,人工輸液的時候我也請全國醫療院所、醫事公會去調查所有的醫療院所到底缺了多少一樣的我們現在會跟相關的團體來密切的結合來才能真正了解到不管是醫中、區域、地區醫院到底它的情況是怎麼樣我們要一個一個分別來解決"},{"start":600.031,"end":618.45,"text":"部長那可不可以告訴我們說因為這個數據還蠻明顯的嘛我們知道在做管理的時候你總是要有一個目標啦我們希望說你們瞭解情況之後是不是可以真實的瞭解說這樣的占床率那你們未來希望這個東西可以怎麼這個數據會怎麼改善以前是87的"},{"start":623.166,"end":646.293,"text":"這個因為我也當過醫學中心的部主任所以常常每個禮拜都在那邊檢討各科的戰狀律師我對戰狀律師非常敏感小台大醫院全部都90幾%都90%可能也如果但是但是這是平均我給你的數據也是你們的資料有的是可能是一般急性病房或者是特殊病房特殊病房有時候"},{"start":647.373,"end":649.577,"text":"但是護理人力的需要充實,我想這是"},{"start":661.965,"end":662.545,"text":"部長,下一頁就是"},{"start":679.267,"end":704.253,"text":"其實賴總統在20212021年的時候有這個健保的國事論壇那其實剛剛講到有關於病床的癥結點其實也有部分可能跟這個健保點子有關那2021年的時任副總統現在的賴總統說這個20幾年來不諱言健保制度也存在很多問題那去年賴總統說要召開健保國事會議想要請問部長什麼時候要召開其實"},{"start":706.134,"end":719.644,"text":"建保國事會議已經我的認知已經包含在過去五六場一個健康台灣大論前國大論壇裡面已經提出了很多具體短期、中期、長期"},{"start":720.925,"end":748.531,"text":"我們要解決的一些健保的改革那這個部分因為今天你沒有時間我們從公務依算歸公務就說公務依算不能用在健保裡面等等的這些處理那這個就可以提出一些經費那是不是研議相關的一些在可能是不是部長因為這個研議真的是研議相當的研議研議了非常的久這次的研議是很記題"},{"start":749.851,"end":777.968,"text":"對,所以可不可以請部長到時候盡速的提出到底你們的願景要怎麼改我想因為因為願景講的都很美好但始終是願景喔看起來問題就是存在那我們一直不面對一直不改善這個東西也拖了好久所以部長您任內一定會強力的推動解決對不對我過去10點就每天在解決這個問題未來一定更加努力好,謝謝部長好,謝謝委員好,謝謝廖偉翔委員現在處理臨時提案"}]}}}}