{"id":154400,"url":"https://ivod.ly.gov.tw/Play/Clip/1M/154400","video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/1f04b26fe05fa65acd6c264b2d34c15afe28e669f0977b51bdae4078ad224fe88b921a11807ddc9c5ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"陳昭姿","委員發言時間":"09:12:31 - 09:24:45","影片長度":"00:12:14","會議時間":"2024-07-01T09:00:00+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23次全體委員會議（事由：邀請衛生福利部部長就「有關健保合理支付、保障醫護人員收入、設置百億癌症基金及健康投資等事項」進行專題報告，並備質詢。）","type":"Clip","date":"2024-07-01","start_time":"2024-07-01T09:12:31+08:00","end_time":"2024-07-01T09:24:45+08:00","duration":734,"meet":{"tmpMeeting":null,"title":"第11屆第1會期社會福利及衛生環境委員會第23次全體委員會議","term":11,"type":"委員會","sessionPeriod":1,"sessionTimes":23,"committees":[26],"id":"委員會-11-1-26-23"},"features":["ai-transcript","gazette"],"gazette":{"lineno":93,"blocks":[["陳委員昭姿：（9時12分）謝謝主席，有請邱部長。"],["主席：請邱部長。"],["邱部長泰源：委員好、主席好。"],["陳委員昭姿：部長早安。賴總統在大選期間提出了一系列的健康臺灣政策，其中有包含百億癌藥基金，今天我想就跟部長您一起來討論這個部分。6月中有一場臺美合作的肺癌倡議的活動，這個表格是健保署官方的資料，我對這份資料裡面有很多的問題，想請教部長。"],["邱部長泰源：是，請指教。"],["陳委員昭姿：首先，部長，這個預算是不是都編列了？這筆預算是不是已經編列了？"],["邱部長泰源：我們已經爭取了明年的公務預算。"],["陳委員昭姿：明年的公務預算？"],["邱部長泰源：因為今年是健保的，今年嘛！"],["陳委員昭姿：對，就是2025嗎？"],["邱部長泰源：就是114年。"],["陳委員昭姿：這個百億基金您預計何時撥款、何時開始運作，可不可以有個參考日期？"],["邱部長泰源：應該是明年初就可以開始。"],["陳委員昭姿：2025年，好。我想再請教，這個計畫是長久性的還是一年的計畫？"],["邱部長泰源：當然是長久性的。"],["陳委員昭姿：長久性的，好。再來我想確定一下內涵，有關這個基金的名稱跟用途，賴總統說這個基金是讓癌症新藥使用，正確嗎？到底是癌症新藥，還是包含癌症新藥的所有新藥？"],["邱部長泰源：不是，謝謝委員的提問，這個也是大家在討論的，我們最近確認以後是癌症方面的新藥。"],["陳委員昭姿：好，癌症新藥，我們今天就是把每一個點都弄清楚。請問這個基金據說有個運作委員會，這個委員會組成了嗎？有沒有包括病友？"],["邱部長泰源：將來一定會包括病友，但是這個基金會……"],["陳委員昭姿：如果明年初要運作，那這個基金會大概也要開始……"],["邱部長泰源：我們有一個作業要點在年底前會來制定。"],["陳委員昭姿：好，部長，因為賴總統講了一句話，他說2030年癌症死亡率要減三分之一，根據我的想法、我的醫學背景，我覺得這個願望非常的奢侈，如果能夠降低三分之一，在醫學上是一個突破耶！再來我想請教部長，您知道每年癌症的死亡人數是多少？"],["邱部長泰源：現在是五萬多人。"],["陳委員昭姿：那癌症登記的人數呢？癌登的人數是……"],["邱部長泰源：一年新發生大概有12萬左右。"],["陳委員昭姿：對，12萬。那總統的意思是說要把這個5萬降成三萬多嗎？你們有去瞭解嗎？因為他說要降低癌症死亡率三分之一。"],["邱部長泰源：我想這個要……"],["陳委員昭姿：請教總統？"],["邱部長泰源：一步一步來。"],["陳委員昭姿：不是，你也是要告訴他這個願望可能太奢侈、達不到。","我們再來看這個基金的適用部分，上面的定義是具醫療迫切需要及治療潛力，但臨床效益、債務衝擊評估不確定的癌藥、新藥或新適應症。部長，您覺得這個定義有清楚嗎？您讀起來清楚嗎？我可以跟部長講，因為我在這個委員會已經滿29年，健保第一天開始，光是這個，你剛才也用英文唸了，unmet medical need就是醫療迫切需求，我可以告訴部長，一個新藥有三個定位，一個叫做突破創新、一個叫比現在的好、一個叫做跟現在的一樣，你知道我看過多少案例？一個藥3個主審都是專家，3個人的定位都不一樣，所以我可以先告訴部長，這個迫切需求大家各說各話，這是第一個。","第二個，臨床效益如果指的是，每讓病人多增加一個有品質的存活所需要的額外費用，這個叫ICER的專業名詞，這個爭議更大了，因為太高一定不給、低也不一定就給，因為我們過去整個對新藥評估，從來沒有將生活或生命的品質放在裡面，所以我們事實上沒有資料，一直都留在價格的部分，沒有價值部分。請教部長，專家沒有資料，而且也沒有人瞭解，你如何去聘專家來做這件事呢？還有，你要用國外的資料嗎？因為我們癌症過去的給付都是限縮的，我們不像其他國家用到能夠比疾病再進展，那可以用國外的資料嗎？這個臨床效益部分您覺得清楚嗎？"],["邱部長泰源：非常敬佩我們委員這麼專業，幾十年來的經驗告訴我們這些事情，我們當然會蒐集各國的資料，那也會……"],["陳委員昭姿：其實部長，像這個就是在運作的時候，我們大家都要有好好的共識跟資料的support。"],["邱部長泰源：一定，一定跟專家一起來討論。"],["陳委員昭姿：還有財務衝擊，這還在第一句話，老實說，因為自從2007年11月開始有提供財務衝擊給專家們去討論新藥的時候，我從來沒看過健保署的評估資料，跟廠商的評估資料或是專家學會的評估資料是一模一樣的，而且差距甚至非常大，超過1億的都有。所以我向部長確認，這裡的財務衝擊不是申報費用，對不對？它是指如果這個病人不用現在有的治療，他要改用新的療法，所額外增加費用，對嗎？是不是這個定義？"],["邱部長泰源：是。"],["陳委員昭姿：財務衝擊是這個定義，這叫財務衝擊，不是申報費用。"],["邱部長泰源：是的。"],["陳委員昭姿：但是財務衝擊就是說……我剛剛講說能夠算得清楚嗎？有真相嗎？因為我從來搞不清新藥預算是怎麼算，過去只編2、30億，今年好像編得多一點有60億，看來明年要編得更多，我們都不知道新藥預算怎麼算用了多少、怎麼用？這個搞不清楚，因為計算很複雜、非常的複雜，計算的方法也是有爭議的，部長，這怎麼辦？財務衝擊……"],["邱部長泰源：報告委員，因為財務風險評估的確是不太確定，所以才會用暫時性支付……"],["陳委員昭姿：我也很同情你們，主計處的GDP成長一年可以調整十幾次，你這裡不能調啊！這裡很固定的就是這樣。","我們再來看期程經費，目前預估是每年100億，所以我再確定一次，這個100億是健保署的實際支出，還是醫院的申報費用？我們都知道現在藥廠跟健保簽有所謂的價量協議，跟給付協議……"],["邱部長泰源：應該是實際的支出。"],["陳委員昭姿：實際支出嗎？因為這個差很大喔！部長，這定義差很大。去年可能還了70億左右，前年是50億，再往前一年是26億，這跟百億都靠近了，你如果定義不清楚，是很模糊欸！部長，您今天說是實際支出？好，確定。","再來請問健保署2024年編列的新藥新科技預算，有包含新藥、新特材、NGS，還有暫時性支付，大概60、70億，剛剛你也報告了。請問這兩塊區分得開嗎？100億跟這個區分得開嗎？還是這100億存在了，你原來的編列就開始縮減了，最後都混在一起了，所以事實上，這個百億基金並沒有提供百億，是打折扣的？部長，這個部分怎麼辦、區分得清楚嗎？"],["邱部長泰源：百億基金應該就是設計在專款專用，不會去影響到健保裡面任何……"],["陳委員昭姿：但是原來就有編新藥新科技嘛！"],["邱部長泰源：對啊！"],["陳委員昭姿：現在又有個百億，所以我要確定這兩塊切得開。"],["邱部長泰源：那不一樣啊！"],["陳委員昭姿：切得開嗎？"],["邱部長泰源：切得開啊！"],["陳委員昭姿：切得開？好，但願如此。財務控管非常非常重要，但是因為健保要永續一定要控制，我再請教，如果療效很好，比預估量還高，或是超過所謂的一個上限值，因為這已經發生太多次了，請問這個多出來費用都要廠商依比例來分攤嗎？就超過的都是廠商的，部長你覺得這樣合理嗎？"],["邱部長泰源：這個因為是參考英國Cancer Drugs Fund的一個制度啦，由廠商……"],["陳委員昭姿：部長，你應該知道醫院還會向廠商要求藥價差啊？我可不可以請教部長，您知道藥價差有多少？一年的藥價差有多少？是這個百億基金的幾倍啊？石署長知道啦，你問他好了。"],["邱部長泰源：請署長說明。"],["陳委員昭姿：沒有，就是一個數字，大概嘛！"],["石署長崇良：這個所謂的藥價差，就是說健保的核價跟我們……"],["陳委員昭姿：支付與這個……對啊，我的意思是說……"],["石署長崇良：做市場調查的醫院進價，這中間的差額，以去年為例大概是在550億左右。"],["陳委員昭姿：你現在靠近一點，多了50億，靠近600億，那這個不得了，現在就是會這樣，如果說廠商被剝了兩次皮，這個地方超過都要還，然後原來醫院也在給，那請問會不會回到現況，它就不參加一些健保給付或留在自費市場？就回到現在的狀況啊，大家還是用不到藥啊！因為這些所謂的突破創新，都是來自國外的廠商嘛，他們有國際的價格某些程度要去保障，那現在怎麼避免呢？還是回到現況啊，我預期它會回到現況啊，這個百億基金最後會回到現況。","沒關係，這個部分不是這麼容易回答，但效益評估的部分，包括納入給付之前跟之後，之前我們只能靠科學文獻跟臺灣的流行病學資料；之後是用真實世界的資料才能評估，那請問真實世界資料的品質如何呢？可信嗎？real-world data，你有沒有找真正的專家來處理，這是一個非常嚴謹的科學啦！"],["邱部長泰源：我們所有任何的研究、相關的計畫，一定都找最適當的專家，所以它的data……"],["陳委員昭姿：我再來討論，而且CHPTA我覺得不應該under在健保署下，它是一個獨立超然的機機構啦！"],["邱部長泰源：是。"],["陳委員昭姿：請問這100億是不是包括登錄系統、維護系統或是檢測費在裡面？"],["邱部長泰源：這個我們已經擬定法的……"],["陳委員昭姿：是放在裡面嗎？好。最後，請主席再給我一點點時間，因為100億實在是很大的金額，健保署很棒，在藥物共擬會的成員、利益迴避書、書面資料、甚至所謂的錄音檔全部公開，那我也希望其他的國家委員會也可以效法，部長，尤其包括疫苗的部分好嗎？看病的部分，都要公開透明的。第二個，所謂財務的衝擊，預估現在有很大的空間，其實對病人來說……因為你現在叫衛福部，你不只是衛生而已，如果你能夠在醫療或非醫療方面，你幫助小孩子回去上課、幫助成人回到職場上班、減輕家庭的照顧、減少長照費資源的使用，這個東西是不是應該納入醫療科技的評估裡面？但是從來沒有啊！醫療科技從2007年提供到現在，還停留在算數，多少病人、多少錢，取代哪個費用直接把它加減扣掉。部長，這個只有價格沒有價值的算法，部長您同意嗎？"],["邱部長泰源：我比較期待用價值的一個算法。"],["陳委員昭姿：我覺得這個沒有真相。不好意思，最後一張是我個人的統計，因為臺灣沒有其他人做這個統計，我統計癌症新藥納入健保平均要等782天啦，我們因為沒有錢一直限縮，所以我們的癌藥跟其他國家不一樣，你要參考別的國家就要小心，因為我們頂多只有三成的病人在裡面支付，要怎麼去接軌呢？怎麼樣用他們的資料來做詮釋呢？所以現在癌症的基金已經在眼前，但是我覺得醫藥新科技、暫時性給付……當然你剛剛提到是劃分得開，這份基金很珍貴，得來不易，我希望它要釐清很多點，如果你不釐清的話，將來它的效益評估、實際的成效不清楚啦！部長你要清楚，才能夠在實際運作跟評估的時候是清楚的，這樣才能夠讓民眾得到保障，也兌現賴總統的一個承諾，部長好嗎？"],["邱部長泰源：好，謝謝委員專業的指導，我們會往這方面努力，謝謝！"],["陳委員昭姿：謝謝部長。"],["主席：謝謝陳昭姿委員的發言。","接下來請林月琴委員發言。"]],"agenda":{"page_end":118,"meet_id":"委員會-11-1-26-23","speakers":["黃秀芳","陳昭姿","林月琴","陳菁徽","邱鎮軍","王育敏","涂權吉","廖偉翔","蘇清泉","王正旭","鄭天財Sra 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95.477, \"score\": 0.825}, {\"word\": \"友\", \"start\": 95.477, \"end\": 95.497, \"score\": 0.0}]}, {\"start\": 111.724, \"end\": 114.866, \"text\": \"因為賴總統講了一句話他說2030年癌症死亡率要讓他減三分之一根據我的想法我在醫學背景我覺得這個願望非常的奢侈\", \"words\": [{\"word\": \"因\", \"start\": 111.724, \"end\": 111.884, \"score\": 0.611}, {\"word\": \"為\"}, {\"word\": \"賴\"}, {\"word\": \"總\"}, {\"word\": \"統\"}, {\"word\": \"講\"}, {\"word\": \"了\", \"start\": 111.884, \"end\": 112.004, \"score\": 0.647}, {\"word\": \"一\", \"start\": 112.004, \"end\": 112.104, \"score\": 0.892}, {\"word\": \"句\", \"start\": 112.104, \"end\": 112.605, \"score\": 0.861}, {\"word\": \"話\"}, {\"word\": \"他\", \"start\": 112.605, \"end\": 112.725, \"score\": 0.793}, {\"word\": \"說\"}, {\"word\": \"2\"}, {\"word\": \"0\"}, {\"word\": \"3\"}, {\"word\": \"0\"}, {\"word\": \"年\", \"start\": 112.725, \"end\": 112.745, \"score\": 0.0}, {\"word\": \"癌\", \"start\": 112.745, \"end\": 112.885, \"score\": 0.643}, {\"word\": \"症\", \"start\": 112.885, \"end\": 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\"我從來沒看過健保署的評估資料跟這個廠商的評估資料或是專家學會的評估資料是一模一樣的而且差距甚至非常大超過一億的都有所以我向部長確認這裡的費用財務衝擊他不是申報費用對不對他是指如果這個病人假設他不用現在有的治療\", \"words\": [{\"word\": \"我\", \"start\": 301.545, \"end\": 302.405, \"score\": 0.927}, {\"word\": \"從\"}, {\"word\": \"來\"}, {\"word\": \"沒\", \"start\": 302.405, \"end\": 302.565, \"score\": 0.825}, {\"word\": \"看\", \"start\": 302.565, \"end\": 302.985, \"score\": 0.902}, {\"word\": \"過\"}, {\"word\": \"健\", \"start\": 302.985, \"end\": 303.185, \"score\": 0.928}, {\"word\": \"保\", \"start\": 303.185, \"end\": 303.385, \"score\": 0.999}, {\"word\": \"署\", \"start\": 303.385, \"end\": 303.485, \"score\": 0.845}, {\"word\": \"的\", \"start\": 303.485, \"end\": 303.766, \"score\": 0.924}, {\"word\": \"評\"}, {\"word\": \"估\", \"start\": 303.766, \"end\": 304.046, \"score\": 0.925}, {\"word\": \"資\"}, {\"word\": \"料\", \"start\": 304.046, \"end\": 304.266, \"score\": 0.968}, {\"word\": \"跟\", \"start\": 304.266, \"end\": 305.586, \"score\": 0.936}, {\"word\": \"這\"}, {\"word\": 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308.267, \"end\": 308.367, \"score\": 0.809}, {\"word\": \"一\", \"start\": 308.367, \"end\": 308.487, \"score\": 0.853}, {\"word\": \"模\", \"start\": 308.487, \"end\": 308.687, \"score\": 0.829}, {\"word\": \"一\", \"start\": 308.687, \"end\": 308.947, \"score\": 0.823}, {\"word\": \"樣\"}, {\"word\": \"的\", \"start\": 308.947, \"end\": 309.467, \"score\": 0.969}, {\"word\": \"而\", \"start\": 309.467, \"end\": 309.547, \"score\": 0.85}, {\"word\": \"且\", \"start\": 309.547, \"end\": 309.707, \"score\": 0.911}, {\"word\": \"差\", \"start\": 309.707, \"end\": 309.967, \"score\": 0.938}, {\"word\": \"距\", \"start\": 309.967, \"end\": 310.147, \"score\": 0.88}, {\"word\": \"甚\", \"start\": 310.147, \"end\": 310.307, \"score\": 0.996}, {\"word\": \"至\", \"start\": 310.307, \"end\": 310.487, \"score\": 0.916}, {\"word\": \"非\", \"start\": 310.487, \"end\": 310.587, \"score\": 0.916}, {\"word\": \"常\", \"start\": 310.587, \"end\": 310.787, \"score\": 0.917}, {\"word\": \"大\", \"start\": 310.787, 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{\"word\": \"費\"}, {\"word\": \"用\", \"start\": 315.468, \"end\": 317.069, \"score\": 0.914}, {\"word\": \"財\"}, {\"word\": \"務\"}, {\"word\": \"衝\"}, {\"word\": \"擊\"}, {\"word\": \"他\", \"start\": 317.069, \"end\": 317.349, \"score\": 0.985}, {\"word\": \"不\", \"start\": 317.349, \"end\": 317.569, \"score\": 0.998}, {\"word\": \"是\", \"start\": 317.569, \"end\": 317.789, \"score\": 0.988}, {\"word\": \"申\", \"start\": 317.789, \"end\": 318.349, \"score\": 0.893}, {\"word\": \"報\"}, {\"word\": \"費\"}, {\"word\": \"用\", \"start\": 318.349, \"end\": 318.649, \"score\": 0.926}, {\"word\": \"對\"}, {\"word\": \"不\", \"start\": 318.649, \"end\": 319.409, \"score\": 0.882}, {\"word\": \"對\"}, {\"word\": \"他\", \"start\": 319.409, \"end\": 319.589, \"score\": 0.982}, {\"word\": \"是\", \"start\": 319.589, \"end\": 319.769, \"score\": 0.963}, {\"word\": \"指\", \"start\": 319.769, \"end\": 319.909, \"score\": 0.989}, {\"word\": \"如\", \"start\": 319.909, \"end\": 320.069, \"score\": 0.937}, {\"word\": \"果\", \"start\": 320.069, \"end\": 320.429, \"score\": 0.829}, {\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"病\", \"start\": 320.429, \"end\": 320.589, \"score\": 0.965}, {\"word\": \"人\", \"start\": 320.589, \"end\": 320.809, \"score\": 0.906}, {\"word\": \"假\", \"start\": 320.809, \"end\": 321.33, \"score\": 0.945}, {\"word\": \"設\"}, {\"word\": \"他\", \"start\": 321.33, \"end\": 321.53, \"score\": 0.977}, {\"word\": \"不\", \"start\": 321.53, \"end\": 321.61, \"score\": 0.986}, {\"word\": \"用\", \"start\": 321.61, \"end\": 322.07, \"score\": 0.956}, {\"word\": \"現\"}, {\"word\": \"在\", \"start\": 322.07, \"end\": 322.29, \"score\": 0.991}, {\"word\": \"有\", \"start\": 322.29, \"end\": 322.49, \"score\": 0.993}, {\"word\": \"的\", \"start\": 322.49, \"end\": 322.83, \"score\": 0.994}, {\"word\": \"治\", \"start\": 322.83, \"end\": 322.85, \"score\": 0.258}, {\"word\": \"療\"}]}, {\"start\": 323.85, \"end\": 330.936, \"text\": \"他要去改用這個新的療法所額外增加來的費用,對嗎?是不是這個定義?財務衝擊是這個定義,這才叫財務衝擊,不是申報費用。那但是財務衝擊就是說,我剛剛講說,甘算得清楚?有真相嗎?\", \"words\": [{\"word\": \"他\", \"start\": 323.85, \"end\": 324.05, \"score\": 0.877}, {\"word\": \"要\", \"start\": 324.05, \"end\": 324.211, \"score\": 0.769}, {\"word\": \"去\", \"start\": 324.211, \"end\": 324.411, \"score\": 0.966}, {\"word\": \"改\", \"start\": 324.411, \"end\": 324.611, \"score\": 0.999}, {\"word\": \"用\", \"start\": 324.611, \"end\": 325.231, \"score\": 0.86}, {\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"新\", \"start\": 325.231, \"end\": 325.412, \"score\": 0.806}, {\"word\": \"的\", \"start\": 325.412, \"end\": 325.732, \"score\": 0.761}, {\"word\": \"療\"}, {\"word\": \"法\", \"start\": 325.732, \"end\": 326.092, \"score\": 0.845}, {\"word\": \"所\", \"start\": 326.092, \"end\": 326.432, \"score\": 0.759}, {\"word\": \"額\"}, {\"word\": \"外\", \"start\": 326.432, \"end\": 326.653, \"score\": 0.93}, {\"word\": \"增\", \"start\": 326.653, \"end\": 326.833, \"score\": 0.992}, 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{\"word\": \",\"}, {\"word\": \"這\"}, {\"word\": \"才\", \"start\": 329.395, \"end\": 329.495, \"score\": 0.978}, {\"word\": \"叫\", \"start\": 329.495, \"end\": 329.555, \"score\": 0.599}, {\"word\": \"財\"}, {\"word\": \"務\"}, {\"word\": \"衝\"}, {\"word\": \"擊\"}, {\"word\": \",\"}, {\"word\": \"不\", \"start\": 329.555, \"end\": 329.675, \"score\": 0.833}, {\"word\": \"是\", \"start\": 329.675, \"end\": 329.735, \"score\": 0.642}, {\"word\": \"申\", \"start\": 329.735, \"end\": 329.835, \"score\": 0.8}, {\"word\": \"報\"}, {\"word\": \"費\"}, {\"word\": \"用\", \"start\": 329.835, \"end\": 329.935, \"score\": 0.751}, {\"word\": \"。\"}, {\"word\": \"那\", \"start\": 329.935, \"end\": 330.035, \"score\": 0.792}, {\"word\": \"但\", \"start\": 330.035, \"end\": 330.055, \"score\": 0.0}, {\"word\": \"是\", \"start\": 330.055, \"end\": 330.176, \"score\": 0.925}, {\"word\": \"財\"}, {\"word\": \"務\"}, {\"word\": \"衝\"}, {\"word\": \"擊\"}, {\"word\": \"就\", \"start\": 330.176, \"end\": 330.196, 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\"我要講的是說因為我從來搞不清新藥預算是怎麼算過去只編2、30億今年好像編的多一點60億那如果再看來明年要編的更多那我們都不知道新藥預算怎麼算說用的多少怎麼用這個搞不清楚因為計算很複雜非常的複雜那計算的方法也是有爭議的部長那這怎麼辦財務中局\", \"words\": [{\"word\": \"我\", \"start\": 342.339, \"end\": 342.459, \"score\": 0.995}, {\"word\": \"要\", \"start\": 342.459, \"end\": 342.619, \"score\": 0.987}, {\"word\": \"講\"}, {\"word\": \"的\", \"start\": 342.619, \"end\": 342.86, \"score\": 0.906}, {\"word\": \"是\", \"start\": 342.86, \"end\": 343.12, \"score\": 0.858}, {\"word\": \"說\"}, {\"word\": \"因\", \"start\": 343.12, \"end\": 343.941, \"score\": 0.973}, {\"word\": \"為\"}, {\"word\": \"我\", \"start\": 343.941, \"end\": 344.381, \"score\": 0.905}, {\"word\": \"從\"}, {\"word\": \"來\"}, {\"word\": \"搞\", \"start\": 344.381, \"end\": 344.501, \"score\": 0.991}, {\"word\": \"不\", \"start\": 344.501, \"end\": 344.641, \"score\": 0.894}, {\"word\": \"清\", \"start\": 344.641, \"end\": 345.422, \"score\": 0.893}, {\"word\": \"新\", \"start\": 345.422, \"end\": 345.582, \"score\": 0.875}, {\"word\": \"藥\"}, {\"word\": \"預\"}, {\"word\": \"算\", \"start\": 345.582, \"end\": 345.742, \"score\": 1.0}, {\"word\": \"是\", \"start\": 345.742, \"end\": 345.842, \"score\": 0.8}, {\"word\": \"怎\", \"start\": 345.842, \"end\": 346.103, \"score\": 0.923}, {\"word\": \"麼\"}, {\"word\": \"算\", \"start\": 346.103, \"end\": 346.563, \"score\": 0.956}, {\"word\": \"過\"}, {\"word\": \"去\", \"start\": 346.563, \"end\": 346.743, \"score\": 1.0}, {\"word\": \"只\", \"start\": 346.743, \"end\": 348.064, \"score\": 0.879}, {\"word\": \"編\"}, {\"word\": \"2\"}, {\"word\": \"、\"}, {\"word\": \"3\"}, {\"word\": \"0\"}, {\"word\": \"億\"}, {\"word\": \"今\", \"start\": 348.064, \"end\": 348.245, \"score\": 0.89}, {\"word\": \"年\", \"start\": 348.245, \"end\": 348.425, \"score\": 0.95}, {\"word\": \"好\", \"start\": 348.425, \"end\": 348.625, \"score\": 0.9}, {\"word\": \"像\", \"start\": 348.625, \"end\": 348.765, \"score\": 0.857}, {\"word\": \"編\"}, {\"word\": \"的\", \"start\": 348.765, \"end\": 348.925, \"score\": 0.885}, {\"word\": \"多\", \"start\": 348.925, \"end\": 350.126, \"score\": 0.933}, {\"word\": \"一\", \"start\": 350.126, \"end\": 350.747, \"score\": 0.967}, {\"word\": \"點\"}, {\"word\": \"6\"}, {\"word\": \"0\"}, {\"word\": \"億\"}, {\"word\": \"那\", \"start\": 350.747, \"end\": 350.947, \"score\": 0.909}, {\"word\": \"如\", \"start\": 350.947, \"end\": 351.067, \"score\": 0.996}, {\"word\": \"果\", \"start\": 351.067, \"end\": 351.227, \"score\": 0.879}, {\"word\": \"再\", \"start\": 351.227, \"end\": 351.408, \"score\": 0.908}, {\"word\": \"看\", \"start\": 351.408, \"end\": 351.708, \"score\": 0.868}, {\"word\": \"來\"}, {\"word\": \"明\", \"start\": 351.708, \"end\": 351.868, \"score\": 0.887}, {\"word\": \"年\", \"start\": 351.868, \"end\": 351.968, \"score\": 0.8}, {\"word\": \"要\", \"start\": 351.968, \"end\": 352.268, \"score\": 0.928}, {\"word\": \"編\"}, {\"word\": \"的\", \"start\": 352.268, \"end\": 352.408, \"score\": 0.858}, {\"word\": \"更\", \"start\": 352.408, \"end\": 352.609, 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{\"word\": \"的\", \"start\": 356.672, \"end\": 356.793, \"score\": 0.962}, {\"word\": \"多\", \"start\": 356.793, \"end\": 357.033, \"score\": 0.999}, {\"word\": \"少\", \"start\": 357.033, \"end\": 357.673, \"score\": 0.968}, {\"word\": \"怎\", \"start\": 357.673, \"end\": 357.954, \"score\": 0.928}, {\"word\": \"麼\"}, {\"word\": \"用\", \"start\": 357.954, \"end\": 359.235, \"score\": 0.969}, {\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"搞\", \"start\": 359.235, \"end\": 359.415, \"score\": 0.991}, {\"word\": \"不\", \"start\": 359.415, \"end\": 359.535, \"score\": 0.997}, {\"word\": \"清\", \"start\": 359.535, \"end\": 359.695, \"score\": 0.934}, {\"word\": \"楚\", \"start\": 359.695, \"end\": 359.795, \"score\": 0.908}, {\"word\": \"因\", \"start\": 359.795, \"end\": 360.216, \"score\": 0.861}, {\"word\": \"為\"}, {\"word\": \"計\"}, {\"word\": \"算\", \"start\": 360.216, \"end\": 360.416, \"score\": 0.997}, {\"word\": \"很\", \"start\": 360.416, \"end\": 361.657, \"score\": 0.967}, {\"word\": \"複\"}, {\"word\": \"雜\"}, {\"word\": \"非\", \"start\": 361.657, \"end\": 361.837, \"score\": 0.986}, {\"word\": \"常\", \"start\": 361.837, \"end\": 362.017, \"score\": 0.899}, {\"word\": \"的\", \"start\": 362.017, \"end\": 362.818, \"score\": 0.95}, {\"word\": \"複\"}, {\"word\": \"雜\"}, {\"word\": \"那\", \"start\": 362.818, \"end\": 363.158, \"score\": 0.939}, {\"word\": \"計\"}, {\"word\": \"算\", \"start\": 363.158, \"end\": 363.319, \"score\": 0.999}, {\"word\": \"的\", \"start\": 363.319, \"end\": 363.459, \"score\": 0.989}, {\"word\": \"方\", \"start\": 363.459, \"end\": 363.679, \"score\": 1.0}, {\"word\": \"法\", \"start\": 363.679, \"end\": 363.939, \"score\": 1.0}, {\"word\": \"也\", \"start\": 363.939, \"end\": 364.119, \"score\": 1.0}, {\"word\": \"是\", \"start\": 364.119, \"end\": 364.3, \"score\": 1.0}, {\"word\": \"有\", \"start\": 364.3, \"end\": 364.48, \"score\": 1.0}, {\"word\": \"爭\"}, {\"word\": \"議\"}, {\"word\": \"的\", \"start\": 364.48, \"end\": 364.56, \"score\": 0.75}, {\"word\": \"部\", \"start\": 364.56, \"end\": 364.78, \"score\": 0.909}, {\"word\": \"長\"}, {\"word\": \"那\", \"start\": 364.78, \"end\": 364.94, \"score\": 0.869}, {\"word\": \"這\"}, {\"word\": \"怎\", \"start\": 364.94, \"end\": 365.1, \"score\": 0.865}, {\"word\": \"麼\"}, {\"word\": \"辦\"}, {\"word\": \"財\"}, {\"word\": \"務\"}, {\"word\": \"中\", \"start\": 365.1, \"end\": 365.861, \"score\": 0.97}, {\"word\": \"局\", \"start\": 365.861, \"end\": 365.881, \"score\": 0.0}]}, {\"start\": 368.323, \"end\": 391.142, \"text\": \"報告委員因為這個財務風險評估的確是不太確定所以才會用暫時性支付這個主基礎的那個GDP成長一年可以調整十幾次你這裡不能調啊這裡就是很固定的就是這樣好我們再來看期成經費目前預估是每年100億所以我再確定一次這個100億是健保署的實際支出\", \"words\": [{\"word\": \"報\"}, {\"word\": \"告\", \"start\": 368.323, \"end\": 368.463, \"score\": 0.973}, {\"word\": \"委\", \"start\": 368.463, \"end\": 368.643, \"score\": 0.852}, {\"word\": \"員\"}, {\"word\": \"因\", \"start\": 368.643, \"end\": 370.065, \"score\": 0.86}, {\"word\": \"為\"}, {\"word\": \"這\"}, {\"word\": \"個\"}, 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709.663, \"score\": 0.775}, {\"word\": \"益\", \"start\": 709.663, \"end\": 709.943, \"score\": 0.763}, {\"word\": \"評\"}, {\"word\": \"估\", \"start\": 709.943, \"end\": 710.043, \"score\": 0.791}, {\"word\": \"他\", \"start\": 710.043, \"end\": 710.203, \"score\": 0.756}, {\"word\": \"的\", \"start\": 710.203, \"end\": 710.223, \"score\": 0.992}, {\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"實\"}, {\"word\": \"際\"}, {\"word\": \"的\", \"start\": 710.223, \"end\": 710.323, \"score\": 0.694}, {\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"成\", \"start\": 710.323, \"end\": 710.343, \"score\": 0.0}, {\"word\": \"效\", \"start\": 710.343, \"end\": 710.363, \"score\": 0.97}, {\"word\": \"陳\"}, {\"word\": \"昭\", \"start\": 714.406, \"end\": 714.426, \"score\": 0.0}, {\"word\": \"姿\", \"start\": 714.426, \"end\": 714.506, \"score\": 0.75}, {\"word\": \"委\", \"start\": 714.506, \"end\": 714.526, \"score\": 0.0}, {\"word\": \"員\"}], \"language\": \"zh\"}","srt":"1\n00:00:05,409 --> 00:00:06,236\n謝謝主席有請邱部長請邱部長\n\n2\n00:00:13,805 --> 00:00:39,853\n部長早安部長賴總統在大選期間提出了一系列的健康臺灣政策其中有包含百億癌藥基金今天我想就跟部長您一起來討論這個部分6月中有一場臺美合作的肺癌倡議的活動這個表格是健保署官方的資料我對這份資料裡面有很多的問題想請教部長首先就是部長這個預算是不是都編列了\n\n3\n00:00:41,905 --> 00:00:58,473\n這個預算這筆預算是不是已經編列了?我們明年已經爭取了明年的公務預算明年的公務預算?因為今年是健保的今年嘛就是2025嘛就是114年這個百億基金您預計何時撥款?何時開始運作?可不可以有個參考日期?\n\n4\n00:01:04,797 --> 00:01:30,722\n應該是明年初就可以開始2025年那我想再請教這個計畫是長久性的還是一年的計畫當然是長久性的那再來我想確定一下這個內涵就是有關這個基金的名稱跟這個用途賴總統說這個基金是讓癌症新藥使用正確嗎到底是癌症新藥還是新藥包含癌症新藥的所有新藥\n\n5\n00:01:31,854 --> 00:01:35,497\n請問這個基金據說有個運作委員會這個委員會組成了嗎有沒有包括病友\n\n6\n00:01:51,724 --> 00:01:54,866\n因為賴總統講了一句話他說2030年癌症死亡率要讓他減三分之一根據我的想法我在醫學背景我覺得這個願望非常的奢侈\n\n7\n00:02:16,081 --> 00:02:24,406\n如果能夠降低三分之一在醫學上是一個突破所以我再來我想請教部長部長你知道每年癌症的死亡人數是多少\n\n8\n00:02:25,538 --> 00:02:28,400\n總統的意思是說要把這個5萬降成3萬多嗎?你們有去了解嗎?因為他說要降低癌症死亡率三分之一啊\n\n9\n00:02:48,417 --> 00:02:51,418\n醫療破解需要治療潛力,但臨床效益、債務衝擊評估等不確定的癌藥、新藥或新適應症。部長您覺得這個定義有清楚嗎?您讀起來清楚嗎?\n\n10\n00:03:16,014 --> 00:03:16,595\n三個人的定位都不一樣\n\n11\n00:03:39,574 --> 00:04:03,853\n所以我可以先告訴部長這個迫切需求這個大家各說各話好這是第一個第二個臨床效益如果指的是每讓病人多增加一個有品質的存活力所需要的額外費用那這個叫埃瑟茲沒有這個專業名詞那這個爭議更大了因為太高一定不給那低也不一定就給那因為我們過去整個對性要評估從來沒有將生活或生命的品質放在裡面\n\n12\n00:04:04,614 --> 00:04:29,966\n所以我們事實上沒有資料我們一直都留在價格的部分沒有價值部分那請教部長專家沒有資料而且也沒有人了解你如何去聘專家來做這件事呢還有你要用國外的資料嗎那國外的資料因為我們的癌症過去的幾副都是限縮的我們不像其他國家就是用到能夠比疾病再進展那可以用國外的資料嗎這個臨床效益部分您覺得清楚嗎\n\n13\n00:04:31,786 --> 00:04:52,419\n非常敬佩我們委員這麼專業那個幾十年來的經驗告訴我們這些事情那我們當然會收集各國的資料那也會其實部長這樣這個就是在運作的時候我們大家都要有好好的一個共識跟這個資料的support一定跟專家一起來討論還有還有財務衝擊這還在第一句話財務衝擊老實說因為自從2007年11月開始有提供財務衝擊給專家們去討論新藥的時候\n\n14\n00:05:01,545 --> 00:05:22,850\n我從來沒看過健保署的評估資料跟這個廠商的評估資料或是專家學會的評估資料是一模一樣的而且差距甚至非常大超過一億的都有所以我向部長確認這裡的費用財務衝擊他不是申報費用對不對他是指如果這個病人假設他不用現在有的治療\n\n15\n00:05:23,850 --> 00:05:30,936\n他要去改用這個新的療法所額外增加來的費用,對嗎?是不是這個定義?財務衝擊是這個定義,這才叫財務衝擊,不是申報費用。那但是財務衝擊就是說,我剛剛講說,甘算得清楚?有真相嗎?\n\n16\n00:05:42,339 --> 00:06:05,881\n我要講的是說因為我從來搞不清新藥預算是怎麼算過去只編2、30億今年好像編的多一點60億那如果再看來明年要編的更多那我們都不知道新藥預算怎麼算說用的多少怎麼用這個搞不清楚因為計算很複雜非常的複雜那計算的方法也是有爭議的部長那這怎麼辦財務中局\n\n17\n00:06:08,323 --> 00:06:31,142\n報告委員因為這個財務風險評估的確是不太確定所以才會用暫時性支付這個主基礎的那個GDP成長一年可以調整十幾次你這裡不能調啊這裡就是很固定的就是這樣好我們再來看期成經費目前預估是每年100億所以我再確定一次這個100億是健保署的實際支出\n\n18\n00:06:32,903 --> 00:07:00,892\n還是醫院的申報費用我們都知道現在有所謂藥廠跟健保簽有所謂的價量協議跟這個所謂的這個支付協議應該是實際的支出實際支出因為這個差很大部長這定義差很大因為去年可能還了70億左右去年大概在前一年是50億在前一年是26億這跟百億都靠近了你如果定義不清楚就模糊了那部長您今天說是\n\n19\n00:07:02,272 --> 00:07:27,258\n實際支出實際支出好確定好再來請問健保屬2024年編列的新藥新科技預算有包含新藥新特產NGS還有暫時性支付大概六七十億剛剛你也報告了請問這兩塊區分的開嗎就是這個一百億跟這個區分的開嗎還是說你這個一百億存在了你這個原來的編列你就開始縮減了最後都混在一起了所以事實上這個百億基金並沒有提供百億事實上是打折扣的\n\n20\n00:07:28,058 --> 00:07:29,980\n百億基金應該就是設計在專款專用不會去影響到健保裡面的\n\n21\n00:07:36,156 --> 00:08:02,972\n但是原來就有編新科技嘛那現在又有個百億嘛所以我要確定這兩塊切得開嗎切得開嗎切得開啊切得開好但願如此好那財務推廣部分非常非常重要但是因為健保要永續嘛一定要控制那我再請教如果療效很好超過了比預估量還高或是超過所謂一個上限值因為這已經發生太多次了請問這個多出來的費用都要廠商依比例來提供嗎來分攤嗎就超過的東西你廠商的\n\n22\n00:08:05,754 --> 00:08:28,193\n部長你覺得這樣合理嗎?這個因為是參考英國的CancelDrugFund的一個制度那由廠商部長你應該知道醫院還會向廠商要求那個要價差啊我可不可以請教部長,您知道要價差有多少嗎?一年的要價差有多少嗎?要價差是這個百億基金的幾倍啊?\n\n23\n00:08:30,261 --> 00:08:36,686\n這個所謂的要價差就是說健保的合價跟我們做這個市場調查的醫院競價那這中間的差額以去年為例大概是在550億左右\n\n24\n00:08:48,055 --> 00:08:48,975\n請問會不會回到現況就是說他就不參加健保給付或留在自費市場\n\n25\n00:09:04,500 --> 00:09:28,582\n那現在就回到現在的狀況大家還是用不到藥啊因為這些都是來自所謂的突破創新都是來自國外的廠商他們有國際的價格要去某些程度的保障那現在怎麼避免呢那還是回到現況我預期他會回到現況這個百億基金會最後還是回到現況那沒關係這個部分不是這麼容易回答那個效益評估的部分效益評估包括這個納入給付之前跟之後\n\n26\n00:09:29,002 --> 00:09:29,563\n請問真實世界資料的品質如何呢可信嗎\n\n27\n00:09:45,171 --> 00:10:03,634\nRealworlddata你有沒有找真正的專家來處理這是一個非常嚴謹的科學我想我們所有任何的研究相關的計畫一定都找最適當的專家這個我再來討論而且CHPTA我覺得不應該under在健保屬下它是一個獨立超然的這個機構那請問這個100億是不是包括登錄系統維護系統或是檢測會在裡面就放在裡面嗎那最後一張請書記再給我一點點時間因為100億實在是很大的均額\n\n28\n00:10:14,317 --> 00:10:29,533\n那個健保署在公開對外務共理會很棒成員、利益迴避書、書面基調甚至這個所謂的錄音檔全部公開那我也希望外部部其他的委員會也可以效法部長尤其包括疫苗的部分好嗎抗病的部分都要公開透明的\n\n29\n00:10:32,914 --> 00:10:51,298\n財務衝擊預估現在有很大的空間其實對病人來說因為你現在叫衛福部你不只是衛生而已那如果說你這個醫療或非醫療你幫助小孩子回去上課幫助成人回到職場上班減輕家庭的照顧減少長照費資源的使用這個東西是不是應該納入醫療科技的評估裡面但是從來沒有醫療科技從2007年提供到現在還留在算數\n\n30\n00:10:58,419 --> 00:11:13,843\n多少病人多少錢取代哪個費用直接把它加減扣掉部長這個只有價格沒有價值的算法部長您同意嗎我比較希望用價值的算法最後不好意思最後一張這個是我個人統計因為台灣沒有其他人做這個統計我的統計癌症性要平均納保持癌藥這是要782天那我們因為沒有錢一直限縮所以我們的癌藥跟其他國家不一樣你要參考別的國家要小心\n\n31\n00:11:27,987 --> 00:11:50,363\n因為我們頂多只有三成的病人在裡面支付那要怎麼去接軌呢?怎麼用他們資料來做這個詮釋呢?那所以現在這個癌症的這個基金已經在眼前但是我覺得醫藥新科技暫時心己負的這個當然你剛剛提到說是劃分的開那這份基金很珍貴得來不易那我希望他要釐清很多點如果你不釐清的話你將來他的效益評估他的這個實際的這個成效\n\n32\n00:11:54,406 --> 00:11:54,526\n陳昭姿委員\n\n","tsv":"start\tend\ttext\n5409\t6236\t謝謝主席 有請邱部長請邱部長\n13805\t39853\t部長早安部長賴總統在大選期間提出了一系列的健康臺灣政策其中有包含百億癌藥基金今天我想就跟部長您一起來討論這個部分6月中有一場臺美合作的肺癌倡議的活動這個表格是健保署官方的資料我對這份資料裡面有很多的問題想請教部長首先就是部長這個預算是不是都編列了\n41905\t58473\t這個預算這筆預算是不是已經編列了?我們明年已經爭取了明年的公務預算明年的公務預算?因為今年是健保的今年嘛就是2025嘛就是114年這個百億基金您預計何時撥款?何時開始運作?可不可以有個參考日期?\n64797\t90722\t應該是明年初就可以開始2025年那我想再請教這個計畫是長久性的還是一年的計畫當然是長久性的那再來我想確定一下這個內涵就是有關這個基金的名稱跟這個用途賴總統說這個基金是讓癌症新藥使用正確嗎到底是癌症新藥還是新藥包含癌症新藥的所有新藥\n91854\t95497\t請問這個基金據說有個運作委員會 這個委員會組成了嗎 有沒有包括病友\n111724\t114866\t因為賴總統講了一句話他說2030年癌症死亡率要讓他減三分之一根據我的想法我在醫學背景我覺得這個願望非常的奢侈\n136081\t144406\t如果能夠降低三分之一在醫學上是一個突破所以我再來我想請教部長部長你知道每年癌症的死亡人數是多少\n145538\t148400\t總統的意思是說要把這個5萬降成3萬多嗎?你們有去了解嗎?因為他說要降低癌症死亡率三分之一啊\n168417\t171418\t醫療破解需要治療潛力,但臨床效益、債務衝擊評估等不確定的癌藥、新藥或新適應症。部長您覺得這個定義有清楚嗎?您讀起來清楚嗎?\n196014\t196595\t三個人的定位都不一樣\n219574\t243853\t所以我可以先告訴部長這個迫切需求這個大家各說各話好這是第一個第二個臨床效益如果指的是每讓病人多增加一個有品質的存活力所需要的額外費用那這個叫埃瑟茲沒有這個專業名詞那這個爭議更大了因為太高一定不給那低也不一定就給那因為我們過去整個對性要評估從來沒有將生活或生命的品質放在裡面\n244614\t269966\t所以我們事實上沒有資料我們一直都留在價格的部分沒有價值部分那請教部長專家沒有資料而且也沒有人了解你如何去聘專家來做這件事呢還有你要用國外的資料嗎那國外的資料因為我們的癌症過去的幾副都是限縮的我們不像其他國家就是用到能夠比疾病再進展那可以用國外的資料嗎這個臨床效益部分您覺得清楚嗎\n271786\t292419\t非常敬佩我們委員這麼專業那個幾十年來的經驗告訴我們這些事情那我們當然會收集各國的資料那也會其實部長這樣這個就是在運作的時候我們大家都要有好好的一個共識跟這個資料的support一定跟專家一起來討論還有還有財務衝擊這還在第一句話財務衝擊老實說因為自從2007年11月開始有提供財務衝擊給專家們去討論新藥的時候\n301545\t322850\t我從來沒看過健保署的評估資料跟這個廠商的評估資料或是專家學會的評估資料是一模一樣的而且差距甚至非常大超過一億的都有所以我向部長確認這裡的費用財務衝擊他不是申報費用對不對他是指如果這個病人假設他不用現在有的治療\n323850\t330936\t他要去改用這個新的療法所額外增加來的費用,對嗎?是不是這個定義?財務衝擊是這個定義,這才叫財務衝擊,不是申報費用。那但是財務衝擊就是說,我剛剛講說,甘算得清楚?有真相嗎?\n342339\t365881\t我要講的是說因為我從來搞不清新藥預算是怎麼算過去只編2、30億今年好像編的多一點60億那如果再看來明年要編的更多那我們都不知道新藥預算怎麼算說用的多少怎麼用這個搞不清楚因為計算很複雜非常的複雜那計算的方法也是有爭議的部長那這怎麼辦財務中局\n368323\t391142\t報告委員因為這個財務風險評估的確是不太確定所以才會用暫時性支付這個主基礎的那個GDP成長一年可以調整十幾次你這裡不能調啊這裡就是很固定的就是這樣好我們再來看期成經費目前預估是每年100億所以我再確定一次這個100億是健保署的實際支出\n392903\t420892\t還是醫院的申報費用我們都知道現在有所謂藥廠跟健保簽有所謂的價量協議跟這個所謂的這個支付協議應該是實際的支出實際支出因為這個差很大部長這定義差很大因為去年可能還了70億左右去年大概在前一年是50億在前一年是26億這跟百億都靠近了你如果定義不清楚就模糊了那部長您今天說是\n422272\t447258\t實際支出實際支出好確定好再來請問健保屬2024年編列的新藥新科技預算有包含新藥新特產NGS還有暫時性支付大概六七十億剛剛你也報告了請問這兩塊區分的開嗎就是這個一百億跟這個區分的開嗎還是說你這個一百億存在了你這個原來的編列你就開始縮減了最後都混在一起了所以事實上這個百億基金並沒有提供百億事實上是打折扣的\n448058\t449980\t百億基金應該就是設計在專款專用不會去影響到健保裡面的\n456156\t482972\t但是原來就有編新科技嘛那現在又有個百億嘛所以我要確定這兩塊切得開嗎切得開嗎切得開啊切得開好但願如此好那財務推廣部分非常非常重要但是因為健保要永續嘛一定要控制那我再請教如果療效很好超過了比預估量還高或是超過所謂一個上限值因為這已經發生太多次了請問這個多出來的費用都要廠商依比例來提供嗎來分攤嗎就超過的東西你廠商的\n485754\t508193\t部長你覺得這樣合理嗎?這個因為是參考英國的Cancel Drug Fund的一個制度那由廠商部長你應該知道醫院還會向廠商要求那個要價差啊我可不可以請教部長,您知道要價差有多少嗎?一年的要價差有多少嗎?要價差是這個百億基金的幾倍啊?\n510261\t516686\t這個所謂的要價差就是說健保的合價跟我們做這個市場調查的醫院競價那這中間的差額以去年為例大概是在550億左右\n528055\t528975\t請問會不會回到現況就是說他就不參加健保給付或留在自費市場\n544500\t568582\t那現在就回到現在的狀況大家還是用不到藥啊因為這些都是來自所謂的突破創新都是來自國外的廠商他們有國際的價格要去某些程度的保障那現在怎麼避免呢那還是回到現況我預期他會回到現況這個百億基金會最後還是回到現況那沒關係這個部分不是這麼容易回答那個效益評估的部分效益評估包括這個納入給付之前跟之後\n569002\t569563\t請問真實世界資料的品質如何呢可信嗎\n585171\t603634\tReal world data你有沒有找真正的專家來處理這是一個非常嚴謹的科學我想我們所有任何的研究相關的計畫一定都找最適當的專家這個我再來討論而且CHPTA我覺得不應該under在健保屬下它是一個獨立超然的這個機構那請問這個100億是不是包括登錄系統維護系統或是檢測會在裡面就放在裡面嗎那最後一張請書記再給我一點點時間因為100億實在是很大的均額\n614317\t629533\t那個健保署在公開對外務共理會很棒成員、利益迴避書、書面基調甚至這個所謂的錄音檔全部公開那我也希望外部部其他的委員會也可以效法部長尤其包括疫苗的部分好嗎抗病的部分都要公開透明的\n632914\t651298\t財務衝擊預估現在有很大的空間其實對病人來說因為你現在叫衛福部你不只是衛生而已那如果說你這個醫療或非醫療你幫助小孩子回去上課幫助成人回到職場上班減輕家庭的照顧減少長照費資源的使用這個東西是不是應該納入醫療科技的評估裡面但是從來沒有醫療科技從2007年提供到現在還留在算數\n658419\t673843\t多少病人多少錢取代哪個費用直接把它加減扣掉部長這個只有價格沒有價值的算法部長您同意嗎我比較希望用價值的算法最後不好意思最後一張這個是我個人統計因為台灣沒有其他人做這個統計我的統計癌症性要平均納保持癌藥這是要782天那我們因為沒有錢一直限縮所以我們的癌藥跟其他國家不一樣你要參考別的國家要小心\n687987\t710363\t因為我們頂多只有三成的病人在裡面支付那要怎麼去接軌呢?怎麼用他們資料來做這個詮釋呢?那所以現在這個癌症的這個基金已經在眼前但是我覺得醫藥新科技暫時心己負的這個當然你剛剛提到說是劃分的開那這份基金很珍貴得來不易那我希望他要釐清很多點如果你不釐清的話你將來他的效益評估他的這個實際的這個成效\n714406\t714526\t陳昭姿委員\n","txt":"謝謝主席 有請邱部長請邱部長\n部長早安部長賴總統在大選期間提出了一系列的健康臺灣政策其中有包含百億癌藥基金今天我想就跟部長您一起來討論這個部分6月中有一場臺美合作的肺癌倡議的活動這個表格是健保署官方的資料我對這份資料裡面有很多的問題想請教部長首先就是部長這個預算是不是都編列了\n這個預算這筆預算是不是已經編列了?我們明年已經爭取了明年的公務預算明年的公務預算?因為今年是健保的今年嘛就是2025嘛就是114年這個百億基金您預計何時撥款?何時開始運作?可不可以有個參考日期?\n應該是明年初就可以開始2025年那我想再請教這個計畫是長久性的還是一年的計畫當然是長久性的那再來我想確定一下這個內涵就是有關這個基金的名稱跟這個用途賴總統說這個基金是讓癌症新藥使用正確嗎到底是癌症新藥還是新藥包含癌症新藥的所有新藥\n請問這個基金據說有個運作委員會 這個委員會組成了嗎 有沒有包括病友\n因為賴總統講了一句話他說2030年癌症死亡率要讓他減三分之一根據我的想法我在醫學背景我覺得這個願望非常的奢侈\n如果能夠降低三分之一在醫學上是一個突破所以我再來我想請教部長部長你知道每年癌症的死亡人數是多少\n總統的意思是說要把這個5萬降成3萬多嗎?你們有去了解嗎?因為他說要降低癌症死亡率三分之一啊\n醫療破解需要治療潛力,但臨床效益、債務衝擊評估等不確定的癌藥、新藥或新適應症。部長您覺得這個定義有清楚嗎?您讀起來清楚嗎?\n三個人的定位都不一樣\n所以我可以先告訴部長這個迫切需求這個大家各說各話好這是第一個第二個臨床效益如果指的是每讓病人多增加一個有品質的存活力所需要的額外費用那這個叫埃瑟茲沒有這個專業名詞那這個爭議更大了因為太高一定不給那低也不一定就給那因為我們過去整個對性要評估從來沒有將生活或生命的品質放在裡面\n所以我們事實上沒有資料我們一直都留在價格的部分沒有價值部分那請教部長專家沒有資料而且也沒有人了解你如何去聘專家來做這件事呢還有你要用國外的資料嗎那國外的資料因為我們的癌症過去的幾副都是限縮的我們不像其他國家就是用到能夠比疾病再進展那可以用國外的資料嗎這個臨床效益部分您覺得清楚嗎\n非常敬佩我們委員這麼專業那個幾十年來的經驗告訴我們這些事情那我們當然會收集各國的資料那也會其實部長這樣這個就是在運作的時候我們大家都要有好好的一個共識跟這個資料的support一定跟專家一起來討論還有還有財務衝擊這還在第一句話財務衝擊老實說因為自從2007年11月開始有提供財務衝擊給專家們去討論新藥的時候\n我從來沒看過健保署的評估資料跟這個廠商的評估資料或是專家學會的評估資料是一模一樣的而且差距甚至非常大超過一億的都有所以我向部長確認這裡的費用財務衝擊他不是申報費用對不對他是指如果這個病人假設他不用現在有的治療\n他要去改用這個新的療法所額外增加來的費用,對嗎?是不是這個定義?財務衝擊是這個定義,這才叫財務衝擊,不是申報費用。那但是財務衝擊就是說,我剛剛講說,甘算得清楚?有真相嗎?\n我要講的是說因為我從來搞不清新藥預算是怎麼算過去只編2、30億今年好像編的多一點60億那如果再看來明年要編的更多那我們都不知道新藥預算怎麼算說用的多少怎麼用這個搞不清楚因為計算很複雜非常的複雜那計算的方法也是有爭議的部長那這怎麼辦財務中局\n報告委員因為這個財務風險評估的確是不太確定所以才會用暫時性支付這個主基礎的那個GDP成長一年可以調整十幾次你這裡不能調啊這裡就是很固定的就是這樣好我們再來看期成經費目前預估是每年100億所以我再確定一次這個100億是健保署的實際支出\n還是醫院的申報費用我們都知道現在有所謂藥廠跟健保簽有所謂的價量協議跟這個所謂的這個支付協議應該是實際的支出實際支出因為這個差很大部長這定義差很大因為去年可能還了70億左右去年大概在前一年是50億在前一年是26億這跟百億都靠近了你如果定義不清楚就模糊了那部長您今天說是\n實際支出實際支出好確定好再來請問健保屬2024年編列的新藥新科技預算有包含新藥新特產NGS還有暫時性支付大概六七十億剛剛你也報告了請問這兩塊區分的開嗎就是這個一百億跟這個區分的開嗎還是說你這個一百億存在了你這個原來的編列你就開始縮減了最後都混在一起了所以事實上這個百億基金並沒有提供百億事實上是打折扣的\n百億基金應該就是設計在專款專用不會去影響到健保裡面的\n但是原來就有編新科技嘛那現在又有個百億嘛所以我要確定這兩塊切得開嗎切得開嗎切得開啊切得開好但願如此好那財務推廣部分非常非常重要但是因為健保要永續嘛一定要控制那我再請教如果療效很好超過了比預估量還高或是超過所謂一個上限值因為這已經發生太多次了請問這個多出來的費用都要廠商依比例來提供嗎來分攤嗎就超過的東西你廠商的\n部長你覺得這樣合理嗎?這個因為是參考英國的Cancel Drug Fund的一個制度那由廠商部長你應該知道醫院還會向廠商要求那個要價差啊我可不可以請教部長,您知道要價差有多少嗎?一年的要價差有多少嗎?要價差是這個百億基金的幾倍啊?\n這個所謂的要價差就是說健保的合價跟我們做這個市場調查的醫院競價那這中間的差額以去年為例大概是在550億左右\n請問會不會回到現況就是說他就不參加健保給付或留在自費市場\n那現在就回到現在的狀況大家還是用不到藥啊因為這些都是來自所謂的突破創新都是來自國外的廠商他們有國際的價格要去某些程度的保障那現在怎麼避免呢那還是回到現況我預期他會回到現況這個百億基金會最後還是回到現況那沒關係這個部分不是這麼容易回答那個效益評估的部分效益評估包括這個納入給付之前跟之後\n請問真實世界資料的品質如何呢可信嗎\nReal world data你有沒有找真正的專家來處理這是一個非常嚴謹的科學我想我們所有任何的研究相關的計畫一定都找最適當的專家這個我再來討論而且CHPTA我覺得不應該under在健保屬下它是一個獨立超然的這個機構那請問這個100億是不是包括登錄系統維護系統或是檢測會在裡面就放在裡面嗎那最後一張請書記再給我一點點時間因為100億實在是很大的均額\n那個健保署在公開對外務共理會很棒成員、利益迴避書、書面基調甚至這個所謂的錄音檔全部公開那我也希望外部部其他的委員會也可以效法部長尤其包括疫苗的部分好嗎抗病的部分都要公開透明的\n財務衝擊預估現在有很大的空間其實對病人來說因為你現在叫衛福部你不只是衛生而已那如果說你這個醫療或非醫療你幫助小孩子回去上課幫助成人回到職場上班減輕家庭的照顧減少長照費資源的使用這個東西是不是應該納入醫療科技的評估裡面但是從來沒有醫療科技從2007年提供到現在還留在算數\n多少病人多少錢取代哪個費用直接把它加減扣掉部長這個只有價格沒有價值的算法部長您同意嗎我比較希望用價值的算法最後不好意思最後一張這個是我個人統計因為台灣沒有其他人做這個統計我的統計癌症性要平均納保持癌藥這是要782天那我們因為沒有錢一直限縮所以我們的癌藥跟其他國家不一樣你要參考別的國家要小心\n因為我們頂多只有三成的病人在裡面支付那要怎麼去接軌呢?怎麼用他們資料來做這個詮釋呢?那所以現在這個癌症的這個基金已經在眼前但是我覺得醫藥新科技暫時心己負的這個當然你剛剛提到說是劃分的開那這份基金很珍貴得來不易那我希望他要釐清很多點如果你不釐清的話你將來他的效益評估他的這個實際的這個成效\n陳昭姿委員\n","vtt":"WEBVTT\n\n00:05.409 --> 00:06.236\n謝謝主席有請邱部長請邱部長\n\n00:13.805 --> 00:39.853\n部長早安部長賴總統在大選期間提出了一系列的健康臺灣政策其中有包含百億癌藥基金今天我想就跟部長您一起來討論這個部分6月中有一場臺美合作的肺癌倡議的活動這個表格是健保署官方的資料我對這份資料裡面有很多的問題想請教部長首先就是部長這個預算是不是都編列了\n\n00:41.905 --> 00:58.473\n這個預算這筆預算是不是已經編列了?我們明年已經爭取了明年的公務預算明年的公務預算?因為今年是健保的今年嘛就是2025嘛就是114年這個百億基金您預計何時撥款?何時開始運作?可不可以有個參考日期?\n\n01:04.797 --> 01:30.722\n應該是明年初就可以開始2025年那我想再請教這個計畫是長久性的還是一年的計畫當然是長久性的那再來我想確定一下這個內涵就是有關這個基金的名稱跟這個用途賴總統說這個基金是讓癌症新藥使用正確嗎到底是癌症新藥還是新藥包含癌症新藥的所有新藥\n\n01:31.854 --> 01:35.497\n請問這個基金據說有個運作委員會這個委員會組成了嗎有沒有包括病友\n\n01:51.724 --> 01:54.866\n因為賴總統講了一句話他說2030年癌症死亡率要讓他減三分之一根據我的想法我在醫學背景我覺得這個願望非常的奢侈\n\n02:16.081 --> 02:24.406\n如果能夠降低三分之一在醫學上是一個突破所以我再來我想請教部長部長你知道每年癌症的死亡人數是多少\n\n02:25.538 --> 02:28.400\n總統的意思是說要把這個5萬降成3萬多嗎?你們有去了解嗎?因為他說要降低癌症死亡率三分之一啊\n\n02:48.417 --> 02:51.418\n醫療破解需要治療潛力,但臨床效益、債務衝擊評估等不確定的癌藥、新藥或新適應症。部長您覺得這個定義有清楚嗎?您讀起來清楚嗎?\n\n03:16.014 --> 03:16.595\n三個人的定位都不一樣\n\n03:39.574 --> 04:03.853\n所以我可以先告訴部長這個迫切需求這個大家各說各話好這是第一個第二個臨床效益如果指的是每讓病人多增加一個有品質的存活力所需要的額外費用那這個叫埃瑟茲沒有這個專業名詞那這個爭議更大了因為太高一定不給那低也不一定就給那因為我們過去整個對性要評估從來沒有將生活或生命的品質放在裡面\n\n04:04.614 --> 04:29.966\n所以我們事實上沒有資料我們一直都留在價格的部分沒有價值部分那請教部長專家沒有資料而且也沒有人了解你如何去聘專家來做這件事呢還有你要用國外的資料嗎那國外的資料因為我們的癌症過去的幾副都是限縮的我們不像其他國家就是用到能夠比疾病再進展那可以用國外的資料嗎這個臨床效益部分您覺得清楚嗎\n\n04:31.786 --> 04:52.419\n非常敬佩我們委員這麼專業那個幾十年來的經驗告訴我們這些事情那我們當然會收集各國的資料那也會其實部長這樣這個就是在運作的時候我們大家都要有好好的一個共識跟這個資料的support一定跟專家一起來討論還有還有財務衝擊這還在第一句話財務衝擊老實說因為自從2007年11月開始有提供財務衝擊給專家們去討論新藥的時候\n\n05:01.545 --> 05:22.850\n我從來沒看過健保署的評估資料跟這個廠商的評估資料或是專家學會的評估資料是一模一樣的而且差距甚至非常大超過一億的都有所以我向部長確認這裡的費用財務衝擊他不是申報費用對不對他是指如果這個病人假設他不用現在有的治療\n\n05:23.850 --> 05:30.936\n他要去改用這個新的療法所額外增加來的費用,對嗎?是不是這個定義?財務衝擊是這個定義,這才叫財務衝擊,不是申報費用。那但是財務衝擊就是說,我剛剛講說,甘算得清楚?有真相嗎?\n\n05:42.339 --> 06:05.881\n我要講的是說因為我從來搞不清新藥預算是怎麼算過去只編2、30億今年好像編的多一點60億那如果再看來明年要編的更多那我們都不知道新藥預算怎麼算說用的多少怎麼用這個搞不清楚因為計算很複雜非常的複雜那計算的方法也是有爭議的部長那這怎麼辦財務中局\n\n06:08.323 --> 06:31.142\n報告委員因為這個財務風險評估的確是不太確定所以才會用暫時性支付這個主基礎的那個GDP成長一年可以調整十幾次你這裡不能調啊這裡就是很固定的就是這樣好我們再來看期成經費目前預估是每年100億所以我再確定一次這個100億是健保署的實際支出\n\n06:32.903 --> 07:00.892\n還是醫院的申報費用我們都知道現在有所謂藥廠跟健保簽有所謂的價量協議跟這個所謂的這個支付協議應該是實際的支出實際支出因為這個差很大部長這定義差很大因為去年可能還了70億左右去年大概在前一年是50億在前一年是26億這跟百億都靠近了你如果定義不清楚就模糊了那部長您今天說是\n\n07:02.272 --> 07:27.258\n實際支出實際支出好確定好再來請問健保屬2024年編列的新藥新科技預算有包含新藥新特產NGS還有暫時性支付大概六七十億剛剛你也報告了請問這兩塊區分的開嗎就是這個一百億跟這個區分的開嗎還是說你這個一百億存在了你這個原來的編列你就開始縮減了最後都混在一起了所以事實上這個百億基金並沒有提供百億事實上是打折扣的\n\n07:28.058 --> 07:29.980\n百億基金應該就是設計在專款專用不會去影響到健保裡面的\n\n07:36.156 --> 08:02.972\n但是原來就有編新科技嘛那現在又有個百億嘛所以我要確定這兩塊切得開嗎切得開嗎切得開啊切得開好但願如此好那財務推廣部分非常非常重要但是因為健保要永續嘛一定要控制那我再請教如果療效很好超過了比預估量還高或是超過所謂一個上限值因為這已經發生太多次了請問這個多出來的費用都要廠商依比例來提供嗎來分攤嗎就超過的東西你廠商的\n\n08:05.754 --> 08:28.193\n部長你覺得這樣合理嗎?這個因為是參考英國的CancelDrugFund的一個制度那由廠商部長你應該知道醫院還會向廠商要求那個要價差啊我可不可以請教部長,您知道要價差有多少嗎?一年的要價差有多少嗎?要價差是這個百億基金的幾倍啊?\n\n08:30.261 --> 08:36.686\n這個所謂的要價差就是說健保的合價跟我們做這個市場調查的醫院競價那這中間的差額以去年為例大概是在550億左右\n\n08:48.055 --> 08:48.975\n請問會不會回到現況就是說他就不參加健保給付或留在自費市場\n\n09:04.500 --> 09:28.582\n那現在就回到現在的狀況大家還是用不到藥啊因為這些都是來自所謂的突破創新都是來自國外的廠商他們有國際的價格要去某些程度的保障那現在怎麼避免呢那還是回到現況我預期他會回到現況這個百億基金會最後還是回到現況那沒關係這個部分不是這麼容易回答那個效益評估的部分效益評估包括這個納入給付之前跟之後\n\n09:29.002 --> 09:29.563\n請問真實世界資料的品質如何呢可信嗎\n\n09:45.171 --> 10:03.634\nRealworlddata你有沒有找真正的專家來處理這是一個非常嚴謹的科學我想我們所有任何的研究相關的計畫一定都找最適當的專家這個我再來討論而且CHPTA我覺得不應該under在健保屬下它是一個獨立超然的這個機構那請問這個100億是不是包括登錄系統維護系統或是檢測會在裡面就放在裡面嗎那最後一張請書記再給我一點點時間因為100億實在是很大的均額\n\n10:14.317 --> 10:29.533\n那個健保署在公開對外務共理會很棒成員、利益迴避書、書面基調甚至這個所謂的錄音檔全部公開那我也希望外部部其他的委員會也可以效法部長尤其包括疫苗的部分好嗎抗病的部分都要公開透明的\n\n10:32.914 --> 10:51.298\n財務衝擊預估現在有很大的空間其實對病人來說因為你現在叫衛福部你不只是衛生而已那如果說你這個醫療或非醫療你幫助小孩子回去上課幫助成人回到職場上班減輕家庭的照顧減少長照費資源的使用這個東西是不是應該納入醫療科技的評估裡面但是從來沒有醫療科技從2007年提供到現在還留在算數\n\n10:58.419 --> 11:13.843\n多少病人多少錢取代哪個費用直接把它加減扣掉部長這個只有價格沒有價值的算法部長您同意嗎我比較希望用價值的算法最後不好意思最後一張這個是我個人統計因為台灣沒有其他人做這個統計我的統計癌症性要平均納保持癌藥這是要782天那我們因為沒有錢一直限縮所以我們的癌藥跟其他國家不一樣你要參考別的國家要小心\n\n11:27.987 --> 11:50.363\n因為我們頂多只有三成的病人在裡面支付那要怎麼去接軌呢?怎麼用他們資料來做這個詮釋呢?那所以現在這個癌症的這個基金已經在眼前但是我覺得醫藥新科技暫時心己負的這個當然你剛剛提到說是劃分的開那這份基金很珍貴得來不易那我希望他要釐清很多點如果你不釐清的話你將來他的效益評估他的這個實際的這個成效\n\n11:54.406 --> 11:54.526\n陳昭姿委員\n\n","segments":[{"start":5.409,"end":6.236,"text":"謝謝主席 有請邱部長請邱部長"},{"start":13.805,"end":39.853,"text":"部長早安部長賴總統在大選期間提出了一系列的健康臺灣政策其中有包含百億癌藥基金今天我想就跟部長您一起來討論這個部分6月中有一場臺美合作的肺癌倡議的活動這個表格是健保署官方的資料我對這份資料裡面有很多的問題想請教部長首先就是部長這個預算是不是都編列了"},{"start":41.905,"end":58.473,"text":"這個預算這筆預算是不是已經編列了?我們明年已經爭取了明年的公務預算明年的公務預算?因為今年是健保的今年嘛就是2025嘛就是114年這個百億基金您預計何時撥款?何時開始運作?可不可以有個參考日期?"},{"start":64.797,"end":90.722,"text":"應該是明年初就可以開始2025年那我想再請教這個計畫是長久性的還是一年的計畫當然是長久性的那再來我想確定一下這個內涵就是有關這個基金的名稱跟這個用途賴總統說這個基金是讓癌症新藥使用正確嗎到底是癌症新藥還是新藥包含癌症新藥的所有新藥"},{"start":91.854,"end":95.497,"text":"請問這個基金據說有個運作委員會 這個委員會組成了嗎 有沒有包括病友"},{"start":111.724,"end":114.866,"text":"因為賴總統講了一句話他說2030年癌症死亡率要讓他減三分之一根據我的想法我在醫學背景我覺得這個願望非常的奢侈"},{"start":136.081,"end":144.406,"text":"如果能夠降低三分之一在醫學上是一個突破所以我再來我想請教部長部長你知道每年癌症的死亡人數是多少"},{"start":145.538,"end":148.4,"text":"總統的意思是說要把這個5萬降成3萬多嗎?你們有去了解嗎?因為他說要降低癌症死亡率三分之一啊"},{"start":168.417,"end":171.418,"text":"醫療破解需要治療潛力,但臨床效益、債務衝擊評估等不確定的癌藥、新藥或新適應症。部長您覺得這個定義有清楚嗎?您讀起來清楚嗎?"},{"start":196.014,"end":196.595,"text":"三個人的定位都不一樣"},{"start":219.574,"end":243.853,"text":"所以我可以先告訴部長這個迫切需求這個大家各說各話好這是第一個第二個臨床效益如果指的是每讓病人多增加一個有品質的存活力所需要的額外費用那這個叫埃瑟茲沒有這個專業名詞那這個爭議更大了因為太高一定不給那低也不一定就給那因為我們過去整個對性要評估從來沒有將生活或生命的品質放在裡面"},{"start":244.614,"end":269.966,"text":"所以我們事實上沒有資料我們一直都留在價格的部分沒有價值部分那請教部長專家沒有資料而且也沒有人了解你如何去聘專家來做這件事呢還有你要用國外的資料嗎那國外的資料因為我們的癌症過去的幾副都是限縮的我們不像其他國家就是用到能夠比疾病再進展那可以用國外的資料嗎這個臨床效益部分您覺得清楚嗎"},{"start":271.786,"end":292.419,"text":"非常敬佩我們委員這麼專業那個幾十年來的經驗告訴我們這些事情那我們當然會收集各國的資料那也會其實部長這樣這個就是在運作的時候我們大家都要有好好的一個共識跟這個資料的support一定跟專家一起來討論還有還有財務衝擊這還在第一句話財務衝擊老實說因為自從2007年11月開始有提供財務衝擊給專家們去討論新藥的時候"},{"start":301.545,"end":322.85,"text":"我從來沒看過健保署的評估資料跟這個廠商的評估資料或是專家學會的評估資料是一模一樣的而且差距甚至非常大超過一億的都有所以我向部長確認這裡的費用財務衝擊他不是申報費用對不對他是指如果這個病人假設他不用現在有的治療"},{"start":323.85,"end":330.936,"text":"他要去改用這個新的療法所額外增加來的費用,對嗎?是不是這個定義?財務衝擊是這個定義,這才叫財務衝擊,不是申報費用。那但是財務衝擊就是說,我剛剛講說,甘算得清楚?有真相嗎?"},{"start":342.339,"end":365.881,"text":"我要講的是說因為我從來搞不清新藥預算是怎麼算過去只編2、30億今年好像編的多一點60億那如果再看來明年要編的更多那我們都不知道新藥預算怎麼算說用的多少怎麼用這個搞不清楚因為計算很複雜非常的複雜那計算的方法也是有爭議的部長那這怎麼辦財務中局"},{"start":368.323,"end":391.142,"text":"報告委員因為這個財務風險評估的確是不太確定所以才會用暫時性支付這個主基礎的那個GDP成長一年可以調整十幾次你這裡不能調啊這裡就是很固定的就是這樣好我們再來看期成經費目前預估是每年100億所以我再確定一次這個100億是健保署的實際支出"},{"start":392.903,"end":420.892,"text":"還是醫院的申報費用我們都知道現在有所謂藥廠跟健保簽有所謂的價量協議跟這個所謂的這個支付協議應該是實際的支出實際支出因為這個差很大部長這定義差很大因為去年可能還了70億左右去年大概在前一年是50億在前一年是26億這跟百億都靠近了你如果定義不清楚就模糊了那部長您今天說是"},{"start":422.272,"end":447.258,"text":"實際支出實際支出好確定好再來請問健保屬2024年編列的新藥新科技預算有包含新藥新特產NGS還有暫時性支付大概六七十億剛剛你也報告了請問這兩塊區分的開嗎就是這個一百億跟這個區分的開嗎還是說你這個一百億存在了你這個原來的編列你就開始縮減了最後都混在一起了所以事實上這個百億基金並沒有提供百億事實上是打折扣的"},{"start":448.058,"end":449.98,"text":"百億基金應該就是設計在專款專用不會去影響到健保裡面的"},{"start":456.156,"end":482.972,"text":"但是原來就有編新科技嘛那現在又有個百億嘛所以我要確定這兩塊切得開嗎切得開嗎切得開啊切得開好但願如此好那財務推廣部分非常非常重要但是因為健保要永續嘛一定要控制那我再請教如果療效很好超過了比預估量還高或是超過所謂一個上限值因為這已經發生太多次了請問這個多出來的費用都要廠商依比例來提供嗎來分攤嗎就超過的東西你廠商的"},{"start":485.754,"end":508.193,"text":"部長你覺得這樣合理嗎?這個因為是參考英國的Cancel Drug Fund的一個制度那由廠商部長你應該知道醫院還會向廠商要求那個要價差啊我可不可以請教部長,您知道要價差有多少嗎?一年的要價差有多少嗎?要價差是這個百億基金的幾倍啊?"},{"start":510.261,"end":516.686,"text":"這個所謂的要價差就是說健保的合價跟我們做這個市場調查的醫院競價那這中間的差額以去年為例大概是在550億左右"},{"start":528.055,"end":528.975,"text":"請問會不會回到現況就是說他就不參加健保給付或留在自費市場"},{"start":544.5,"end":568.582,"text":"那現在就回到現在的狀況大家還是用不到藥啊因為這些都是來自所謂的突破創新都是來自國外的廠商他們有國際的價格要去某些程度的保障那現在怎麼避免呢那還是回到現況我預期他會回到現況這個百億基金會最後還是回到現況那沒關係這個部分不是這麼容易回答那個效益評估的部分效益評估包括這個納入給付之前跟之後"},{"start":569.002,"end":569.563,"text":"請問真實世界資料的品質如何呢可信嗎"},{"start":585.171,"end":603.634,"text":"Real world data你有沒有找真正的專家來處理這是一個非常嚴謹的科學我想我們所有任何的研究相關的計畫一定都找最適當的專家這個我再來討論而且CHPTA我覺得不應該under在健保屬下它是一個獨立超然的這個機構那請問這個100億是不是包括登錄系統維護系統或是檢測會在裡面就放在裡面嗎那最後一張請書記再給我一點點時間因為100億實在是很大的均額"},{"start":614.317,"end":629.533,"text":"那個健保署在公開對外務共理會很棒成員、利益迴避書、書面基調甚至這個所謂的錄音檔全部公開那我也希望外部部其他的委員會也可以效法部長尤其包括疫苗的部分好嗎抗病的部分都要公開透明的"},{"start":632.914,"end":651.298,"text":"財務衝擊預估現在有很大的空間其實對病人來說因為你現在叫衛福部你不只是衛生而已那如果說你這個醫療或非醫療你幫助小孩子回去上課幫助成人回到職場上班減輕家庭的照顧減少長照費資源的使用這個東西是不是應該納入醫療科技的評估裡面但是從來沒有醫療科技從2007年提供到現在還留在算數"},{"start":658.419,"end":673.843,"text":"多少病人多少錢取代哪個費用直接把它加減扣掉部長這個只有價格沒有價值的算法部長您同意嗎我比較希望用價值的算法最後不好意思最後一張這個是我個人統計因為台灣沒有其他人做這個統計我的統計癌症性要平均納保持癌藥這是要782天那我們因為沒有錢一直限縮所以我們的癌藥跟其他國家不一樣你要參考別的國家要小心"},{"start":687.987,"end":710.363,"text":"因為我們頂多只有三成的病人在裡面支付那要怎麼去接軌呢?怎麼用他們資料來做這個詮釋呢?那所以現在這個癌症的這個基金已經在眼前但是我覺得醫藥新科技暫時心己負的這個當然你剛剛提到說是劃分的開那這份基金很珍貴得來不易那我希望他要釐清很多點如果你不釐清的話你將來他的效益評估他的這個實際的這個成效"},{"start":714.406,"end":714.526,"text":"陳昭姿委員"}]}}}}