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\"題\"}]}, {\"start\": 101.976, \"end\": 129.518, \"text\": \"是這部分有沒有國政署有沒有要跟我們幫忙說明一下跟委員報告齁那目前這個修法草案的設計代孕是以無償的方式去進行的就是禁止商業代孕那習慣有一些相關費用的部分那這個部分我們在如果未來修法通過之後我們還跟相關的專家去做相關的嚴定跟所以目前是還沒有考慮到這些事情等於是細節上還沒有考還沒有還沒有一個比較明確的\", \"words\": [{\"word\": \"是\", \"start\": 101.976, \"end\": 102.116, \"score\": 0.857}, {\"word\": \"這\"}, {\"word\": \"部\", \"start\": 102.116, \"end\": 102.196, \"score\": 0.783}, {\"word\": \"分\", \"start\": 102.196, \"end\": 102.256, \"score\": 0.664}, {\"word\": \"有\", \"start\": 102.256, \"end\": 102.356, \"score\": 0.809}, {\"word\": \"沒\", \"start\": 102.356, \"end\": 102.596, \"score\": 0.912}, {\"word\": \"有\", \"start\": 102.596, \"end\": 102.716, \"score\": 0.833}, {\"word\": \"國\"}, {\"word\": \"政\", \"start\": 102.716, \"end\": 102.857, \"score\": 0.861}, {\"word\": \"署\", \"start\": 102.857, \"end\": 102.997, \"score\": 0.856}, {\"word\": \"有\", \"start\": 102.997, \"end\": 103.077, \"score\": 0.754}, {\"word\": \"沒\", \"start\": 103.077, \"end\": 103.197, 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00:01:29,629\n我想這個就是一直大家所關注的所以我想問一下說目前你們評估的狀況跟要怎麼做我們現在訂出來的標準其實雖然目前還在做討論研議當中但是我們初步來看他訂出來的都是非常保護母體母親就是懷孕\n\n5\n00:01:30,370 --> 00:01:39,976\n所以你目前覺得說那怎麼確保他的這個自主權跟他營養費上限是否有足夠那會不會出現商業化漏洞這三個問題\n\n6\n00:01:41,976 --> 00:02:09,518\n是這部分有沒有國政署有沒有要跟我們幫忙說明一下跟委員報告齁那目前這個修法草案的設計代孕是以無償的方式去進行的就是禁止商業代孕那習慣有一些相關費用的部分那這個部分我們在如果未來修法通過之後我們還跟相關的專家去做相關的嚴定跟所以目前是還沒有考慮到這些事情等於是細節上還沒有考還沒有還沒有一個比較明確的\n\n7\n00:02:10,902 --> 00:02:15,446\n那你覺得這部分會不會出現商業漏洞?商業化的漏洞?我想剛剛部長也談到我們還是以這個代理母的保護當作優先。我們會盡量去做這個比較周全的考量。\n\n8\n00:02:36,311 --> 00:02:39,094\n好再來那如果代孕過程中出現這個醫療風險或法規爭議的話我們衛福部會如何處理跟調解\n\n9\n00:02:45,597 --> 00:03:09,790\n我講現在草案設計師要求這個待運的部分有進行相關的評估那也有待運服務機構的機制設計在裡面那就是包括剛提到法律的部分那另外也要投保這個人身保險跟這個健康保險那假設有這個相關的部分在保險上面也能夠獲得給付那這整個懷孕過程那如果有這個\n\n10\n00:03:12,092 --> 00:03:33,707\n這個法規規定需要進行這個人工流產的部分那也可以照這個相關法令來做辦理目前草案的設計是這個樣子所以這目前裡面草案都有具體的設計好那再來我想問一下接下來就是回到今天的主題根據這個衛福部自己統計的資料這三年的自殺人數節節攀升\n\n11\n00:03:36,289 --> 00:03:49,017\n那其實剛好也是社安網第二期施行的年份等於是社安網二期編列預算後反倒成果越來越差我想要請教一下部長你覺得這次預算不夠還是執行不彰導致效果不好\n\n12\n00:03:52,215 --> 00:04:16,746\n因為從自殺防治中心開始的時候我就是其中裡面的一個一員所以我們就知道大家的努力都可以讓自殺比如說在但我說從結果論來講你看後面三年後面三年你看一下當然這個我們要再分析原因是不是整個社會變遷是預算還是還是因為執行不彰還是可能細節還沒有思考周全\n\n13\n00:04:18,367 --> 00:04:43,409\n說執行不章我個人覺得從自殺防治那些那麼用心多年來的這些精神科醫師團隊的部長其實我想說可能兩者有互相影響因為中央預算中央政府預算明年稅出是3兆1325億那現在卓院長的預算總諮詢的報告中說社安網二期的預算只有75億\n\n14\n00:04:44,750 --> 00:04:46,979\n基本上就是說不到0.24%那我想你認為這樣子的預算夠嗎?\n\n15\n00:04:51,653 --> 00:04:52,213\n你懂我意思嗎?\n\n16\n00:05:19,963 --> 00:05:40,435\n報告委員我想社會安全往事社會所重視的不管是朝野：好所以我想要進一步講的就是這個部長前年修正的精神衛生法即將在今年的12月14日實行那請問部長經衛法的第三條定義很清楚但是幾乎都是圍繞在精神疾病\n\n17\n00:05:41,235 --> 00:06:08,881\n都是圍繞在精神疾病但是心理健康促進卻是沒有被定義的部長治療基本上已經是最末端的處理但是中階段的預防剛剛講到中階段預防和最初階段的心理健康促進卻沒有被明確的定義清楚那請教部長現在修法當然是可能已經是來不及也不可能但是亡羊補牢還是有機會是不是可以用這個修正施行細則的方式把心理健康促進放進去\n\n18\n00:06:09,960 --> 00:06:34,513\n謝謝委員的指教對沒錯我們就是要在精神衛生法施行記者裡面納入心理健康促進是很好啊因為2022年WHO最新的世界心理報告第6.1章節標題就是心理健康促進跟普遍性的預防所以也謝謝這個部長正面回應其實心理健康很重要平常政府就有責任做好心理健康促進\n\n19\n00:06:35,313 --> 00:07:00,060\n不是等到發病或是有狀況之後才來做治療跟危機處理所以這個部分我要提醒這個部長在事情細節的部分要盡速的把它列出來謝謝委員的指教這也是符合剛剛委員所講的WHO的一個趨勢對那另外還有一群人的確是被社安網給忽略的依照這個特殊教育法在在學期間這些自閉症或是有情緒障礙\n\n20\n00:07:20,801 --> 00:07:43,183\n我想在...好,部長就是對啦好不好我跟你講,就是這樣子啦是是是所以這群人如果沒有去做這個鑑定的話那他其實福利無法獲取之外更重要是社政單位就會漏接所以我在這裡要告訴部長的是如果他們回到社區沒有足夠的支持跟支持管道的時候他就比較容易發生憾事了\n\n21\n00:07:44,427 --> 00:08:03,085\n所以部長這部分我想要問你們,你們有什麼方法去加強嗎?加強宣導或者是在校的輔導對象要追蹤這個部分?這部分是不是可以去進一步的去做宣導跟追蹤?你們現在有考慮到這件事情嗎?\n\n22\n00:08:04,912 --> 00:08:05,052\n貪寇的問題喔\n\n23\n00:08:24,386 --> 00:08:36,673\n部長你當立委的時候其實針對健保攤扣對當時的反正當時的部長提出質詢所以我想你應該非常清楚攤扣那部長請問你認同和支持攤扣的做法嗎\n\n24\n00:08:39,332 --> 00:09:01,480\n因為在總額制度之下真的就是在一定的總額然後成長力如果有限可是醫療的需求對但部長您當初也是有質詢這個我知道醫療需求一直暴漲所以會絕對會呈現點子下降的一種趨勢那如果讓點子不要那麼明顯的下降可能會用不管是\n\n25\n00:09:02,320 --> 00:09:25,456\n部長所以你知道這個很有趣喔我等一下還講到喔我覺得這是醫院真的醫院的痛啦對嘛我就想要問一下這個邏輯是有問題的對不對臺北區的醫院是採取探戶嘛事後探戶那所以當那當然所以我想問部長你是認同這個嗎很多很多的\n\n26\n00:09:27,217 --> 00:09:44,447\n問題是在有限的資源裡面也尊重各區的一個自主管理但是你本人是不是不認同和不支持的我當然是希望健保能夠永續因為各位委員報告因為我們還是要有時候要站在人民\n\n27\n00:09:44,787 --> 00:09:48,068\n其實簡單來講這個貪扣的部分就是好像是假設健保是買方那醫院算是賣方\n\n28\n00:10:02,699 --> 00:10:19,500\n其實也算是付錢的一方啦健保的部分嘛所以如果一般商品賣方不符合這些商品的這個品質啊或是他的產出有問題那你當然可以要求他驗收不合格退貨可是部長你用貪扣的方式啊你是等於是代表你要求所有的賣家一起減價這個收受\n\n29\n00:10:21,903 --> 00:10:44,240\n所以您也知道這個就是這個概念嘛對不對所以這樣子的攤扣制度就會讓這些公司立意願他的不只是無所適從可能會導致他所有經營上面的困難包含著我們後面會提到非常多但我想就不一一贅述但是基本上根據立法院這個決議當初的主決議就是要達到0.95對不對\n\n30\n00:10:46,181 --> 00:11:15,501\n那如果說依照憲法規定我們通過的事情行政院只能遵守或是經總統何可提出復議那因此我們在提的這個主決議0.95等於1點這個就是勢必勢在必行不可以有折扣但是實務上你們現在除了公務預算的挹注但是實務上你們卻提高了這個攤扣的金額處理方式我們也接到很多陳情有某醫院他去年同期努力服務成長的金額幾乎全額被扣除\n\n31\n00:11:16,321 --> 00:11:35,822\n好那還要再倒扣約50%那點值上你說好像我用這種方式去提高了點值但實際上其實是倒貼的部分所以我想要跟你講你看這個是你們全民健保這個這個各種額部門的結算結果他直接在上面寫攤扣後我想請問部長你有攤扣前的數據嗎你們有公佈攤扣前的數據嗎\n\n32\n00:11:38,425 --> 00:11:38,585\n〔廖偉翔發言〕\n\n33\n00:11:56,992 --> 00:11:59,234\n貪扣這個詞其實是一個很大的問題貪扣請問有法律授權嗎有依法有據嗎\n\n34\n00:12:19,961 --> 00:12:45,897\n這個就是各區自主管理的一個機制所以其實是沒有法源嘛對不對像臺北市的臺北區的基層點子比較低所以後來發現說好部長高價的要把他打走這樣子就是沒有法源嘛對不對所以比如說健保啊醫療院所是不是有依據健保法全民健康這個保險醫事服務機構特約及管理辦法訂定合約成為特約醫事服務機構那\n\n35\n00:12:48,538 --> 00:13:06,845\n請問簽約的合約範本上任何有跟攤扣有關的規定嗎?我還是要講這個,就是你就是沒有法約嗎?不管是攤扣或者是先各醫院總額,像南區就是醫院總額嘛。沒有,部長你要回答我問題啊。都是自己的精神啊。在這個簽約的合約範本裡面有沒有?是不是沒有?\n\n36\n00:13:08,416 --> 00:13:14,182\n全民健康保險醫療費用申報與核負及醫療服務審查辦法裡面其實是有一個叫做健保核三的法源依據但是完全沒有攤扣相關的規定\n\n37\n00:13:27,455 --> 00:13:53,004\n所以這會變成是政府可以用一紙命令就扣錢就扣這個就合扣費用嗎其實這我還是要回過頭來講這樣子的問題就是導致現在這個醫院或是醫療院所經營上面的問題那你可能導致他們在採購或甚至現在要發年終然後因為你攤扣後的數字完全跟他經營上面對不起來所以變成他們很困難甚至間接也導致這個醫護他在家\n\n38\n00:13:54,384 --> 00:13:56,846\n這個問題其實也蠻久的然後你們嘴巴上都一直說很重視很重視可是你完全沒有解方啊\n\n39\n00:14:23,684 --> 00:14:53,204\n還有我們當時會訂總額的制度除非我們好好來檢討總額這件事情我會請部長因為時間請你深入瞭解貪扣的法律授權還有瞭解貪扣對於公司我想其實這個部分你很清楚公司營業經營的影響還有貪扣是否對於醫護人員工作獎金發放設備購置甚至這個醫療投資人員禁用等等的進行全方面的瞭解\n\n40\n00:14:54,726 --> 00:15:03,819\n我想你們在這部分應該是很清楚所以我其實就是要跟你說你們是這個攤扣是沒有法源依據的請部長深入了解一下攤扣法律授權好不好\n\n41\n00:15:05,437 --> 00:15:21,832\n好這個沒問題但是就是說其實在管理方面是各區自主性的管理的精神那你可不可以針對我說的這個問題給我一個簡單的說明給我一份報告說你們的授權到底在哪裡還是你們覺得這個到底有沒有法律我們會回答回答委員謝謝謝謝委員關心謝謝謝謝廖委員謝謝部長\n\n","tsv":"start\tend\ttext\n14572\t33771\t謝謝主席 請我們的邱部長部長好部長好 部長早安喔早我想要先問一下喔針對這個人工生殖法的修正草案是否有明確的立法時間表那預計何時能夠完成立法因為\n36212\t52019\t預告的時候有600多則的意見那當然基本上都在代理應募這個部比較多啦所以經過開了實際場的一個會議大概我們希望在11月底能夠送行證願預計希望在11月底送行證願好OK\n53900\t68175\t那第二個就是在無償代孕中要如何確保這個代理孕母的自主權然後以及對於這個營養費上限的設定是否有足夠會不會出現有商業化的漏洞這個部分可不可以請部長也指教一下\n68752\t89629\t我想這個就是一直大家所關注的所以我想問一下說目前你們評估的狀況跟要怎麼做我們現在訂出來的標準其實雖然目前還在做討論研議當中但是我們初步來看他訂出來的都是非常保護母體母親就是懷孕\n90370\t99976\t所以你目前覺得說那怎麼確保他的這個自主權跟他營養費上限是否有足夠那會不會出現商業化漏洞這三個問題\n101976\t129518\t是這部分有沒有國政署有沒有要跟我們幫忙說明一下跟委員報告齁那目前這個修法草案的設計代孕是以無償的方式去進行的就是禁止商業代孕那習慣有一些相關費用的部分那這個部分我們在如果未來修法通過之後我們還跟相關的專家去做相關的嚴定跟所以目前是還沒有考慮到這些事情等於是細節上還沒有考還沒有還沒有一個比較明確的\n130902\t135446\t那你覺得這部分會不會出現商業漏洞?商業化的漏洞?我想剛剛部長也談到我們還是以這個代理母的保護當作優先。我們會盡量去做這個比較周全的考量。\n156311\t159094\t好再來那如果代孕過程中出現這個醫療風險或法規爭議的話我們衛福部會如何處理跟調解\n165597\t189790\t我講現在草案設計師要求這個待運的部分有進行相關的評估那也有待運服務機構的機制設計在裡面那就是包括剛提到法律的部分那另外也要投保這個人身保險跟這個健康保險那假設有這個相關的部分在保險上面也能夠獲得給付那這整個懷孕過程那如果有這個\n192092\t213707\t這個法規規定需要進行這個人工流產的部分那也可以照這個相關法令來做辦理目前草案的設計是這個樣子所以這目前裡面草案都有具體的設計好那再來我想問一下接下來就是回到今天的主題根據這個衛福部自己統計的資料這三年的自殺人數節節攀升\n216289\t229017\t那其實剛好也是社安網第二期施行的年份等於是社安網二期編列預算後反倒成果越來越差我想要請教一下部長你覺得這次預算不夠還是執行不彰導致效果不好\n232215\t256746\t因為從自殺防治中心開始的時候我就是其中裡面的一個一員所以我們就知道大家的努力都可以讓自殺比如說在但我說從結果論來講你看後面三年後面三年你看一下當然這個我們要再分析原因是不是整個社會變遷是預算還是還是因為執行不彰還是可能細節還沒有思考周全\n258367\t283409\t說執行不章我個人覺得從自殺防治那些那麼用心多年來的這些精神科醫師團隊的部長其實我想說可能兩者有互相影響因為中央預算中央政府預算明年稅出是3兆1325億那現在卓院長的預算總諮詢的報告中說社安網二期的預算只有75億\n284750\t286979\t基本上就是說不到0.24%那我想你認為這樣子的預算夠嗎?\n291653\t292213\t你懂我意思嗎?\n319963\t340435\t報告委員我想社會安全往事社會所重視的不管是朝野：好所以我想要進一步講的就是這個部長前年修正的精神衛生法即將在今年的12月14日實行那請問部長經衛法的第三條定義很清楚但是幾乎都是圍繞在精神疾病\n341235\t368881\t都是圍繞在精神疾病但是心理健康促進卻是沒有被定義的部長治療基本上已經是最末端的處理但是中階段的預防剛剛講到中階段預防和最初階段的心理健康促進卻沒有被明確的定義清楚那請教部長現在修法當然是可能已經是來不及也不可能但是亡羊補牢還是有機會是不是可以用這個修正施行細則的方式把心理健康促進放進去\n369960\t394513\t謝謝委員的指教對沒錯我們就是要在精神衛生法施行記者裡面納入心理健康促進是很好啊因為2022年WHO最新的世界心理報告第6.1章節標題就是心理健康促進跟普遍性的預防所以也謝謝這個部長正面回應其實心理健康很重要平常政府就有責任做好心理健康促進\n395313\t420060\t不是等到發病或是有狀況之後才來做治療跟危機處理所以這個部分我要提醒這個部長在事情細節的部分要盡速的把它列出來謝謝委員的指教這也是符合剛剛委員所講的WHO的一個趨勢對那另外還有一群人的確是被社安網給忽略的依照這個特殊教育法在在學期間這些自閉症或是有情緒障礙\n421220\t438063\t呃\n440801\t463183\t我想在...好,部長就是對啦好不好我跟你講,就是這樣子啦是是是所以這群人如果沒有去做這個鑑定的話那他其實福利無法獲取之外更重要是社政單位就會漏接所以我在這裡要告訴部長的是如果他們回到社區沒有足夠的支持跟支持管道的時候他就比較容易發生憾事了\n464427\t483085\t所以部長這部分我想要問你們,你們有什麼方法去加強嗎?加強宣導或者是在校的輔導對象要追蹤這個部分?這部分是不是可以去進一步的去做宣導跟追蹤?你們現在有考慮到這件事情嗎?\n484912\t485052\t貪寇的問題喔\n504386\t516673\t部長你當立委的時候其實針對健保攤扣對當時的反正當時的部長提出質詢所以我想你應該非常清楚攤扣那部長請問你認同和支持攤扣的做法嗎\n519332\t541480\t因為在總額制度之下真的就是在一定的總額然後成長力如果有限可是醫療的需求對但部長您當初也是有質詢這個我知道醫療需求一直暴漲所以會絕對會呈現點子下降的一種趨勢那如果讓點子不要那麼明顯的下降可能會用不管是\n542320\t565456\t部長所以你知道這個很有趣喔我等一下還講到喔我覺得這是醫院真的醫院的痛啦對嘛我就想要問一下這個邏輯是有問題的對不對臺北區的醫院是採取探戶嘛事後探戶那所以當那當然所以我想問部長你是認同這個嗎很多很多的\n567217\t584447\t問題是在有限的資源裡面也尊重各區的一個自主管理但是你本人是不是不認同和不支持的我當然是希望健保能夠永續因為各位委員報告因為我們還是要有時候要站在人民\n584787\t588068\t其實簡單來講這個貪扣的部分就是好像是假設健保是買方那醫院算是賣方\n602699\t619500\t其實也算是付錢的一方啦健保的部分嘛所以如果一般商品賣方不符合這些商品的這個品質啊或是他的產出有問題那你當然可以要求他驗收不合格退貨可是部長你用貪扣的方式啊你是等於是代表你要求所有的賣家一起減價這個收受\n621903\t644240\t所以您也知道這個就是這個概念嘛 對不對所以這樣子的攤扣制度就會讓這些公司立意願他的不只是無所適從可能會導致他所有經營上面的困難包含著我們後面會提到非常多但我想就不一一贅述但是基本上根據立法院這個決議當初的主決議就是要達到0.95對不對\n646181\t675501\t那如果說依照憲法規定我們通過的事情行政院只能遵守或是經總統何可提出復議那因此我們在提的這個主決議0.95等於1點這個就是勢必勢在必行不可以有折扣但是實務上你們現在除了公務預算的挹注但是實務上你們卻提高了這個攤扣的金額處理方式我們也接到很多陳情有某醫院他去年同期努力服務成長的金額幾乎全額被扣除\n676321\t695822\t好那還要再倒扣約50%那點值上你說好像我用這種方式去提高了點值但實際上其實是倒貼的部分所以我想要跟你講你看這個是你們全民健保這個這個各種額部門的結算結果他直接在上面寫攤扣後我想請問部長你有攤扣前的數據嗎你們有公佈攤扣前的數據嗎\n698425\t698585\t〔廖偉翔發言〕\n716992\t719234\t貪扣這個詞其實是一個很大的問題貪扣請問有法律授權嗎有依法有據嗎\n739961\t765897\t這個就是各區自主管理的一個機制所以其實是沒有法源嘛對不對像臺北市的臺北區的基層點子比較低所以後來發現說好部長高價的要把他打走這樣子就是沒有法源嘛對不對所以比如說健保啊醫療院所是不是有依據健保法全民健康這個保險醫事服務機構特約及管理辦法訂定合約成為特約醫事服務機構那\n768538\t786845\t請問簽約的合約範本上任何有跟攤扣有關的規定嗎?我還是要講這個,就是你就是沒有法約嗎?不管是攤扣或者是先各醫院總額,像南區就是醫院總額嘛。沒有,部長你要回答我問題啊。都是自己的精神啊。在這個簽約的合約範本裡面有沒有?是不是沒有?\n788416\t794182\t全民健康保險醫療費用申報與核負及醫療服務審查辦法裡面其實是有一個叫做健保核三的法源依據但是完全沒有攤扣相關的規定\n807455\t833004\t所以這會變成是政府可以用一紙命令就扣錢就扣這個就合扣費用嗎其實這我還是要回過頭來講這樣子的問題就是導致現在這個醫院或是醫療院所經營上面的問題那你可能導致他們在採購或甚至現在要發年終然後因為你攤扣後的數字完全跟他經營上面對不起來所以變成他們很困難甚至間接也導致這個醫護他在家\n834384\t836846\t這個問題其實也蠻久的然後你們嘴巴上都一直說很重視很重視可是你完全沒有解方啊\n863684\t893204\t還有我們當時會訂總額的制度除非我們好好來檢討總額這件事情我會請部長因為時間請你深入瞭解貪扣的法律授權還有瞭解貪扣對於公司我想其實這個部分你很清楚公司營業經營的影響還有貪扣是否對於醫護人員工作獎金發放設備購置甚至這個醫療投資人員禁用等等的進行全方面的瞭解\n894726\t903819\t我想你們在這部分應該是很清楚所以我其實就是要跟你說你們是這個攤扣是沒有法源依據的請部長深入了解一下攤扣法律授權好不好\n905437\t921832\t好 這個沒問題但是就是說其實在管理方面是各區自主性的管理的精神那你可不可以針對我說的這個問題給我一個簡單的說明給我一份報告說你們的授權到底在哪裡還是你們覺得這個到底有沒有法律我們會回答回答委員謝謝 謝謝委員關心謝謝 謝謝廖委員 謝謝部長\n","txt":"謝謝主席 請我們的邱部長部長好部長好 部長早安喔早我想要先問一下喔針對這個人工生殖法的修正草案是否有明確的立法時間表那預計何時能夠完成立法因為\n預告的時候有600多則的意見那當然基本上都在代理應募這個部比較多啦所以經過開了實際場的一個會議大概我們希望在11月底能夠送行證願預計希望在11月底送行證願好OK\n那第二個就是在無償代孕中要如何確保這個代理孕母的自主權然後以及對於這個營養費上限的設定是否有足夠會不會出現有商業化的漏洞這個部分可不可以請部長也指教一下\n我想這個就是一直大家所關注的所以我想問一下說目前你們評估的狀況跟要怎麼做我們現在訂出來的標準其實雖然目前還在做討論研議當中但是我們初步來看他訂出來的都是非常保護母體母親就是懷孕\n所以你目前覺得說那怎麼確保他的這個自主權跟他營養費上限是否有足夠那會不會出現商業化漏洞這三個問題\n是這部分有沒有國政署有沒有要跟我們幫忙說明一下跟委員報告齁那目前這個修法草案的設計代孕是以無償的方式去進行的就是禁止商業代孕那習慣有一些相關費用的部分那這個部分我們在如果未來修法通過之後我們還跟相關的專家去做相關的嚴定跟所以目前是還沒有考慮到這些事情等於是細節上還沒有考還沒有還沒有一個比較明確的\n那你覺得這部分會不會出現商業漏洞?商業化的漏洞?我想剛剛部長也談到我們還是以這個代理母的保護當作優先。我們會盡量去做這個比較周全的考量。\n好再來那如果代孕過程中出現這個醫療風險或法規爭議的話我們衛福部會如何處理跟調解\n我講現在草案設計師要求這個待運的部分有進行相關的評估那也有待運服務機構的機制設計在裡面那就是包括剛提到法律的部分那另外也要投保這個人身保險跟這個健康保險那假設有這個相關的部分在保險上面也能夠獲得給付那這整個懷孕過程那如果有這個\n這個法規規定需要進行這個人工流產的部分那也可以照這個相關法令來做辦理目前草案的設計是這個樣子所以這目前裡面草案都有具體的設計好那再來我想問一下接下來就是回到今天的主題根據這個衛福部自己統計的資料這三年的自殺人數節節攀升\n那其實剛好也是社安網第二期施行的年份等於是社安網二期編列預算後反倒成果越來越差我想要請教一下部長你覺得這次預算不夠還是執行不彰導致效果不好\n因為從自殺防治中心開始的時候我就是其中裡面的一個一員所以我們就知道大家的努力都可以讓自殺比如說在但我說從結果論來講你看後面三年後面三年你看一下當然這個我們要再分析原因是不是整個社會變遷是預算還是還是因為執行不彰還是可能細節還沒有思考周全\n說執行不章我個人覺得從自殺防治那些那麼用心多年來的這些精神科醫師團隊的部長其實我想說可能兩者有互相影響因為中央預算中央政府預算明年稅出是3兆1325億那現在卓院長的預算總諮詢的報告中說社安網二期的預算只有75億\n基本上就是說不到0.24%那我想你認為這樣子的預算夠嗎?\n你懂我意思嗎?\n報告委員我想社會安全往事社會所重視的不管是朝野：好所以我想要進一步講的就是這個部長前年修正的精神衛生法即將在今年的12月14日實行那請問部長經衛法的第三條定義很清楚但是幾乎都是圍繞在精神疾病\n都是圍繞在精神疾病但是心理健康促進卻是沒有被定義的部長治療基本上已經是最末端的處理但是中階段的預防剛剛講到中階段預防和最初階段的心理健康促進卻沒有被明確的定義清楚那請教部長現在修法當然是可能已經是來不及也不可能但是亡羊補牢還是有機會是不是可以用這個修正施行細則的方式把心理健康促進放進去\n謝謝委員的指教對沒錯我們就是要在精神衛生法施行記者裡面納入心理健康促進是很好啊因為2022年WHO最新的世界心理報告第6.1章節標題就是心理健康促進跟普遍性的預防所以也謝謝這個部長正面回應其實心理健康很重要平常政府就有責任做好心理健康促進\n不是等到發病或是有狀況之後才來做治療跟危機處理所以這個部分我要提醒這個部長在事情細節的部分要盡速的把它列出來謝謝委員的指教這也是符合剛剛委員所講的WHO的一個趨勢對那另外還有一群人的確是被社安網給忽略的依照這個特殊教育法在在學期間這些自閉症或是有情緒障礙\n呃\n我想在...好,部長就是對啦好不好我跟你講,就是這樣子啦是是是所以這群人如果沒有去做這個鑑定的話那他其實福利無法獲取之外更重要是社政單位就會漏接所以我在這裡要告訴部長的是如果他們回到社區沒有足夠的支持跟支持管道的時候他就比較容易發生憾事了\n所以部長這部分我想要問你們,你們有什麼方法去加強嗎?加強宣導或者是在校的輔導對象要追蹤這個部分?這部分是不是可以去進一步的去做宣導跟追蹤?你們現在有考慮到這件事情嗎?\n貪寇的問題喔\n部長你當立委的時候其實針對健保攤扣對當時的反正當時的部長提出質詢所以我想你應該非常清楚攤扣那部長請問你認同和支持攤扣的做法嗎\n因為在總額制度之下真的就是在一定的總額然後成長力如果有限可是醫療的需求對但部長您當初也是有質詢這個我知道醫療需求一直暴漲所以會絕對會呈現點子下降的一種趨勢那如果讓點子不要那麼明顯的下降可能會用不管是\n部長所以你知道這個很有趣喔我等一下還講到喔我覺得這是醫院真的醫院的痛啦對嘛我就想要問一下這個邏輯是有問題的對不對臺北區的醫院是採取探戶嘛事後探戶那所以當那當然所以我想問部長你是認同這個嗎很多很多的\n問題是在有限的資源裡面也尊重各區的一個自主管理但是你本人是不是不認同和不支持的我當然是希望健保能夠永續因為各位委員報告因為我們還是要有時候要站在人民\n其實簡單來講這個貪扣的部分就是好像是假設健保是買方那醫院算是賣方\n其實也算是付錢的一方啦健保的部分嘛所以如果一般商品賣方不符合這些商品的這個品質啊或是他的產出有問題那你當然可以要求他驗收不合格退貨可是部長你用貪扣的方式啊你是等於是代表你要求所有的賣家一起減價這個收受\n所以您也知道這個就是這個概念嘛 對不對所以這樣子的攤扣制度就會讓這些公司立意願他的不只是無所適從可能會導致他所有經營上面的困難包含著我們後面會提到非常多但我想就不一一贅述但是基本上根據立法院這個決議當初的主決議就是要達到0.95對不對\n那如果說依照憲法規定我們通過的事情行政院只能遵守或是經總統何可提出復議那因此我們在提的這個主決議0.95等於1點這個就是勢必勢在必行不可以有折扣但是實務上你們現在除了公務預算的挹注但是實務上你們卻提高了這個攤扣的金額處理方式我們也接到很多陳情有某醫院他去年同期努力服務成長的金額幾乎全額被扣除\n好那還要再倒扣約50%那點值上你說好像我用這種方式去提高了點值但實際上其實是倒貼的部分所以我想要跟你講你看這個是你們全民健保這個這個各種額部門的結算結果他直接在上面寫攤扣後我想請問部長你有攤扣前的數據嗎你們有公佈攤扣前的數據嗎\n〔廖偉翔發言〕\n貪扣這個詞其實是一個很大的問題貪扣請問有法律授權嗎有依法有據嗎\n這個就是各區自主管理的一個機制所以其實是沒有法源嘛對不對像臺北市的臺北區的基層點子比較低所以後來發現說好部長高價的要把他打走這樣子就是沒有法源嘛對不對所以比如說健保啊醫療院所是不是有依據健保法全民健康這個保險醫事服務機構特約及管理辦法訂定合約成為特約醫事服務機構那\n請問簽約的合約範本上任何有跟攤扣有關的規定嗎?我還是要講這個,就是你就是沒有法約嗎?不管是攤扣或者是先各醫院總額,像南區就是醫院總額嘛。沒有,部長你要回答我問題啊。都是自己的精神啊。在這個簽約的合約範本裡面有沒有?是不是沒有?\n全民健康保險醫療費用申報與核負及醫療服務審查辦法裡面其實是有一個叫做健保核三的法源依據但是完全沒有攤扣相關的規定\n所以這會變成是政府可以用一紙命令就扣錢就扣這個就合扣費用嗎其實這我還是要回過頭來講這樣子的問題就是導致現在這個醫院或是醫療院所經營上面的問題那你可能導致他們在採購或甚至現在要發年終然後因為你攤扣後的數字完全跟他經營上面對不起來所以變成他們很困難甚至間接也導致這個醫護他在家\n這個問題其實也蠻久的然後你們嘴巴上都一直說很重視很重視可是你完全沒有解方啊\n還有我們當時會訂總額的制度除非我們好好來檢討總額這件事情我會請部長因為時間請你深入瞭解貪扣的法律授權還有瞭解貪扣對於公司我想其實這個部分你很清楚公司營業經營的影響還有貪扣是否對於醫護人員工作獎金發放設備購置甚至這個醫療投資人員禁用等等的進行全方面的瞭解\n我想你們在這部分應該是很清楚所以我其實就是要跟你說你們是這個攤扣是沒有法源依據的請部長深入了解一下攤扣法律授權好不好\n好 這個沒問題但是就是說其實在管理方面是各區自主性的管理的精神那你可不可以針對我說的這個問題給我一個簡單的說明給我一份報告說你們的授權到底在哪裡還是你們覺得這個到底有沒有法律我們會回答回答委員謝謝 謝謝委員關心謝謝 謝謝廖委員 謝謝部長\n","vtt":"WEBVTT\n\n00:14.572 --> 00:33.771\n謝謝主席請我們的邱部長部長好部長好部長早安喔早我想要先問一下喔針對這個人工生殖法的修正草案是否有明確的立法時間表那預計何時能夠完成立法因為\n\n00:36.212 --> 00:52.019\n預告的時候有600多則的意見那當然基本上都在代理應募這個部比較多啦所以經過開了實際場的一個會議大概我們希望在11月底能夠送行證願預計希望在11月底送行證願好OK\n\n00:53.900 --> 01:08.175\n那第二個就是在無償代孕中要如何確保這個代理孕母的自主權然後以及對於這個營養費上限的設定是否有足夠會不會出現有商業化的漏洞這個部分可不可以請部長也指教一下\n\n01:08.752 --> 01:29.629\n我想這個就是一直大家所關注的所以我想問一下說目前你們評估的狀況跟要怎麼做我們現在訂出來的標準其實雖然目前還在做討論研議當中但是我們初步來看他訂出來的都是非常保護母體母親就是懷孕\n\n01:30.370 --> 01:39.976\n所以你目前覺得說那怎麼確保他的這個自主權跟他營養費上限是否有足夠那會不會出現商業化漏洞這三個問題\n\n01:41.976 --> 02:09.518\n是這部分有沒有國政署有沒有要跟我們幫忙說明一下跟委員報告齁那目前這個修法草案的設計代孕是以無償的方式去進行的就是禁止商業代孕那習慣有一些相關費用的部分那這個部分我們在如果未來修法通過之後我們還跟相關的專家去做相關的嚴定跟所以目前是還沒有考慮到這些事情等於是細節上還沒有考還沒有還沒有一個比較明確的\n\n02:10.902 --> 02:15.446\n那你覺得這部分會不會出現商業漏洞?商業化的漏洞?我想剛剛部長也談到我們還是以這個代理母的保護當作優先。我們會盡量去做這個比較周全的考量。\n\n02:36.311 --> 02:39.094\n好再來那如果代孕過程中出現這個醫療風險或法規爭議的話我們衛福部會如何處理跟調解\n\n02:45.597 --> 03:09.790\n我講現在草案設計師要求這個待運的部分有進行相關的評估那也有待運服務機構的機制設計在裡面那就是包括剛提到法律的部分那另外也要投保這個人身保險跟這個健康保險那假設有這個相關的部分在保險上面也能夠獲得給付那這整個懷孕過程那如果有這個\n\n03:12.092 --> 03:33.707\n這個法規規定需要進行這個人工流產的部分那也可以照這個相關法令來做辦理目前草案的設計是這個樣子所以這目前裡面草案都有具體的設計好那再來我想問一下接下來就是回到今天的主題根據這個衛福部自己統計的資料這三年的自殺人數節節攀升\n\n03:36.289 --> 03:49.017\n那其實剛好也是社安網第二期施行的年份等於是社安網二期編列預算後反倒成果越來越差我想要請教一下部長你覺得這次預算不夠還是執行不彰導致效果不好\n\n03:52.215 --> 04:16.746\n因為從自殺防治中心開始的時候我就是其中裡面的一個一員所以我們就知道大家的努力都可以讓自殺比如說在但我說從結果論來講你看後面三年後面三年你看一下當然這個我們要再分析原因是不是整個社會變遷是預算還是還是因為執行不彰還是可能細節還沒有思考周全\n\n04:18.367 --> 04:43.409\n說執行不章我個人覺得從自殺防治那些那麼用心多年來的這些精神科醫師團隊的部長其實我想說可能兩者有互相影響因為中央預算中央政府預算明年稅出是3兆1325億那現在卓院長的預算總諮詢的報告中說社安網二期的預算只有75億\n\n04:44.750 --> 04:46.979\n基本上就是說不到0.24%那我想你認為這樣子的預算夠嗎?\n\n04:51.653 --> 04:52.213\n你懂我意思嗎?\n\n05:19.963 --> 05:40.435\n報告委員我想社會安全往事社會所重視的不管是朝野：好所以我想要進一步講的就是這個部長前年修正的精神衛生法即將在今年的12月14日實行那請問部長經衛法的第三條定義很清楚但是幾乎都是圍繞在精神疾病\n\n05:41.235 --> 06:08.881\n都是圍繞在精神疾病但是心理健康促進卻是沒有被定義的部長治療基本上已經是最末端的處理但是中階段的預防剛剛講到中階段預防和最初階段的心理健康促進卻沒有被明確的定義清楚那請教部長現在修法當然是可能已經是來不及也不可能但是亡羊補牢還是有機會是不是可以用這個修正施行細則的方式把心理健康促進放進去\n\n06:09.960 --> 06:34.513\n謝謝委員的指教對沒錯我們就是要在精神衛生法施行記者裡面納入心理健康促進是很好啊因為2022年WHO最新的世界心理報告第6.1章節標題就是心理健康促進跟普遍性的預防所以也謝謝這個部長正面回應其實心理健康很重要平常政府就有責任做好心理健康促進\n\n06:35.313 --> 07:00.060\n不是等到發病或是有狀況之後才來做治療跟危機處理所以這個部分我要提醒這個部長在事情細節的部分要盡速的把它列出來謝謝委員的指教這也是符合剛剛委員所講的WHO的一個趨勢對那另外還有一群人的確是被社安網給忽略的依照這個特殊教育法在在學期間這些自閉症或是有情緒障礙\n\n07:20.801 --> 07:43.183\n我想在...好,部長就是對啦好不好我跟你講,就是這樣子啦是是是所以這群人如果沒有去做這個鑑定的話那他其實福利無法獲取之外更重要是社政單位就會漏接所以我在這裡要告訴部長的是如果他們回到社區沒有足夠的支持跟支持管道的時候他就比較容易發生憾事了\n\n07:44.427 --> 08:03.085\n所以部長這部分我想要問你們,你們有什麼方法去加強嗎?加強宣導或者是在校的輔導對象要追蹤這個部分?這部分是不是可以去進一步的去做宣導跟追蹤?你們現在有考慮到這件事情嗎?\n\n08:04.912 --> 08:05.052\n貪寇的問題喔\n\n08:24.386 --> 08:36.673\n部長你當立委的時候其實針對健保攤扣對當時的反正當時的部長提出質詢所以我想你應該非常清楚攤扣那部長請問你認同和支持攤扣的做法嗎\n\n08:39.332 --> 09:01.480\n因為在總額制度之下真的就是在一定的總額然後成長力如果有限可是醫療的需求對但部長您當初也是有質詢這個我知道醫療需求一直暴漲所以會絕對會呈現點子下降的一種趨勢那如果讓點子不要那麼明顯的下降可能會用不管是\n\n09:02.320 --> 09:25.456\n部長所以你知道這個很有趣喔我等一下還講到喔我覺得這是醫院真的醫院的痛啦對嘛我就想要問一下這個邏輯是有問題的對不對臺北區的醫院是採取探戶嘛事後探戶那所以當那當然所以我想問部長你是認同這個嗎很多很多的\n\n09:27.217 --> 09:44.447\n問題是在有限的資源裡面也尊重各區的一個自主管理但是你本人是不是不認同和不支持的我當然是希望健保能夠永續因為各位委員報告因為我們還是要有時候要站在人民\n\n09:44.787 --> 09:48.068\n其實簡單來講這個貪扣的部分就是好像是假設健保是買方那醫院算是賣方\n\n10:02.699 --> 10:19.500\n其實也算是付錢的一方啦健保的部分嘛所以如果一般商品賣方不符合這些商品的這個品質啊或是他的產出有問題那你當然可以要求他驗收不合格退貨可是部長你用貪扣的方式啊你是等於是代表你要求所有的賣家一起減價這個收受\n\n10:21.903 --> 10:44.240\n所以您也知道這個就是這個概念嘛對不對所以這樣子的攤扣制度就會讓這些公司立意願他的不只是無所適從可能會導致他所有經營上面的困難包含著我們後面會提到非常多但我想就不一一贅述但是基本上根據立法院這個決議當初的主決議就是要達到0.95對不對\n\n10:46.181 --> 11:15.501\n那如果說依照憲法規定我們通過的事情行政院只能遵守或是經總統何可提出復議那因此我們在提的這個主決議0.95等於1點這個就是勢必勢在必行不可以有折扣但是實務上你們現在除了公務預算的挹注但是實務上你們卻提高了這個攤扣的金額處理方式我們也接到很多陳情有某醫院他去年同期努力服務成長的金額幾乎全額被扣除\n\n11:16.321 --> 11:35.822\n好那還要再倒扣約50%那點值上你說好像我用這種方式去提高了點值但實際上其實是倒貼的部分所以我想要跟你講你看這個是你們全民健保這個這個各種額部門的結算結果他直接在上面寫攤扣後我想請問部長你有攤扣前的數據嗎你們有公佈攤扣前的數據嗎\n\n11:38.425 --> 11:38.585\n〔廖偉翔發言〕\n\n11:56.992 --> 11:59.234\n貪扣這個詞其實是一個很大的問題貪扣請問有法律授權嗎有依法有據嗎\n\n12:19.961 --> 12:45.897\n這個就是各區自主管理的一個機制所以其實是沒有法源嘛對不對像臺北市的臺北區的基層點子比較低所以後來發現說好部長高價的要把他打走這樣子就是沒有法源嘛對不對所以比如說健保啊醫療院所是不是有依據健保法全民健康這個保險醫事服務機構特約及管理辦法訂定合約成為特約醫事服務機構那\n\n12:48.538 --> 13:06.845\n請問簽約的合約範本上任何有跟攤扣有關的規定嗎?我還是要講這個,就是你就是沒有法約嗎?不管是攤扣或者是先各醫院總額,像南區就是醫院總額嘛。沒有,部長你要回答我問題啊。都是自己的精神啊。在這個簽約的合約範本裡面有沒有?是不是沒有?\n\n13:08.416 --> 13:14.182\n全民健康保險醫療費用申報與核負及醫療服務審查辦法裡面其實是有一個叫做健保核三的法源依據但是完全沒有攤扣相關的規定\n\n13:27.455 --> 13:53.004\n所以這會變成是政府可以用一紙命令就扣錢就扣這個就合扣費用嗎其實這我還是要回過頭來講這樣子的問題就是導致現在這個醫院或是醫療院所經營上面的問題那你可能導致他們在採購或甚至現在要發年終然後因為你攤扣後的數字完全跟他經營上面對不起來所以變成他們很困難甚至間接也導致這個醫護他在家\n\n13:54.384 --> 13:56.846\n這個問題其實也蠻久的然後你們嘴巴上都一直說很重視很重視可是你完全沒有解方啊\n\n14:23.684 --> 14:53.204\n還有我們當時會訂總額的制度除非我們好好來檢討總額這件事情我會請部長因為時間請你深入瞭解貪扣的法律授權還有瞭解貪扣對於公司我想其實這個部分你很清楚公司營業經營的影響還有貪扣是否對於醫護人員工作獎金發放設備購置甚至這個醫療投資人員禁用等等的進行全方面的瞭解\n\n14:54.726 --> 15:03.819\n我想你們在這部分應該是很清楚所以我其實就是要跟你說你們是這個攤扣是沒有法源依據的請部長深入了解一下攤扣法律授權好不好\n\n15:05.437 --> 15:21.832\n好這個沒問題但是就是說其實在管理方面是各區自主性的管理的精神那你可不可以針對我說的這個問題給我一個簡單的說明給我一份報告說你們的授權到底在哪裡還是你們覺得這個到底有沒有法律我們會回答回答委員謝謝謝謝委員關心謝謝謝謝廖委員謝謝部長\n\n","segments":[{"start":14.572,"end":33.771,"text":"謝謝主席 請我們的邱部長部長好部長好 部長早安喔早我想要先問一下喔針對這個人工生殖法的修正草案是否有明確的立法時間表那預計何時能夠完成立法因為"},{"start":36.212,"end":52.019,"text":"預告的時候有600多則的意見那當然基本上都在代理應募這個部比較多啦所以經過開了實際場的一個會議大概我們希望在11月底能夠送行證願預計希望在11月底送行證願好OK"},{"start":53.9,"end":68.175,"text":"那第二個就是在無償代孕中要如何確保這個代理孕母的自主權然後以及對於這個營養費上限的設定是否有足夠會不會出現有商業化的漏洞這個部分可不可以請部長也指教一下"},{"start":68.752,"end":89.629,"text":"我想這個就是一直大家所關注的所以我想問一下說目前你們評估的狀況跟要怎麼做我們現在訂出來的標準其實雖然目前還在做討論研議當中但是我們初步來看他訂出來的都是非常保護母體母親就是懷孕"},{"start":90.37,"end":99.976,"text":"所以你目前覺得說那怎麼確保他的這個自主權跟他營養費上限是否有足夠那會不會出現商業化漏洞這三個問題"},{"start":101.976,"end":129.518,"text":"是這部分有沒有國政署有沒有要跟我們幫忙說明一下跟委員報告齁那目前這個修法草案的設計代孕是以無償的方式去進行的就是禁止商業代孕那習慣有一些相關費用的部分那這個部分我們在如果未來修法通過之後我們還跟相關的專家去做相關的嚴定跟所以目前是還沒有考慮到這些事情等於是細節上還沒有考還沒有還沒有一個比較明確的"},{"start":130.902,"end":135.446,"text":"那你覺得這部分會不會出現商業漏洞?商業化的漏洞?我想剛剛部長也談到我們還是以這個代理母的保護當作優先。我們會盡量去做這個比較周全的考量。"},{"start":156.311,"end":159.094,"text":"好再來那如果代孕過程中出現這個醫療風險或法規爭議的話我們衛福部會如何處理跟調解"},{"start":165.597,"end":189.79,"text":"我講現在草案設計師要求這個待運的部分有進行相關的評估那也有待運服務機構的機制設計在裡面那就是包括剛提到法律的部分那另外也要投保這個人身保險跟這個健康保險那假設有這個相關的部分在保險上面也能夠獲得給付那這整個懷孕過程那如果有這個"},{"start":192.092,"end":213.707,"text":"這個法規規定需要進行這個人工流產的部分那也可以照這個相關法令來做辦理目前草案的設計是這個樣子所以這目前裡面草案都有具體的設計好那再來我想問一下接下來就是回到今天的主題根據這個衛福部自己統計的資料這三年的自殺人數節節攀升"},{"start":216.289,"end":229.017,"text":"那其實剛好也是社安網第二期施行的年份等於是社安網二期編列預算後反倒成果越來越差我想要請教一下部長你覺得這次預算不夠還是執行不彰導致效果不好"},{"start":232.215,"end":256.746,"text":"因為從自殺防治中心開始的時候我就是其中裡面的一個一員所以我們就知道大家的努力都可以讓自殺比如說在但我說從結果論來講你看後面三年後面三年你看一下當然這個我們要再分析原因是不是整個社會變遷是預算還是還是因為執行不彰還是可能細節還沒有思考周全"},{"start":258.367,"end":283.409,"text":"說執行不章我個人覺得從自殺防治那些那麼用心多年來的這些精神科醫師團隊的部長其實我想說可能兩者有互相影響因為中央預算中央政府預算明年稅出是3兆1325億那現在卓院長的預算總諮詢的報告中說社安網二期的預算只有75億"},{"start":284.75,"end":286.979,"text":"基本上就是說不到0.24%那我想你認為這樣子的預算夠嗎?"},{"start":291.653,"end":292.213,"text":"你懂我意思嗎?"},{"start":319.963,"end":340.435,"text":"報告委員我想社會安全往事社會所重視的不管是朝野：好所以我想要進一步講的就是這個部長前年修正的精神衛生法即將在今年的12月14日實行那請問部長經衛法的第三條定義很清楚但是幾乎都是圍繞在精神疾病"},{"start":341.235,"end":368.881,"text":"都是圍繞在精神疾病但是心理健康促進卻是沒有被定義的部長治療基本上已經是最末端的處理但是中階段的預防剛剛講到中階段預防和最初階段的心理健康促進卻沒有被明確的定義清楚那請教部長現在修法當然是可能已經是來不及也不可能但是亡羊補牢還是有機會是不是可以用這個修正施行細則的方式把心理健康促進放進去"},{"start":369.96,"end":394.513,"text":"謝謝委員的指教對沒錯我們就是要在精神衛生法施行記者裡面納入心理健康促進是很好啊因為2022年WHO最新的世界心理報告第6.1章節標題就是心理健康促進跟普遍性的預防所以也謝謝這個部長正面回應其實心理健康很重要平常政府就有責任做好心理健康促進"},{"start":395.313,"end":420.06,"text":"不是等到發病或是有狀況之後才來做治療跟危機處理所以這個部分我要提醒這個部長在事情細節的部分要盡速的把它列出來謝謝委員的指教這也是符合剛剛委員所講的WHO的一個趨勢對那另外還有一群人的確是被社安網給忽略的依照這個特殊教育法在在學期間這些自閉症或是有情緒障礙"},{"start":421.22,"end":438.063,"text":"呃"},{"start":440.801,"end":463.183,"text":"我想在...好,部長就是對啦好不好我跟你講,就是這樣子啦是是是所以這群人如果沒有去做這個鑑定的話那他其實福利無法獲取之外更重要是社政單位就會漏接所以我在這裡要告訴部長的是如果他們回到社區沒有足夠的支持跟支持管道的時候他就比較容易發生憾事了"},{"start":464.427,"end":483.085,"text":"所以部長這部分我想要問你們,你們有什麼方法去加強嗎?加強宣導或者是在校的輔導對象要追蹤這個部分?這部分是不是可以去進一步的去做宣導跟追蹤?你們現在有考慮到這件事情嗎?"},{"start":484.912,"end":485.052,"text":"貪寇的問題喔"},{"start":504.386,"end":516.673,"text":"部長你當立委的時候其實針對健保攤扣對當時的反正當時的部長提出質詢所以我想你應該非常清楚攤扣那部長請問你認同和支持攤扣的做法嗎"},{"start":519.332,"end":541.48,"text":"因為在總額制度之下真的就是在一定的總額然後成長力如果有限可是醫療的需求對但部長您當初也是有質詢這個我知道醫療需求一直暴漲所以會絕對會呈現點子下降的一種趨勢那如果讓點子不要那麼明顯的下降可能會用不管是"},{"start":542.32,"end":565.456,"text":"部長所以你知道這個很有趣喔我等一下還講到喔我覺得這是醫院真的醫院的痛啦對嘛我就想要問一下這個邏輯是有問題的對不對臺北區的醫院是採取探戶嘛事後探戶那所以當那當然所以我想問部長你是認同這個嗎很多很多的"},{"start":567.217,"end":584.447,"text":"問題是在有限的資源裡面也尊重各區的一個自主管理但是你本人是不是不認同和不支持的我當然是希望健保能夠永續因為各位委員報告因為我們還是要有時候要站在人民"},{"start":584.787,"end":588.068,"text":"其實簡單來講這個貪扣的部分就是好像是假設健保是買方那醫院算是賣方"},{"start":602.699,"end":619.5,"text":"其實也算是付錢的一方啦健保的部分嘛所以如果一般商品賣方不符合這些商品的這個品質啊或是他的產出有問題那你當然可以要求他驗收不合格退貨可是部長你用貪扣的方式啊你是等於是代表你要求所有的賣家一起減價這個收受"},{"start":621.903,"end":644.24,"text":"所以您也知道這個就是這個概念嘛 對不對所以這樣子的攤扣制度就會讓這些公司立意願他的不只是無所適從可能會導致他所有經營上面的困難包含著我們後面會提到非常多但我想就不一一贅述但是基本上根據立法院這個決議當初的主決議就是要達到0.95對不對"},{"start":646.181,"end":675.501,"text":"那如果說依照憲法規定我們通過的事情行政院只能遵守或是經總統何可提出復議那因此我們在提的這個主決議0.95等於1點這個就是勢必勢在必行不可以有折扣但是實務上你們現在除了公務預算的挹注但是實務上你們卻提高了這個攤扣的金額處理方式我們也接到很多陳情有某醫院他去年同期努力服務成長的金額幾乎全額被扣除"},{"start":676.321,"end":695.822,"text":"好那還要再倒扣約50%那點值上你說好像我用這種方式去提高了點值但實際上其實是倒貼的部分所以我想要跟你講你看這個是你們全民健保這個這個各種額部門的結算結果他直接在上面寫攤扣後我想請問部長你有攤扣前的數據嗎你們有公佈攤扣前的數據嗎"},{"start":698.425,"end":698.585,"text":"〔廖偉翔發言〕"},{"start":716.992,"end":719.234,"text":"貪扣這個詞其實是一個很大的問題貪扣請問有法律授權嗎有依法有據嗎"},{"start":739.961,"end":765.897,"text":"這個就是各區自主管理的一個機制所以其實是沒有法源嘛對不對像臺北市的臺北區的基層點子比較低所以後來發現說好部長高價的要把他打走這樣子就是沒有法源嘛對不對所以比如說健保啊醫療院所是不是有依據健保法全民健康這個保險醫事服務機構特約及管理辦法訂定合約成為特約醫事服務機構那"},{"start":768.538,"end":786.845,"text":"請問簽約的合約範本上任何有跟攤扣有關的規定嗎?我還是要講這個,就是你就是沒有法約嗎?不管是攤扣或者是先各醫院總額,像南區就是醫院總額嘛。沒有,部長你要回答我問題啊。都是自己的精神啊。在這個簽約的合約範本裡面有沒有?是不是沒有?"},{"start":788.416,"end":794.182,"text":"全民健康保險醫療費用申報與核負及醫療服務審查辦法裡面其實是有一個叫做健保核三的法源依據但是完全沒有攤扣相關的規定"},{"start":807.455,"end":833.004,"text":"所以這會變成是政府可以用一紙命令就扣錢就扣這個就合扣費用嗎其實這我還是要回過頭來講這樣子的問題就是導致現在這個醫院或是醫療院所經營上面的問題那你可能導致他們在採購或甚至現在要發年終然後因為你攤扣後的數字完全跟他經營上面對不起來所以變成他們很困難甚至間接也導致這個醫護他在家"},{"start":834.384,"end":836.846,"text":"這個問題其實也蠻久的然後你們嘴巴上都一直說很重視很重視可是你完全沒有解方啊"},{"start":863.684,"end":893.204,"text":"還有我們當時會訂總額的制度除非我們好好來檢討總額這件事情我會請部長因為時間請你深入瞭解貪扣的法律授權還有瞭解貪扣對於公司我想其實這個部分你很清楚公司營業經營的影響還有貪扣是否對於醫護人員工作獎金發放設備購置甚至這個醫療投資人員禁用等等的進行全方面的瞭解"},{"start":894.726,"end":903.819,"text":"我想你們在這部分應該是很清楚所以我其實就是要跟你說你們是這個攤扣是沒有法源依據的請部長深入了解一下攤扣法律授權好不好"},{"start":905.437,"end":921.832,"text":"好 這個沒問題但是就是說其實在管理方面是各區自主性的管理的精神那你可不可以針對我說的這個問題給我一個簡單的說明給我一份報告說你們的授權到底在哪裡還是你們覺得這個到底有沒有法律我們會回答回答委員謝謝 謝謝委員關心謝謝 謝謝廖委員 謝謝部長"}]}}},"gazette":{"lineno":290,"blocks":[["廖委員偉翔：（10時2分）謝謝主席，請邱部長。"],["主席：部長請。"],["邱部長泰源：委員好。"],["廖委員偉翔：部長好、部長早安。"],["邱部長泰源：早。"],["廖委員偉翔：我想先問一下，針對人工生殖法修正草案是否有明確的立法時間表？預計何時能夠完成立法？"],["邱部長泰源：因為預告時有六百多則意見，基本上以代理孕母這部分比較多，所以我們開了十幾場會議，希望能在11月底送行政院。"],["廖委員偉翔：預計在11月底送行政院？好，OK。","第二個，無償代孕中如何確保代理孕母的自主權？對於營養費上限的設定是否足夠？會不會出現商業化的漏洞？這部分可不可以請部長指教一下？"],["邱部長泰源：這就是大家一直關注的……"],["廖委員偉翔：所以我想問一下目前你們的評估狀況及要怎麼做？"],["邱部長泰源：我們現在訂出來的標準……其實目前還在討論與研議當中，但初步來看，所訂出來的都非常保護母體、母親，就是懷孕……"],["廖委員偉翔：所以你覺得到底要怎麼確保其自主權？營養費上限是否足夠？以及會不會出現商業化漏洞這三個問題？"],["邱部長泰源：這部分請國健署幫忙說明。"],["蔡副組長維誼：跟委員報告，以目前修法草案的設計來說，代孕是以無償方式去進行的，也就是禁止商業代孕。至於相關費用部分，未來修法通過後，我們會與專家做相關的研訂跟……"],["廖委員偉翔：所以目前還沒有考慮到這些事情？等於細節上還沒有比較明確的……"],["蔡副組長維誼：給予的給付與保護項目已經列入，但多少錢等細節部分，還要再跟相關專家與團體做討論。"],["廖委員偉翔：你覺得這部分會不會出現商業化漏洞？"],["蔡副組長維誼：剛剛部長也談到，我們還是以代理孕母的保護為優先，儘量去做比較周全的考量。"],["廖委員偉翔：再來，如果代孕過程中出現醫療風險或法規爭議的話，請問衛福部將如何處理與調解？"],["蔡副組長維誼：現在草案的設計是要求代孕部分要進行相關評估，也有代孕服務機構的機制設計在內，包括剛剛提到的法律部分。另外，也要投保人身保險及健康保險，若有相關問題發生的話，在保險上也能獲得給付。在整個懷孕過程中，若有法規規定需要進行人工流產，也可以照相關法令辦理，目前草案的設計是這樣子。"],["廖委員偉翔：目前草案裡都有……"],["蔡副組長維誼：都已經有具體設計了。"],["廖委員偉翔：接下來就是回到今天的主題。根據衛福部的統計資料顯示，這三年的自殺人數節節攀升，今年剛好也是社安網第二期施行的年份，等於社安網二期編列預算後，成果反而越來越差。請教部長，你覺得這是預算不夠，還是執行不彰，導致效果不好？"],["邱部長泰源：從自殺防治中心開始設置時，我就是其中一員，所以我們知道透過大家的努力可以讓自殺……譬如說100年就下降了……"],["廖委員偉翔：以結果論來講，你看看後面三年……"],["邱部長泰源：這個我們當然要再分析原因，看是不是社會變遷……"],["廖委員偉翔：是預算還是因為執行不彰？還是細節沒有思考周全？"],["邱部長泰源：說執行不彰……我個人覺得從自殺防治來說，多年來這些精神科醫師、團隊那麼用心在……"],["廖委員偉翔：部長，我想可能兩者互有影響。中央政府總預算明年歲出是3兆1,325億，但卓院長在總預算報告中提到的社安網二期預算只有75億，不到0.24%，你認為這樣子的預算夠嗎？尤其面對隨機殺人事件，政府不編足社會安全網預算，好及早發現高危險族群對象，反倒在發生遺憾事情後，才用嚴刑峻法去處罰！以鄭捷為例，政府用一顆子彈的預算、一顆子彈的經費，把應該要負擔和維護社會安全，促進心理健康的責任一槍終結，你懂我意思嗎？"],["邱部長泰源：報告委員，社會安全網是社會所重視的，不管是朝野……"],["廖委員偉翔：我想要進一步講的就是這個。部長，前年修正的精神衛生法即將在今年12月14日施行，精衛法第三條雖然定義得很清楚，卻幾乎都圍繞在精神疾病上，而心理健康促進卻沒有被定義！治療基本上已經是最末端的處理，中階段的預防和最初階段的心理健康促進並沒有被明確定義清楚。請教部長，現在修法當然已經來不及，也不可能了，不過還是有機會亡羊補牢，是不是可以用修正施行細則的方式把心理健康促進放進去？"],["邱部長泰源：謝謝委員的指教。對，沒錯，我們就是要在精神衛生法施行細則裡納入心理健康促進……"],["廖委員偉翔：很好！2022年WHO最新的世界心理報告第6.1章節標題就是心理健康促進跟普遍性的預防，所以謝謝部長的正面回應。其實心理健康很重要，政府平常就有責任做好心理健康促進……"],["邱部長泰源：謝謝委員指教。"],["廖委員偉翔：不是等到發病或有狀況後才來做治療跟危機處理，所以這部分我要提醒部長，在施行細節上要儘速列出來。"],["邱部長泰源：謝謝委員指教，這也符合剛剛委員所講WHO的趨勢。"],["廖委員偉翔：其實另外還有一群人被社安網給忽略了！依照特殊教育法規定，自閉症或有情緒障礙者於就學期間都有學校老師給予輔導。我想請問部長，這些人一旦畢業，若他們沒有做身心障礙鑑定的話，那麼在身分上是不是就不會列入身心障礙族群，對嗎？"],["邱部長泰源：我想在……"],["廖委員偉翔：部長，我告訴你，就是這樣子！"],["邱部長泰源：是、是。"],["廖委員偉翔：這群人如果沒做鑑定的話，除了無法獲取福利外，更重要是社政單位會漏接！所以我在這裡要告訴部長，如果他們回到社區沒有足夠的支持與支持管道時，就比較容易發生憾事！這部分我想問部長，你們有什麼方法可以加強宣導，或追蹤在校輔導對象？"],["邱部長泰源：謝謝委員，我想我們請……"],["廖委員偉翔：這部分是不是可以進一步做宣導與追蹤？你們現在有考慮到這件事情嗎？"],["邱部長泰源：好，我們一定……"],["廖委員偉翔：你們現在有考慮到這件事情嗎？看起來是目前沒有，對不對？所以這部分本席提出來，是不是可以請你們回去了解、研究、評估一下，告訴本席這個部分要怎麼處理？"],["邱部長泰源：好，沒問題。"],["廖委員偉翔：再來我要討論攤扣的問題，部長，你當立委的時候，曾針對健保攤扣對當時的部長提出質詢，所以我想你應該非常清楚攤扣，請問部長，你認同和支持攤扣的作法嗎？"],["邱部長泰源：因為在總額制度之下，總額一定，成長力如果有限，可是醫療的需求……"],["廖委員偉翔：但是部長您當初也是有質詢這個……"],["邱部長泰源：我知道，醫療需求一直暴漲，所以絕對會呈現點值下降的一種趨勢，那如果讓點值不要那麼明顯的下降，可能會用不管是斷頭或斷尾……"],["廖委員偉翔：部長，所以你知道這個很有趣喔，我等一下要講到……"],["邱部長泰源：沒有，沒有，我覺得這真的是醫院的痛……"],["廖委員偉翔：對嘛，我就想要問一下，這個邏輯是有問題的，對不對？"],["邱部長泰源：像臺北區的醫院是採取事後攤扣，所以當然……"],["廖委員偉翔：所以我想問部長，你是認同、支持嗎？"],["邱部長泰源：要做很多很多的……問題是在有限的資源裡也尊重……"],["廖委員偉翔：所以其實你本身是不認同的，對不對？不認同和不支持的。"],["邱部長泰源：我尊重各區的自主管理。"],["廖委員偉翔：但是你本人是不是不認同和不支持的？"],["邱部長泰源：我當然是希望健保能夠永續，跟委員報告，因為我們有時候還是要站在人民……"],["廖委員偉翔：好啦，我們也是站在人民的角度，所以我要跟您報告……"],["邱部長泰源：國家的財務狀況、國家的整體發展，然後我們醫界自己怎麼樣來創造價值。"],["廖委員偉翔：其實簡單來講，這個攤扣的部分就是假設健保是買方，醫院算是賣方，其實也算是付錢的一方，健保的部分，一般商品如果賣方的商品品質或產出有問題，你當然可以要求他，驗收不合格退貨，可是部長，你用攤扣的方式，就等於你要求所有賣家一起減價銷售，您也知道就是這個概念，對不對？所以這樣子的攤扣制度，就會讓這些公私立醫院不只是無所適從，可能會導致它經營上的困難，我們後面會提到非常多，我就不一一贅述。但是基本上根據立法院當初的主決議，就是要達到0.95，對不對？依照憲法規定，我們通過的事情行政院只能遵守或是經總統核可提出覆議，因此，我們提的0.95等於1點這個主決議就是勢在必行，不可以有折扣，但是你們現在除了公務預算的挹注，實務上你們卻以提高攤扣金額的處理方式。我們也接到很多陳情，某醫院去年同期努力服務成長的金額幾乎全額被扣除，還要再倒扣約50%，點值上你說你用這種方式去提高了點值，但實際上其實是倒貼的部分。所以我想要跟你講，你看這是你們全民健保各總額部門的結算結果，你們直接在上面寫「攤扣後」，我想請問部長，你有攤扣前的數據嗎？你們有公布攤扣前的數據嗎？我想這才可以讓人家了解這個點值真正發生了什麼問題。你現在就只有這個攤扣後的數據？"],["邱部長泰源：攤扣前、攤扣後應該都有資料。"],["廖委員偉翔：沒有，攤扣後有啊，我問你攤扣前有沒有？因為你這都是攤扣完的資料，所以沒有辦法真實的反映健保點值到底多少……"],["邱部長泰源：處理的時候一定有攤扣前，怎麼樣攤扣給其他可能比較小的醫院……"],["廖委員偉翔：對，但我的意思是你們公開資料沒有……"],["邱部長泰源：所以應該資料都有吧。"],["廖委員偉翔：攤扣前的也有嗎？"],["邱部長泰源：應該有。"],["廖委員偉翔：那可不可以給本席攤扣前的資料？"],["邱部長泰源：可以，沒問題。"],["廖委員偉翔：但是我想要問一件事，攤扣這個詞其實是一個很大的問題，攤扣請問有法律授權嗎？依法有據嗎？"],["邱部長泰源：這個就是各區自主管理的一個機制。"],["廖委員偉翔：所以其實是沒有法源嘛，對不對？"],["邱部長泰源：像臺北區基層點值比較低，所以後來發現說有些太高，要把它打折這樣……"],["廖委員偉翔：好，部長，我知道，所以基本上就是沒有法源，對不對？譬如健保醫療院所是不是有依據健保法、全民健康保險醫事服務機構特約及管理辦法訂定合約成為特約醫事服務機構，那請問簽約的合約範本上有任何跟攤扣有關的規定嗎？我還是要講這個，其實你就是沒有法源。"],["邱部長泰源：不管是攤扣或者是各醫院總額，像南區就是醫院總額……"],["廖委員偉翔：部長，你要回答我的問題。"],["邱部長泰源：都是自主的精神。"],["廖委員偉翔：在簽約的合約範本裡面有沒有？是不是沒有？"],["邱部長泰源：簽約的合約裡面應該是沒有提到這個。"],["廖委員偉翔：沒有這個詞嘛，對不對？"],["邱部長泰源：都是自主管理。"],["廖委員偉翔：全民健康保險醫療費用申報與核付及醫療服務審查辦法裡面，其實有一個叫做健保核刪的法源依據，但是完全沒有攤扣的相關規定，所以這就變成是政府可以用一紙命令就核扣費用嗎？我還是要回過頭來講，這樣子的問題就會導致現在醫院或醫療院所經營上面的問題，可能導致他們在採購甚至現在要發年終，因為攤扣後的數字完全跟他經營上的數字對不起來，所以變成他們很困難，甚至間接也導致醫護年終的部分可能受到影響。我看你們也頻頻點頭，你們是知道這個狀況的。"],["邱部長泰源：沒有，我們非常重視醫護人員、醫事人員的薪資跟工作環境，當然也希望醫療院所能夠順暢的來運作，健保的資源有限，怎麼樣讓各區自主管理，所以我們並沒有明定它用什麼方式。"],["廖委員偉翔：部長，這個問題其實也蠻久的，你們嘴巴上都一直說很重視，可是完全沒有解方。"],["邱部長泰源：還有我們當時會訂總額的制度，除非我們好好來檢討總額這件事情……"],["廖委員偉翔：我可不可以請部長，因為時間的關係，請你深入了解攤扣的法律授權。"],["邱部長泰源：好。"],["廖委員偉翔：還有了解攤扣對公私醫院營業經營的影響，我想其實這個部分你很清楚，攤扣是否對於醫護人員工作獎金發放、設備購置，甚至醫療投資、人員進用等等，進行全方面的了解。"],["邱部長泰源：好。"],["廖委員偉翔：我想你們在這部分應該是很清楚，我其實就是要跟你說，你們這個攤扣是沒有法源依據的，請部長深入了解一下攤扣的法律授權，好不好？"],["邱部長泰源：好，這個沒問題，但是就是在管理方面是各區自主性管理的精神，所以……"],["廖委員偉翔：那你可不可以針對我說的這個問題，給我一個簡單的說明？給我一份報告說你們的授權到底在哪裡，還是這個到底有沒有法律依據。"],["邱部長泰源：我們會回答委員，謝謝委員關心。"],["主席：謝謝廖委員，謝謝部長，應該是違法。","接下來請邱鎮軍委員質詢，我們在涂權吉委員質詢完畢之後，休息10分鐘。"]],"agenda":{"page_end":272,"meet_id":"委員會-11-2-26-7","speakers":["蘇清泉","陳昭姿","陳菁徽","林月琴","廖偉翔","邱鎮軍","涂權吉","王正旭","鍾佳濱","林國成","楊瓊瓔","林淑芬","賴士葆","黃秀芳","陳雪生","王育敏","劉建國","牛煦庭","楊曜","陳瑩","黃國昌","盧縣一"],"page_start":199,"meetingDate":["2024-11-04"],"gazette_id":"1139301","agenda_lcidc_ids":["1139301_00004"],"meet_name":"立法院第11屆第2會期社會福利及衛生環境委員會第7次全體委員會議紀錄","content":"一、繼續處理中華民國113年度中央政府總預算有關衛生福利部主管預算凍結報告案1案；二、邀\n請衛生福利部部長針對「社區精神病患照護優化」進行專題報告，並備質詢","agenda_id":"1139301_00003"}}}