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\"score\": 0.9}, {\"word\": \"安\", \"start\": 1291.656, \"end\": 1291.877, \"score\": 0.906}, {\"word\": \"疑\", \"start\": 1291.877, \"end\": 1292.377, \"score\": 0.914}, {\"word\": \"慮\"}, {\"word\": \"的\", \"start\": 1292.377, \"end\": 1292.537, \"score\": 0.995}, {\"word\": \"那\", \"start\": 1292.537, \"end\": 1292.698, \"score\": 0.868}, {\"word\": \"些\", \"start\": 1292.698, \"end\": 1293.158, \"score\": 0.928}, {\"word\": \"醫\"}, {\"word\": \"院\", \"start\": 1293.158, \"end\": 1293.398, \"score\": 0.976}, {\"word\": \"的\", \"start\": 1293.398, \"end\": 1293.678, \"score\": 0.927}, {\"word\": \"資\"}, {\"word\": \"料\", \"start\": 1293.678, \"end\": 1294.359, \"score\": 0.904}, {\"word\": \"一\", \"start\": 1294.359, \"end\": 1294.619, \"score\": 0.888}, {\"word\": \"個\"}, {\"word\": \"月\", \"start\": 1294.619, \"end\": 1294.98, \"score\": 0.887}, {\"word\": \"內\"}, {\"word\": \"提\", \"start\": 1294.98, \"end\": 1295.16, \"score\": 0.905}, {\"word\": \"供\", \"start\": 1295.16, \"end\": 1295.34, \"score\": 0.99}, {\"word\": \"好\", \"start\": 1295.34, \"end\": 1295.36, \"score\": 0.0}, {\"word\": \"沒\", \"start\": 1295.36, \"end\": 1295.38, \"score\": 0.0}, {\"word\": \"問\"}, {\"word\": \"題\"}, {\"word\": \"謝\"}, {\"word\": \"謝\"}], \"language\": \"zh\"}","srt":"1\n00:00:17,298 --> 00:00:20,340\n好,謝謝主席。是不是要請我們邱部長?部長,10月9號的時候我在這裡質詢過你就是說衛福部有沒有去盤點目前有公安問題的醫院有幾家因為我當時就說了根據醫策會網站106到112年醫院評鑑及教學醫院評鑑合格名單一共有417家\n\n2\n00:00:46,175 --> 00:01:06,614\n而醫院評鑑效期到今年12月31到期的這個醫院要重新做評鑑的有117家換言之有四分之一的加數將在今年年底都要做那甚至有的已經開始做了就像我們從之前講的失火的醫院事實上也都做了\n\n3\n00:01:07,955 --> 00:01:12,361\n那你們到底有沒有掌握117家醫院有沒有跟我們屏東失火的醫院一樣有一些管線的問題啦、疏散動線的問題啊這種公安的問題的存在\n\n4\n00:01:23,877 --> 00:01:43,434\n那如果有的話已經有前車之鑒我在10月9號也談一次現在又談一次那我要問你說有到底有問題的有幾家我沒有問你是哪幾家我問的是一共有幾家而評鑒結果出來以前如果有一些問題那你要如何處置\n\n5\n00:01:44,929 --> 00:02:00,694\n好謝謝委員那我的新聞齁那第一個就是說我們相關的事件發生以後我們當然就啟動了補典你直接回答就好了到底有問題還幾經啦你那發言沒有為什麼要談這個呢你知道嗎你們從10月9號我補典你也當請聽話你們從10月9號我質詢問你到現在你們連回答都沒回答\n\n6\n00:02:12,757 --> 00:02:16,179\n將近一個月了,連書面的資料都沒有。你們當我們立法院是啥?我們都在這裡問你,你沒說。結束了質詢,也沒有任何書面資料提供給我們。所以你們現在是裝睡的人叫不行嗎?還是說直接就不予理會,立法院立委的質詢直接忽略?\n\n7\n00:02:34,810 --> 00:02:52,236\n所以今天在這裡我再問你一次你到底能不能告訴我有哪幾一共有多少的醫院有病安有公安醫律而你的補強作為是什麼你們到底盤點了沒你不要扯東扯西你告訴我到底有多少\n\n8\n00:02:53,584 --> 00:03:04,692\n因為這個事務應該是要地方政府跟消防局方面阿你以為在這裡諮詢過你們,你們都沒有去盤點,沒有跟地方聯絡,你們醫政會都沒有去看一下所以在這裡告別人才會公認就沒有了嗎?你不是也質詢在這裡當一回事嗎?\n\n9\n00:03:13,629 --> 00:03:20,994\n你告訴我這個答案是什麼?立委從10月9號問你到現在將近一個月了,你們現在還是回答不出來?保證你是說什麼?還是沒有掌握?有類似病安或公安疑慮的,有管線問題有疏散動線問題這種公安疑慮的\n\n10\n00:03:41,394 --> 00:03:44,536\n我們當然很關心117家有幾家我們很關心醫院的一個保定你答非所問不要在這裡胡說八道我現在問你是一共有幾家有公安的疑慮啦這個恐怕要再調查一下10月9號問你到現在還在恐怕要調查10月9號諮詢過一次了勒所以這個是不曉得你們是\n\n11\n00:04:10,953 --> 00:04:16,057\n我們會去調查各個地方政府還有消防局他們所調查的結果對啦,什麼時候可以給答案一個月之內好了\n\n12\n00:04:33,251 --> 00:04:40,354\n好就再給你一個月希望在一個月裡面大家都平安那我現在不是要繼續談這個我現在要談的是說你們從去年7月1號去年衛福部調整了部分負擔的心智針對門診藥品部分負擔還有急診的部分負擔進行調整\n\n13\n00:04:53,280 --> 00:05:15,094\n你們的目的是說要落實分級醫療、珍惜健保資源事實上你們就是希望我們解決急診擁捨還有你們希望大家要分級醫療到地區醫院不要全部擠到這個教學醫院裡面來你們的目的啊就希望大家珍惜醫療資源期待就醫分流解決急診人馬為患的這個狀況然後讓穩定的慢性的病人鼓勵他們到急診診所\n\n14\n00:05:21,138 --> 00:05:28,926\n那在這種狀況裡面我來看一下這個部長實施一年以後已經一年了成效如何?成效如何?\n\n15\n00:05:34,939 --> 00:06:03,012\n實施了以後基層門診的就診案件的戰力從多了有多了不多啦0.22%那慢性病以及診所就醫率從大概增加了4.61%這個也是比較正面的一個成果的確是有改有進步第二個就是改善急診的用篩降幅大概有到達2.27到6.43那當然慢性病處方\n\n16\n00:06:03,872 --> 00:06:09,755\n來來部長我替你回答啦因為你現在照稿念嘛因為你們健保署發布新聞稿有五個觀察有初步的成效第一個促進了分級醫療啦第二個改善了急診擁捨啦第三個避免藥品的浪費啦第四改善付費公平性及健保財務啦第五持續保障弱勢啦這個是你們健保署的\n\n17\n00:06:28,345 --> 00:06:41,569\n新聞稿你們的新聞稿其實是來自於健保會第113年第9次的委員會會議資料就是第一案新制部分負擔監測指標的監測結果及成效檢討報告的內容部長你自己有看過嗎\n\n18\n00:06:46,090 --> 00:06:57,414\n新制的部分負擔你這樣子從你當立委到當部長這樣子一路走來這是一個大的政策因為就是長這個部分負擔嘛那你自己有沒有看過這麼重要的這麼重大的政策上的調整一年的有效還是沒有效你自己有看過這個報告嗎?\n\n19\n00:07:09,582 --> 00:07:10,823\n所以你們有改善來急診勇赦嗎?\n\n20\n00:07:21,854 --> 00:07:47,808\n一統計的數字是有進步來我就跟你分享這一些來來來來來來我自己在7月1號就質詢時就跟你分享有我的朋友的家人在急診區等很久一直遲遲等不到病床結果在急診的急診區直接進行插管治療而且除了我以外王正旭委員今年的\n\n21\n00:07:48,368 --> 00:07:53,832\n也特別提到好多急診量能滿載王委員很客氣然後國民黨的委員也講了那部長當時也有回答說如果你聽台大吳明顯院長講這個急診的時候後床是日常的事情那我們都知道說民眾要問的不是這樣子民眾要問的是要等多久\n\n22\n00:08:15,146 --> 00:08:34,939\n你們認為有改善急診的這個候診時間急診的泳色有改善那為什麼這一年來等待的時間卻越來越長然後呢調整部分負擔叫大家都不要去然後就說\n\n23\n00:08:36,620 --> 00:08:50,011\n一定會改善,而且你們報告說已經有改善,但事實真的那樣子嗎?這個根據健保署的報告,實施條長部分負擔以後,每個人負擔的金額比2022年,這個第一張\n\n24\n00:08:59,502 --> 00:09:25,232\n比2022年來比增加了149人價格調漲了沒有錯這一張來但是呢急診的平均每人就醫次數來到2019年來的歷史新高大概幾道急診裡面的次數創下歷史新高反而是負擔金額最低的2022年的平均每人就醫次數是相對低的\n\n25\n00:09:26,152 --> 00:09:26,292\n林淑芬議員\n\n26\n00:09:41,049 --> 00:10:07,466\n平均國人每人就醫到急診就醫的次數創歷史新高你漲了部分負擔了可是就醫的次數創新高那你們說要以價值量的這個政策手段你說是有效啦這個是有效嗎等待的時間增加錢付的更多品質更下降這個政策就是你們說的急診永設有改善嗎\n\n27\n00:10:14,292 --> 00:10:34,350\n謝謝委員指教我了解那個因為會有這樣的趨勢大幅上升阿你們說有效阿他的原因真的是要多元化來分析阿對多元化分析可以好這樣講阿所以你現在又有原因因為可能不是只有一個原因而且這個是不是說我們這樣我們過去也常常在談嘛你到底\n\n28\n00:10:35,171 --> 00:10:40,433\n你講得很好欸可是你們當時告訴人家我就是要以價製量啊我要給你漲部分負擔啊要以價製量一定可以控制急診勇社啊可以導引人民到正確的路上去分級醫療啊你們當時就這樣錢都漲了結果你們的政策目的是什麼漲價是手段欸\n\n29\n00:11:01,539 --> 00:11:25,554\n你是要大家解決急診涌射的狀況要分級醫療的政策能夠落實結果你的目的是這兩個政策有達到嗎?你的新聞稿說你們達到了所以我問你有達到嗎?你現在要說淡書了我想我們多年來一直在推展分級醫療改善體系我想...我原來...我不要說這個數據就好他提出這個...五年提出這個方法並不是我...\n\n30\n00:11:33,119 --> 00:11:36,722\n你不要為那個政策買單的意思?那你要調整嗎?不是,我應該是要改善加強基層...\n\n31\n00:11:47,149 --> 00:11:50,211\n我希望民眾真的要相信我們基層醫師基層醫師的能力基層醫療的可靠性然後信任感是叫人民相信就相信的嗎\n\n32\n00:12:03,686 --> 00:12:32,380\n你用什麼有效的手段然後再講下一張醫學中心的急診申報件數從疫情以來都是有增無減調整部分負擔以後急診申報件數也是創新高而相對的地區醫院從疫情以來的戰略卻來到新低所以你們自己說我們解決了其實你比較的年度是比較最差的你說你看綠色的地區醫院成長了你怎麼不比109年\n\n33\n00:12:33,681 --> 00:12:48,943\n你怎麼不比這個112年112年的去年沒有那個COVID-19的疫情啦他還是下降啊對地區醫院基層醫院他的就診率下降欸\n\n34\n00:12:49,964 --> 00:13:03,864\n所以你就要去醫學中心的、急診的、門診的部分負擔但是沒有人民沒有跑到這個急診醫院去反而你來看他粉紅色的醫學中心跟去年比還屢創新高\n\n35\n00:13:06,698 --> 00:13:25,394\n所以在這種狀況裡面難怪有這種民間團體在質疑啊你漲部分負擔只是為了填補這個健保財務空洞可是呢醫療品質沒有提升急診的等待時間越來越長越來越長所以你剛剛講不是漲價可以解決的漲價的手段你不能把它當成目的啊\n\n36\n00:13:35,523 --> 00:13:37,664\n沒有下降啊好再下一張那你們在講說急診減傷戰略你們講說你們有效解決你們剛才那個還報告說健保署還說你們已經解決了這個急診擁捨的狀況我們就來看一般急診我們在減傷一級跟二級我們就看他戰流時間\n\n37\n00:14:01,345 --> 00:14:23,032\n一級跟二級就是要命的啦最急的可是它暫留的時間越來越長而你們自己都知道2019到2024醫學中心急診的相關指標就是減傷一級的急診病人要轉入病房要小於8小時減傷一級要幾分鐘以內馬上立即處理來沒錯減傷一級是多嚴重\n\n38\n00:14:29,097 --> 00:14:49,396\n要立即處理他們要轉入病房內能夠在8個小時裡面轉入不管家戶病房還是什麼病房是時間停留時間他們可以8小時裡面就轉到病房的比例越來越少所以他們都暫留暫留的時間越來越多\n\n39\n00:14:50,217 --> 00:14:55,320\n所以這種狀況裡面急診暫留時間上升然後減傷一級在2024年上半年比2023年的下半年還要多出一個小時來到平均要15.43小時已經是你們建議的8小時的健保品質的兩倍的時間所以上不去所以才有我說的直接在急診區直接插管\n\n40\n00:15:22,498 --> 00:15:39,141\n這像話嗎?像話嗎?以前八小時裡面就轉到病房去然後馬上處理的以前至少五成而且是作五忘六你看作五忘六急診插管是在救命所以是常見的啊當然即使要上病床也要插管最好是沒有感染的風險啦等一下一堆人走到人來人往可以直接好啦沒關係啦你不要跟我說插管的轉移焦點啦\n\n41\n00:15:47,583 --> 00:15:47,863\n林淑芬議員\n\n42\n00:16:17,723 --> 00:16:17,883\n林淑芬\n\n43\n00:16:37,028 --> 00:16:52,763\n那只是部分的一個策略而已,整體的策略才是重要的。好,下一張,來我們再看喔。所以我們來講一下啦齁,你們在這種狀況裡面部分負擔漲了、漲了、漲了,然後再下一張,不是這一張。\n\n44\n00:16:56,104 --> 00:17:16,920\n好,沒關係,我自己講結論好了啦在這種狀況裡面,調整部分募單的政策要以佳質量沒有發生那對分級醫療來講也沒有效,地區醫院、基層醫院看診的、就診的人數越來越少所以沒有發生啊,錢有啊,錢啊\n\n45\n00:17:18,661 --> 00:17:18,721\n林淑芬議員\n\n46\n00:17:38,364 --> 00:17:38,924\n我為了救我的親人我再沒錢我再窮\n\n47\n00:18:05,675 --> 00:18:07,437\n報告委員醫療界如果對於要增加人民負擔我們真的也都不忍心\n\n48\n00:18:32,739 --> 00:18:52,049\n所以大家講說部分負擔叫做殭屍理論啦長部分負擔就被人家稱之為是殭屍理論第二個最後講一個對分級醫療也無效我們剛剛已經講了就是說基層這個在基層門診的就醫建樹占有率在今年\n\n49\n00:19:17,288 --> 00:19:33,313\n聽了這篇新聞稿,調整了參考的年度,然後講了最有利自己的叉子抹粉的政策的有效性。那其實就是要去突顯說你們是有效的假象。這不是保險人應該有的這個應該有應有之局啊。所以部長你剛才講說這個手段恐怕是有問題的。\n\n50\n00:19:40,535 --> 00:19:56,859\n那如果有問題的話,你的檢討政策,你的手段跟結果之間的落差,那你要怎麼調整呢?報告委員,我不是說有問題,我是說在整體的各種策略裡面,它也是一個策略。我剛剛講已經告訴你沒有效啦。那我們都會檢討。我就跟你講,剛剛這些數據我們告訴你沒有效。\n\n51\n00:20:05,097 --> 00:20:31,208\n阿你只是讓人民的荷包變得更扁因為要改善醫療體系不是那麼一個簡單的對非常複雜那你要拿出一個比較有效的手段而不是在那裡讓我們等了更久非常願意來拿出手段那這個要考慮阿你的手段是什麼考慮醫政考慮政府對啦你的手段可能我們在這裡聽一下我們可能的手段會是什麼錢都讓你漲了除了漲錢以外\n\n52\n00:20:32,108 --> 00:20:58,825\n你還有什麼有效的手段我們第一個一定要維護那個病人的品質第二個也要有醫療人員醫療人員也要好的工作環境啊他不是醫療人員也需要薪水也需要好的一個環境第三個醫療院所要你講的這個都是我們的理想你不用講這不是你的政策這個不是政策啦才會來一個一個來看怎麼去達到\n\n53\n00:21:01,207 --> 00:21:06,111\n我們部分負擔在急診從450讓你漲到750內,然後我們這個讓你漲到750,漲這麼多,啊你現在拿不出手段來,你就要趕快宣誓信再念一遍。\n\n54\n00:21:18,443 --> 00:21:35,380\n這不是在這裡虛偽行李如意的在那裡呼嚨立委嗎?好啦我們陳學生立委一直在趕了啦你都書面交一篇書面報告啦還有那個有公安疑慮的那些醫院的資料一個月內提供好沒問題謝謝\n\n","tsv":"start\tend\ttext\n17298\t20340\t好,謝謝主席。是不是要請我們邱部長?部長,10月9號的時候我在這裡質詢過你就是說衛福部有沒有去盤點目前有公安問題的醫院有幾家因為我當時就說了根據醫策會網站106到112年醫院評鑑及教學醫院評鑑合格名單一共有417家\n46175\t66614\t而醫院評鑑效期到今年12月31到期的這個醫院要重新做評鑑的有117家換言之有四分之一的加數將在今年年底都要做那甚至有的已經開始做了就像我們從之前講的失火的醫院事實上也都做了\n67955\t72361\t那你們到底有沒有掌握117家醫院有沒有跟我們屏東失火的醫院一樣有一些管線的問題啦、疏散動線的問題啊這種公安的問題的存在\n83877\t103434\t那如果有的話已經有前車之鑒我在10月9號也談一次現在又談一次那我要問你說有到底有問題的有幾家我沒有問你是哪幾家我問的是一共有幾家而評鑒結果出來以前如果有一些問題那你要如何處置\n104929\t120694\t好 謝謝委員那我的新聞齁那第一個就是說我們相關的事件發生以後我們當然就啟動了補典你直接回答就好了到底有問題還幾經啦你那發言沒有為什麼要談這個呢你知道嗎你們從10月9號我補典你也當請聽話你們從10月9號我質詢問你到現在你們連回答都沒回答\n132757\t136179\t將近一個月了,連書面的資料都沒有。你們當我們立法院是啥?我們都在這裡問你,你沒說。結束了質詢,也沒有任何書面資料提供給我們。所以你們現在是裝睡的人叫不行嗎?還是說直接就不予理會,立法院立委的質詢直接忽略?\n154810\t172236\t所以今天在這裡我再問你一次你到底能不能告訴我有哪幾一共有多少的醫院有病安有公安醫律而你的補強作為是什麼你們到底盤點了沒你不要扯東扯西你告訴我到底有多少\n173584\t184692\t因為這個事務應該是要地方政府跟消防局方面阿你以為在這裡諮詢過你們,你們都沒有去盤點,沒有跟地方聯絡,你們醫政會都沒有去看一下所以在這裡告別人才會公認就沒有了嗎?你不是也質詢在這裡當一回事嗎?\n193629\t200994\t你告訴我這個答案是什麼?立委從10月9號問你到現在將近一個月了,你們現在還是回答不出來?保證你是說什麼?還是沒有掌握?有類似病安或公安疑慮的,有管線問題有疏散動線問題這種公安疑慮的\n221394\t224536\t我們當然很關心117家有幾家我們很關心醫院的一個保定你答非所問不要在這裡胡說八道我現在問你是一共有幾家有公安的疑慮啦這個恐怕要再調查一下10月9號問你到現在還在恐怕要調查10月9號諮詢過一次了勒所以這個是不曉得你們是\n250953\t256057\t我們會去調查各個地方政府還有消防局他們所調查的結果對啦,什麼時候可以給答案一個月之內好了\n273251\t280354\t好就再給你一個月希望在一個月裡面大家都平安那我現在不是要繼續談這個我現在要談的是說你們從去年7月1號去年衛福部調整了部分負擔的心智針對門診藥品部分負擔還有急診的部分負擔進行調整\n293280\t315094\t你們的目的是說要落實分級醫療、珍惜健保資源事實上你們就是希望我們解決急診擁捨還有你們希望大家要分級醫療到地區醫院不要全部擠到這個教學醫院裡面來你們的目的啊就希望大家珍惜醫療資源期待就醫分流解決急診人馬為患的這個狀況然後讓穩定的慢性的病人鼓勵他們到急診診所\n321138\t328926\t那在這種狀況裡面我來看一下這個部長實施一年以後已經一年了成效如何?成效如何?\n334939\t363012\t實施了以後基層門診的就診案件的戰力從多了有多了不多啦0.22%那慢性病以及診所就醫率從大概增加了4.61%這個也是比較正面的一個成果的確是有改有進步第二個就是改善急診的用篩降幅大概有到達2.27到6.43那當然慢性病處方\n363872\t369755\t來來部長我替你回答啦因為你現在照稿念嘛因為你們健保署發布新聞稿有五個觀察有初步的成效第一個促進了分級醫療啦第二個改善了急診擁捨啦第三個避免藥品的浪費啦第四改善付費公平性及健保財務啦第五持續保障弱勢啦這個是你們健保署的\n388345\t401569\t新聞稿你們的新聞稿其實是來自於健保會第113年第9次的委員會會議資料就是第一案新制部分負擔監測指標的監測結果及成效檢討報告的內容部長你自己有看過嗎\n406090\t417414\t新制的部分負擔你這樣子從你當立委到當部長這樣子一路走來這是一個大的政策因為就是長這個部分負擔嘛那你自己有沒有看過這麼重要的這麼重大的政策上的調整一年的有效還是沒有效你自己有看過這個報告嗎?\n429582\t430823\t所以你們有改善來急診勇赦嗎?\n441854\t467808\t一統計的數字是有進步來我就跟你分享這一些來來來來來來我自己在7月1號就質詢時就跟你分享有我的朋友的家人在急診區等很久一直遲遲等不到病床結果在急診的急診區直接進行插管治療而且除了我以外王正旭委員今年的\n468368\t473832\t也特別提到好多急診量能滿載王委員很客氣然後國民黨的委員也講了那部長當時也有回答說如果你聽台大吳明顯院長講這個急診的時候後床是日常的事情那我們都知道說民眾要問的不是這樣子民眾要問的是要等多久\n495146\t514939\t你們認為有改善急診的這個候診時間急診的泳色有改善那為什麼這一年來等待的時間卻越來越長然後呢調整部分負擔叫大家都不要去然後就說\n516620\t530011\t一定會改善,而且你們報告說已經有改善,但事實真的那樣子嗎?這個根據健保署的報告,實施條長部分負擔以後,每個人負擔的金額比2022年,這個第一張\n539502\t565232\t比2022年來比增加了149人價格調漲了沒有錯這一張來但是呢急診的平均每人就醫次數來到2019年來的歷史新高大概幾道急診裡面的次數創下歷史新高反而是負擔金額最低的2022年的平均每人就醫次數是相對低的\n566152\t566292\t林淑芬議員\n581049\t607466\t平均國人每人就醫到急診就醫的次數創歷史新高你漲了部分負擔了可是就醫的次數創新高那你們說要以價值量的這個政策手段你說是有效啦這個是有效嗎等待的時間增加錢付的更多品質更下降這個政策就是你們說的急診永設有改善嗎\n614292\t634350\t謝謝委員指教我了解那個因為會有這樣的趨勢大幅上升阿你們說有效阿他的原因真的是要多元化來分析阿對多元化分析可以好這樣講阿所以你現在又有原因因為可能不是只有一個原因而且這個是不是說我們這樣我們過去也常常在談嘛你到底\n635171\t640433\t你講得很好欸可是你們當時告訴人家我就是要以價製量啊我要給你漲部分負擔啊要以價製量一定可以控制急診勇社啊可以導引人民到正確的路上去分級醫療啊你們當時就這樣錢都漲了結果你們的政策目的是什麼漲價是手段欸\n661539\t685554\t你是要大家解決急診涌射的狀況要分級醫療的政策能夠落實結果你的目的是這兩個政策有達到嗎?你的新聞稿說你們達到了所以我問你有達到嗎?你現在要說淡書了我想我們多年來一直在推展分級醫療改善體系我想...我原來...我不要說這個數據就好他提出這個...五年提出這個方法並不是我...\n693119\t696722\t你不要為那個政策買單的意思?那你要調整嗎?不是,我應該是要改善加強基層...\n707149\t710211\t我希望民眾真的要相信我們基層醫師基層醫師的能力基層醫療的可靠性然後信任感是叫人民相信就相信的嗎\n723686\t752380\t你用什麼有效的手段然後再講下一張醫學中心的急診申報件數從疫情以來都是有增無減調整部分負擔以後急診申報件數也是創新高而相對的地區醫院從疫情以來的戰略卻來到新低所以你們自己說我們解決了其實你比較的年度是比較最差的你說你看綠色的地區醫院成長了你怎麼不比109年\n753681\t768943\t你怎麼不比這個112年112年的去年沒有那個COVID-19的疫情啦他還是下降啊對地區醫院基層醫院他的就診率下降欸\n769964\t783864\t所以你就要去醫學中心的、急診的、門診的部分負擔但是沒有人民沒有跑到這個急診醫院去反而你來看他粉紅色的醫學中心跟去年比還屢創新高\n786698\t805394\t所以在這種狀況裡面難怪有這種民間團體在質疑啊你漲部分負擔只是為了填補這個健保財務空洞可是呢醫療品質沒有提升急診的等待時間越來越長越來越長所以你剛剛講不是漲價可以解決的漲價的手段你不能把它當成目的啊\n815523\t817664\t沒有下降啊好再下一張那你們在講說急診減傷戰略你們講說你們有效解決你們剛才那個還報告說健保署還說你們已經解決了這個急診擁捨的狀況我們就來看一般急診我們在減傷一級跟二級我們就看他戰流時間\n841345\t863032\t一級跟二級就是要命的啦 最急的可是它暫留的時間越來越長而你們自己都知道2019到2024醫學中心急診的相關指標就是減傷一級的急診病人要轉入病房要小於8小時減傷一級要幾分鐘以內馬上立即處理 來 沒錯 減傷一級是多嚴重\n869097\t889396\t要立即處理他們要轉入病房內能夠在8個小時裡面轉入不管家戶病房還是什麼病房是時間停留時間他們可以8小時裡面就轉到病房的比例越來越少所以他們都暫留暫留的時間越來越多\n890217\t895320\t所以這種狀況裡面急診暫留時間上升然後減傷一級在2024年上半年比2023年的下半年還要多出一個小時來到平均要15.43小時已經是你們建議的8小時的健保品質的兩倍的時間所以上不去所以才有我說的直接在急診區直接插管\n922498\t939141\t這像話嗎?像話嗎?以前八小時裡面就轉到病房去然後馬上處理的以前至少五成而且是作五忘六你看作五忘六急診插管是在救命所以是常見的啊當然即使要上病床也要插管最好是沒有感染的風險啦等一下一堆人走到人來人往可以直接好啦沒關係啦你不要跟我說插管的轉移焦點啦\n947583\t947863\t林淑芬議員\n977723\t977883\t林淑芬\n997028\t1012763\t那只是部分的一個策略而已,整體的策略才是重要的。好,下一張,來我們再看喔。所以我們來講一下啦齁,你們在這種狀況裡面部分負擔漲了、漲了、漲了,然後再下一張,不是這一張。\n1016104\t1036920\t好,沒關係,我自己講結論好了啦在這種狀況裡面,調整部分募單的政策要以佳質量沒有發生那對分級醫療來講也沒有效,地區醫院、基層醫院看診的、就診的人數越來越少所以沒有發生啊,錢有啊,錢啊\n1038661\t1038721\t林淑芬議員\n1058364\t1058924\t我為了救我的親人我再沒錢我再窮\n1085675\t1087437\t報告委員醫療界如果對於要增加人民負擔我們真的也都不忍心\n1112739\t1132049\t所以大家講說部分負擔叫做殭屍理論啦長部分負擔就被人家稱之為是殭屍理論第二個最後講一個對分級醫療也無效我們剛剛已經講了就是說基層這個在基層門診的就醫建樹占有率在今年\n1133029\t1156988\t﹗\n1157288\t1173313\t聽了這篇新聞稿,調整了參考的年度,然後講了最有利自己的叉子抹粉的政策的有效性。那其實就是要去突顯說你們是有效的假象。這不是保險人應該有的這個應該有應有之局啊。所以部長你剛才講說這個手段恐怕是有問題的。\n1180535\t1196859\t那如果有問題的話,你的檢討政策,你的手段跟結果之間的落差,那你要怎麼調整呢?報告委員,我不是說有問題,我是說在整體的各種策略裡面,它也是一個策略。我剛剛講已經告訴你沒有效啦。那我們都會檢討。我就跟你講,剛剛這些數據我們告訴你沒有效。\n1205097\t1231208\t阿你只是讓人民的荷包變得更扁因為要改善醫療體系不是那麼一個簡單的對 非常複雜那你要拿出一個比較有效的手段而不是在那裡讓我們等了更久非常願意來拿出手段那這個要考慮阿你的手段是什麼考慮醫政考慮政府對啦你的手段可能我們在這裡聽一下我們可能的手段會是什麼錢都讓你漲了除了漲錢以外\n1232108\t1258825\t你還有什麼有效的手段我們第一個一定要維護那個病人的品質第二個也要有醫療人員醫療人員也要好的工作環境啊他不是醫療人員也需要薪水也需要好的一個環境第三個醫療院所要你講的這個都是我們的理想你不用講這不是你的政策這個不是政策啦才會來一個一個來看怎麼去達到\n1261207\t1266111\t我們部分負擔在急診從450讓你漲到750內,然後我們這個讓你漲到750,漲這麼多,啊你現在拿不出手段來,你就要趕快宣誓信再念一遍。\n1278443\t1295380\t這不是在這裡虛偽行李如意的在那裡呼嚨立委嗎?好啦我們陳學生立委一直在趕了啦你都書面交一篇書面報告啦還有那個有公安疑慮的那些醫院的資料一個月內提供好沒問題謝謝\n","txt":"好,謝謝主席。是不是要請我們邱部長?部長,10月9號的時候我在這裡質詢過你就是說衛福部有沒有去盤點目前有公安問題的醫院有幾家因為我當時就說了根據醫策會網站106到112年醫院評鑑及教學醫院評鑑合格名單一共有417家\n而醫院評鑑效期到今年12月31到期的這個醫院要重新做評鑑的有117家換言之有四分之一的加數將在今年年底都要做那甚至有的已經開始做了就像我們從之前講的失火的醫院事實上也都做了\n那你們到底有沒有掌握117家醫院有沒有跟我們屏東失火的醫院一樣有一些管線的問題啦、疏散動線的問題啊這種公安的問題的存在\n那如果有的話已經有前車之鑒我在10月9號也談一次現在又談一次那我要問你說有到底有問題的有幾家我沒有問你是哪幾家我問的是一共有幾家而評鑒結果出來以前如果有一些問題那你要如何處置\n好 謝謝委員那我的新聞齁那第一個就是說我們相關的事件發生以後我們當然就啟動了補典你直接回答就好了到底有問題還幾經啦你那發言沒有為什麼要談這個呢你知道嗎你們從10月9號我補典你也當請聽話你們從10月9號我質詢問你到現在你們連回答都沒回答\n將近一個月了,連書面的資料都沒有。你們當我們立法院是啥?我們都在這裡問你,你沒說。結束了質詢,也沒有任何書面資料提供給我們。所以你們現在是裝睡的人叫不行嗎?還是說直接就不予理會,立法院立委的質詢直接忽略?\n所以今天在這裡我再問你一次你到底能不能告訴我有哪幾一共有多少的醫院有病安有公安醫律而你的補強作為是什麼你們到底盤點了沒你不要扯東扯西你告訴我到底有多少\n因為這個事務應該是要地方政府跟消防局方面阿你以為在這裡諮詢過你們,你們都沒有去盤點,沒有跟地方聯絡,你們醫政會都沒有去看一下所以在這裡告別人才會公認就沒有了嗎?你不是也質詢在這裡當一回事嗎?\n你告訴我這個答案是什麼?立委從10月9號問你到現在將近一個月了,你們現在還是回答不出來?保證你是說什麼?還是沒有掌握?有類似病安或公安疑慮的,有管線問題有疏散動線問題這種公安疑慮的\n我們當然很關心117家有幾家我們很關心醫院的一個保定你答非所問不要在這裡胡說八道我現在問你是一共有幾家有公安的疑慮啦這個恐怕要再調查一下10月9號問你到現在還在恐怕要調查10月9號諮詢過一次了勒所以這個是不曉得你們是\n我們會去調查各個地方政府還有消防局他們所調查的結果對啦,什麼時候可以給答案一個月之內好了\n好就再給你一個月希望在一個月裡面大家都平安那我現在不是要繼續談這個我現在要談的是說你們從去年7月1號去年衛福部調整了部分負擔的心智針對門診藥品部分負擔還有急診的部分負擔進行調整\n你們的目的是說要落實分級醫療、珍惜健保資源事實上你們就是希望我們解決急診擁捨還有你們希望大家要分級醫療到地區醫院不要全部擠到這個教學醫院裡面來你們的目的啊就希望大家珍惜醫療資源期待就醫分流解決急診人馬為患的這個狀況然後讓穩定的慢性的病人鼓勵他們到急診診所\n那在這種狀況裡面我來看一下這個部長實施一年以後已經一年了成效如何?成效如何?\n實施了以後基層門診的就診案件的戰力從多了有多了不多啦0.22%那慢性病以及診所就醫率從大概增加了4.61%這個也是比較正面的一個成果的確是有改有進步第二個就是改善急診的用篩降幅大概有到達2.27到6.43那當然慢性病處方\n來來部長我替你回答啦因為你現在照稿念嘛因為你們健保署發布新聞稿有五個觀察有初步的成效第一個促進了分級醫療啦第二個改善了急診擁捨啦第三個避免藥品的浪費啦第四改善付費公平性及健保財務啦第五持續保障弱勢啦這個是你們健保署的\n新聞稿你們的新聞稿其實是來自於健保會第113年第9次的委員會會議資料就是第一案新制部分負擔監測指標的監測結果及成效檢討報告的內容部長你自己有看過嗎\n新制的部分負擔你這樣子從你當立委到當部長這樣子一路走來這是一個大的政策因為就是長這個部分負擔嘛那你自己有沒有看過這麼重要的這麼重大的政策上的調整一年的有效還是沒有效你自己有看過這個報告嗎?\n所以你們有改善來急診勇赦嗎?\n一統計的數字是有進步來我就跟你分享這一些來來來來來來我自己在7月1號就質詢時就跟你分享有我的朋友的家人在急診區等很久一直遲遲等不到病床結果在急診的急診區直接進行插管治療而且除了我以外王正旭委員今年的\n也特別提到好多急診量能滿載王委員很客氣然後國民黨的委員也講了那部長當時也有回答說如果你聽台大吳明顯院長講這個急診的時候後床是日常的事情那我們都知道說民眾要問的不是這樣子民眾要問的是要等多久\n你們認為有改善急診的這個候診時間急診的泳色有改善那為什麼這一年來等待的時間卻越來越長然後呢調整部分負擔叫大家都不要去然後就說\n一定會改善,而且你們報告說已經有改善,但事實真的那樣子嗎?這個根據健保署的報告,實施條長部分負擔以後,每個人負擔的金額比2022年,這個第一張\n比2022年來比增加了149人價格調漲了沒有錯這一張來但是呢急診的平均每人就醫次數來到2019年來的歷史新高大概幾道急診裡面的次數創下歷史新高反而是負擔金額最低的2022年的平均每人就醫次數是相對低的\n林淑芬議員\n平均國人每人就醫到急診就醫的次數創歷史新高你漲了部分負擔了可是就醫的次數創新高那你們說要以價值量的這個政策手段你說是有效啦這個是有效嗎等待的時間增加錢付的更多品質更下降這個政策就是你們說的急診永設有改善嗎\n謝謝委員指教我了解那個因為會有這樣的趨勢大幅上升阿你們說有效阿他的原因真的是要多元化來分析阿對多元化分析可以好這樣講阿所以你現在又有原因因為可能不是只有一個原因而且這個是不是說我們這樣我們過去也常常在談嘛你到底\n你講得很好欸可是你們當時告訴人家我就是要以價製量啊我要給你漲部分負擔啊要以價製量一定可以控制急診勇社啊可以導引人民到正確的路上去分級醫療啊你們當時就這樣錢都漲了結果你們的政策目的是什麼漲價是手段欸\n你是要大家解決急診涌射的狀況要分級醫療的政策能夠落實結果你的目的是這兩個政策有達到嗎?你的新聞稿說你們達到了所以我問你有達到嗎?你現在要說淡書了我想我們多年來一直在推展分級醫療改善體系我想...我原來...我不要說這個數據就好他提出這個...五年提出這個方法並不是我...\n你不要為那個政策買單的意思?那你要調整嗎?不是,我應該是要改善加強基層...\n我希望民眾真的要相信我們基層醫師基層醫師的能力基層醫療的可靠性然後信任感是叫人民相信就相信的嗎\n你用什麼有效的手段然後再講下一張醫學中心的急診申報件數從疫情以來都是有增無減調整部分負擔以後急診申報件數也是創新高而相對的地區醫院從疫情以來的戰略卻來到新低所以你們自己說我們解決了其實你比較的年度是比較最差的你說你看綠色的地區醫院成長了你怎麼不比109年\n你怎麼不比這個112年112年的去年沒有那個COVID-19的疫情啦他還是下降啊對地區醫院基層醫院他的就診率下降欸\n所以你就要去醫學中心的、急診的、門診的部分負擔但是沒有人民沒有跑到這個急診醫院去反而你來看他粉紅色的醫學中心跟去年比還屢創新高\n所以在這種狀況裡面難怪有這種民間團體在質疑啊你漲部分負擔只是為了填補這個健保財務空洞可是呢醫療品質沒有提升急診的等待時間越來越長越來越長所以你剛剛講不是漲價可以解決的漲價的手段你不能把它當成目的啊\n沒有下降啊好再下一張那你們在講說急診減傷戰略你們講說你們有效解決你們剛才那個還報告說健保署還說你們已經解決了這個急診擁捨的狀況我們就來看一般急診我們在減傷一級跟二級我們就看他戰流時間\n一級跟二級就是要命的啦 最急的可是它暫留的時間越來越長而你們自己都知道2019到2024醫學中心急診的相關指標就是減傷一級的急診病人要轉入病房要小於8小時減傷一級要幾分鐘以內馬上立即處理 來 沒錯 減傷一級是多嚴重\n要立即處理他們要轉入病房內能夠在8個小時裡面轉入不管家戶病房還是什麼病房是時間停留時間他們可以8小時裡面就轉到病房的比例越來越少所以他們都暫留暫留的時間越來越多\n所以這種狀況裡面急診暫留時間上升然後減傷一級在2024年上半年比2023年的下半年還要多出一個小時來到平均要15.43小時已經是你們建議的8小時的健保品質的兩倍的時間所以上不去所以才有我說的直接在急診區直接插管\n這像話嗎?像話嗎?以前八小時裡面就轉到病房去然後馬上處理的以前至少五成而且是作五忘六你看作五忘六急診插管是在救命所以是常見的啊當然即使要上病床也要插管最好是沒有感染的風險啦等一下一堆人走到人來人往可以直接好啦沒關係啦你不要跟我說插管的轉移焦點啦\n林淑芬議員\n林淑芬\n那只是部分的一個策略而已,整體的策略才是重要的。好,下一張,來我們再看喔。所以我們來講一下啦齁,你們在這種狀況裡面部分負擔漲了、漲了、漲了,然後再下一張,不是這一張。\n好,沒關係,我自己講結論好了啦在這種狀況裡面,調整部分募單的政策要以佳質量沒有發生那對分級醫療來講也沒有效,地區醫院、基層醫院看診的、就診的人數越來越少所以沒有發生啊,錢有啊,錢啊\n林淑芬議員\n我為了救我的親人我再沒錢我再窮\n報告委員醫療界如果對於要增加人民負擔我們真的也都不忍心\n所以大家講說部分負擔叫做殭屍理論啦長部分負擔就被人家稱之為是殭屍理論第二個最後講一個對分級醫療也無效我們剛剛已經講了就是說基層這個在基層門診的就醫建樹占有率在今年\n﹗\n聽了這篇新聞稿,調整了參考的年度,然後講了最有利自己的叉子抹粉的政策的有效性。那其實就是要去突顯說你們是有效的假象。這不是保險人應該有的這個應該有應有之局啊。所以部長你剛才講說這個手段恐怕是有問題的。\n那如果有問題的話,你的檢討政策,你的手段跟結果之間的落差,那你要怎麼調整呢?報告委員,我不是說有問題,我是說在整體的各種策略裡面,它也是一個策略。我剛剛講已經告訴你沒有效啦。那我們都會檢討。我就跟你講,剛剛這些數據我們告訴你沒有效。\n阿你只是讓人民的荷包變得更扁因為要改善醫療體系不是那麼一個簡單的對 非常複雜那你要拿出一個比較有效的手段而不是在那裡讓我們等了更久非常願意來拿出手段那這個要考慮阿你的手段是什麼考慮醫政考慮政府對啦你的手段可能我們在這裡聽一下我們可能的手段會是什麼錢都讓你漲了除了漲錢以外\n你還有什麼有效的手段我們第一個一定要維護那個病人的品質第二個也要有醫療人員醫療人員也要好的工作環境啊他不是醫療人員也需要薪水也需要好的一個環境第三個醫療院所要你講的這個都是我們的理想你不用講這不是你的政策這個不是政策啦才會來一個一個來看怎麼去達到\n我們部分負擔在急診從450讓你漲到750內,然後我們這個讓你漲到750,漲這麼多,啊你現在拿不出手段來,你就要趕快宣誓信再念一遍。\n這不是在這裡虛偽行李如意的在那裡呼嚨立委嗎?好啦我們陳學生立委一直在趕了啦你都書面交一篇書面報告啦還有那個有公安疑慮的那些醫院的資料一個月內提供好沒問題謝謝\n","vtt":"WEBVTT\n\n00:17.298 --> 00:20.340\n好,謝謝主席。是不是要請我們邱部長?部長,10月9號的時候我在這裡質詢過你就是說衛福部有沒有去盤點目前有公安問題的醫院有幾家因為我當時就說了根據醫策會網站106到112年醫院評鑑及教學醫院評鑑合格名單一共有417家\n\n00:46.175 --> 01:06.614\n而醫院評鑑效期到今年12月31到期的這個醫院要重新做評鑑的有117家換言之有四分之一的加數將在今年年底都要做那甚至有的已經開始做了就像我們從之前講的失火的醫院事實上也都做了\n\n01:07.955 --> 01:12.361\n那你們到底有沒有掌握117家醫院有沒有跟我們屏東失火的醫院一樣有一些管線的問題啦、疏散動線的問題啊這種公安的問題的存在\n\n01:23.877 --> 01:43.434\n那如果有的話已經有前車之鑒我在10月9號也談一次現在又談一次那我要問你說有到底有問題的有幾家我沒有問你是哪幾家我問的是一共有幾家而評鑒結果出來以前如果有一些問題那你要如何處置\n\n01:44.929 --> 02:00.694\n好謝謝委員那我的新聞齁那第一個就是說我們相關的事件發生以後我們當然就啟動了補典你直接回答就好了到底有問題還幾經啦你那發言沒有為什麼要談這個呢你知道嗎你們從10月9號我補典你也當請聽話你們從10月9號我質詢問你到現在你們連回答都沒回答\n\n02:12.757 --> 02:16.179\n將近一個月了,連書面的資料都沒有。你們當我們立法院是啥?我們都在這裡問你,你沒說。結束了質詢,也沒有任何書面資料提供給我們。所以你們現在是裝睡的人叫不行嗎?還是說直接就不予理會,立法院立委的質詢直接忽略?\n\n02:34.810 --> 02:52.236\n所以今天在這裡我再問你一次你到底能不能告訴我有哪幾一共有多少的醫院有病安有公安醫律而你的補強作為是什麼你們到底盤點了沒你不要扯東扯西你告訴我到底有多少\n\n02:53.584 --> 03:04.692\n因為這個事務應該是要地方政府跟消防局方面阿你以為在這裡諮詢過你們,你們都沒有去盤點,沒有跟地方聯絡,你們醫政會都沒有去看一下所以在這裡告別人才會公認就沒有了嗎?你不是也質詢在這裡當一回事嗎?\n\n03:13.629 --> 03:20.994\n你告訴我這個答案是什麼?立委從10月9號問你到現在將近一個月了,你們現在還是回答不出來?保證你是說什麼?還是沒有掌握?有類似病安或公安疑慮的,有管線問題有疏散動線問題這種公安疑慮的\n\n03:41.394 --> 03:44.536\n我們當然很關心117家有幾家我們很關心醫院的一個保定你答非所問不要在這裡胡說八道我現在問你是一共有幾家有公安的疑慮啦這個恐怕要再調查一下10月9號問你到現在還在恐怕要調查10月9號諮詢過一次了勒所以這個是不曉得你們是\n\n04:10.953 --> 04:16.057\n我們會去調查各個地方政府還有消防局他們所調查的結果對啦,什麼時候可以給答案一個月之內好了\n\n04:33.251 --> 04:40.354\n好就再給你一個月希望在一個月裡面大家都平安那我現在不是要繼續談這個我現在要談的是說你們從去年7月1號去年衛福部調整了部分負擔的心智針對門診藥品部分負擔還有急診的部分負擔進行調整\n\n04:53.280 --> 05:15.094\n你們的目的是說要落實分級醫療、珍惜健保資源事實上你們就是希望我們解決急診擁捨還有你們希望大家要分級醫療到地區醫院不要全部擠到這個教學醫院裡面來你們的目的啊就希望大家珍惜醫療資源期待就醫分流解決急診人馬為患的這個狀況然後讓穩定的慢性的病人鼓勵他們到急診診所\n\n05:21.138 --> 05:28.926\n那在這種狀況裡面我來看一下這個部長實施一年以後已經一年了成效如何?成效如何?\n\n05:34.939 --> 06:03.012\n實施了以後基層門診的就診案件的戰力從多了有多了不多啦0.22%那慢性病以及診所就醫率從大概增加了4.61%這個也是比較正面的一個成果的確是有改有進步第二個就是改善急診的用篩降幅大概有到達2.27到6.43那當然慢性病處方\n\n06:03.872 --> 06:09.755\n來來部長我替你回答啦因為你現在照稿念嘛因為你們健保署發布新聞稿有五個觀察有初步的成效第一個促進了分級醫療啦第二個改善了急診擁捨啦第三個避免藥品的浪費啦第四改善付費公平性及健保財務啦第五持續保障弱勢啦這個是你們健保署的\n\n06:28.345 --> 06:41.569\n新聞稿你們的新聞稿其實是來自於健保會第113年第9次的委員會會議資料就是第一案新制部分負擔監測指標的監測結果及成效檢討報告的內容部長你自己有看過嗎\n\n06:46.090 --> 06:57.414\n新制的部分負擔你這樣子從你當立委到當部長這樣子一路走來這是一個大的政策因為就是長這個部分負擔嘛那你自己有沒有看過這麼重要的這麼重大的政策上的調整一年的有效還是沒有效你自己有看過這個報告嗎?\n\n07:09.582 --> 07:10.823\n所以你們有改善來急診勇赦嗎?\n\n07:21.854 --> 07:47.808\n一統計的數字是有進步來我就跟你分享這一些來來來來來來我自己在7月1號就質詢時就跟你分享有我的朋友的家人在急診區等很久一直遲遲等不到病床結果在急診的急診區直接進行插管治療而且除了我以外王正旭委員今年的\n\n07:48.368 --> 07:53.832\n也特別提到好多急診量能滿載王委員很客氣然後國民黨的委員也講了那部長當時也有回答說如果你聽台大吳明顯院長講這個急診的時候後床是日常的事情那我們都知道說民眾要問的不是這樣子民眾要問的是要等多久\n\n08:15.146 --> 08:34.939\n你們認為有改善急診的這個候診時間急診的泳色有改善那為什麼這一年來等待的時間卻越來越長然後呢調整部分負擔叫大家都不要去然後就說\n\n08:36.620 --> 08:50.011\n一定會改善,而且你們報告說已經有改善,但事實真的那樣子嗎?這個根據健保署的報告,實施條長部分負擔以後,每個人負擔的金額比2022年,這個第一張\n\n08:59.502 --> 09:25.232\n比2022年來比增加了149人價格調漲了沒有錯這一張來但是呢急診的平均每人就醫次數來到2019年來的歷史新高大概幾道急診裡面的次數創下歷史新高反而是負擔金額最低的2022年的平均每人就醫次數是相對低的\n\n09:26.152 --> 09:26.292\n林淑芬議員\n\n09:41.049 --> 10:07.466\n平均國人每人就醫到急診就醫的次數創歷史新高你漲了部分負擔了可是就醫的次數創新高那你們說要以價值量的這個政策手段你說是有效啦這個是有效嗎等待的時間增加錢付的更多品質更下降這個政策就是你們說的急診永設有改善嗎\n\n10:14.292 --> 10:34.350\n謝謝委員指教我了解那個因為會有這樣的趨勢大幅上升阿你們說有效阿他的原因真的是要多元化來分析阿對多元化分析可以好這樣講阿所以你現在又有原因因為可能不是只有一個原因而且這個是不是說我們這樣我們過去也常常在談嘛你到底\n\n10:35.171 --> 10:40.433\n你講得很好欸可是你們當時告訴人家我就是要以價製量啊我要給你漲部分負擔啊要以價製量一定可以控制急診勇社啊可以導引人民到正確的路上去分級醫療啊你們當時就這樣錢都漲了結果你們的政策目的是什麼漲價是手段欸\n\n11:01.539 --> 11:25.554\n你是要大家解決急診涌射的狀況要分級醫療的政策能夠落實結果你的目的是這兩個政策有達到嗎?你的新聞稿說你們達到了所以我問你有達到嗎?你現在要說淡書了我想我們多年來一直在推展分級醫療改善體系我想...我原來...我不要說這個數據就好他提出這個...五年提出這個方法並不是我...\n\n11:33.119 --> 11:36.722\n你不要為那個政策買單的意思?那你要調整嗎?不是,我應該是要改善加強基層...\n\n11:47.149 --> 11:50.211\n我希望民眾真的要相信我們基層醫師基層醫師的能力基層醫療的可靠性然後信任感是叫人民相信就相信的嗎\n\n12:03.686 --> 12:32.380\n你用什麼有效的手段然後再講下一張醫學中心的急診申報件數從疫情以來都是有增無減調整部分負擔以後急診申報件數也是創新高而相對的地區醫院從疫情以來的戰略卻來到新低所以你們自己說我們解決了其實你比較的年度是比較最差的你說你看綠色的地區醫院成長了你怎麼不比109年\n\n12:33.681 --> 12:48.943\n你怎麼不比這個112年112年的去年沒有那個COVID-19的疫情啦他還是下降啊對地區醫院基層醫院他的就診率下降欸\n\n12:49.964 --> 13:03.864\n所以你就要去醫學中心的、急診的、門診的部分負擔但是沒有人民沒有跑到這個急診醫院去反而你來看他粉紅色的醫學中心跟去年比還屢創新高\n\n13:06.698 --> 13:25.394\n所以在這種狀況裡面難怪有這種民間團體在質疑啊你漲部分負擔只是為了填補這個健保財務空洞可是呢醫療品質沒有提升急診的等待時間越來越長越來越長所以你剛剛講不是漲價可以解決的漲價的手段你不能把它當成目的啊\n\n13:35.523 --> 13:37.664\n沒有下降啊好再下一張那你們在講說急診減傷戰略你們講說你們有效解決你們剛才那個還報告說健保署還說你們已經解決了這個急診擁捨的狀況我們就來看一般急診我們在減傷一級跟二級我們就看他戰流時間\n\n14:01.345 --> 14:23.032\n一級跟二級就是要命的啦最急的可是它暫留的時間越來越長而你們自己都知道2019到2024醫學中心急診的相關指標就是減傷一級的急診病人要轉入病房要小於8小時減傷一級要幾分鐘以內馬上立即處理來沒錯減傷一級是多嚴重\n\n14:29.097 --> 14:49.396\n要立即處理他們要轉入病房內能夠在8個小時裡面轉入不管家戶病房還是什麼病房是時間停留時間他們可以8小時裡面就轉到病房的比例越來越少所以他們都暫留暫留的時間越來越多\n\n14:50.217 --> 14:55.320\n所以這種狀況裡面急診暫留時間上升然後減傷一級在2024年上半年比2023年的下半年還要多出一個小時來到平均要15.43小時已經是你們建議的8小時的健保品質的兩倍的時間所以上不去所以才有我說的直接在急診區直接插管\n\n15:22.498 --> 15:39.141\n這像話嗎?像話嗎?以前八小時裡面就轉到病房去然後馬上處理的以前至少五成而且是作五忘六你看作五忘六急診插管是在救命所以是常見的啊當然即使要上病床也要插管最好是沒有感染的風險啦等一下一堆人走到人來人往可以直接好啦沒關係啦你不要跟我說插管的轉移焦點啦\n\n15:47.583 --> 15:47.863\n林淑芬議員\n\n16:17.723 --> 16:17.883\n林淑芬\n\n16:37.028 --> 16:52.763\n那只是部分的一個策略而已,整體的策略才是重要的。好,下一張,來我們再看喔。所以我們來講一下啦齁,你們在這種狀況裡面部分負擔漲了、漲了、漲了,然後再下一張,不是這一張。\n\n16:56.104 --> 17:16.920\n好,沒關係,我自己講結論好了啦在這種狀況裡面,調整部分募單的政策要以佳質量沒有發生那對分級醫療來講也沒有效,地區醫院、基層醫院看診的、就診的人數越來越少所以沒有發生啊,錢有啊,錢啊\n\n17:18.661 --> 17:18.721\n林淑芬議員\n\n17:38.364 --> 17:38.924\n我為了救我的親人我再沒錢我再窮\n\n18:05.675 --> 18:07.437\n報告委員醫療界如果對於要增加人民負擔我們真的也都不忍心\n\n18:32.739 --> 18:52.049\n所以大家講說部分負擔叫做殭屍理論啦長部分負擔就被人家稱之為是殭屍理論第二個最後講一個對分級醫療也無效我們剛剛已經講了就是說基層這個在基層門診的就醫建樹占有率在今年\n\n19:17.288 --> 19:33.313\n聽了這篇新聞稿,調整了參考的年度,然後講了最有利自己的叉子抹粉的政策的有效性。那其實就是要去突顯說你們是有效的假象。這不是保險人應該有的這個應該有應有之局啊。所以部長你剛才講說這個手段恐怕是有問題的。\n\n19:40.535 --> 19:56.859\n那如果有問題的話,你的檢討政策,你的手段跟結果之間的落差,那你要怎麼調整呢?報告委員,我不是說有問題,我是說在整體的各種策略裡面,它也是一個策略。我剛剛講已經告訴你沒有效啦。那我們都會檢討。我就跟你講,剛剛這些數據我們告訴你沒有效。\n\n20:05.097 --> 20:31.208\n阿你只是讓人民的荷包變得更扁因為要改善醫療體系不是那麼一個簡單的對非常複雜那你要拿出一個比較有效的手段而不是在那裡讓我們等了更久非常願意來拿出手段那這個要考慮阿你的手段是什麼考慮醫政考慮政府對啦你的手段可能我們在這裡聽一下我們可能的手段會是什麼錢都讓你漲了除了漲錢以外\n\n20:32.108 --> 20:58.825\n你還有什麼有效的手段我們第一個一定要維護那個病人的品質第二個也要有醫療人員醫療人員也要好的工作環境啊他不是醫療人員也需要薪水也需要好的一個環境第三個醫療院所要你講的這個都是我們的理想你不用講這不是你的政策這個不是政策啦才會來一個一個來看怎麼去達到\n\n21:01.207 --> 21:06.111\n我們部分負擔在急診從450讓你漲到750內,然後我們這個讓你漲到750,漲這麼多,啊你現在拿不出手段來,你就要趕快宣誓信再念一遍。\n\n21:18.443 --> 21:35.380\n這不是在這裡虛偽行李如意的在那裡呼嚨立委嗎?好啦我們陳學生立委一直在趕了啦你都書面交一篇書面報告啦還有那個有公安疑慮的那些醫院的資料一個月內提供好沒問題謝謝\n\n","segments":[{"start":17.298,"end":20.34,"text":"好,謝謝主席。是不是要請我們邱部長?部長,10月9號的時候我在這裡質詢過你就是說衛福部有沒有去盤點目前有公安問題的醫院有幾家因為我當時就說了根據醫策會網站106到112年醫院評鑑及教學醫院評鑑合格名單一共有417家"},{"start":46.175,"end":66.614,"text":"而醫院評鑑效期到今年12月31到期的這個醫院要重新做評鑑的有117家換言之有四分之一的加數將在今年年底都要做那甚至有的已經開始做了就像我們從之前講的失火的醫院事實上也都做了"},{"start":67.955,"end":72.361,"text":"那你們到底有沒有掌握117家醫院有沒有跟我們屏東失火的醫院一樣有一些管線的問題啦、疏散動線的問題啊這種公安的問題的存在"},{"start":83.877,"end":103.434,"text":"那如果有的話已經有前車之鑒我在10月9號也談一次現在又談一次那我要問你說有到底有問題的有幾家我沒有問你是哪幾家我問的是一共有幾家而評鑒結果出來以前如果有一些問題那你要如何處置"},{"start":104.929,"end":120.694,"text":"好 謝謝委員那我的新聞齁那第一個就是說我們相關的事件發生以後我們當然就啟動了補典你直接回答就好了到底有問題還幾經啦你那發言沒有為什麼要談這個呢你知道嗎你們從10月9號我補典你也當請聽話你們從10月9號我質詢問你到現在你們連回答都沒回答"},{"start":132.757,"end":136.179,"text":"將近一個月了,連書面的資料都沒有。你們當我們立法院是啥?我們都在這裡問你,你沒說。結束了質詢,也沒有任何書面資料提供給我們。所以你們現在是裝睡的人叫不行嗎?還是說直接就不予理會,立法院立委的質詢直接忽略?"},{"start":154.81,"end":172.236,"text":"所以今天在這裡我再問你一次你到底能不能告訴我有哪幾一共有多少的醫院有病安有公安醫律而你的補強作為是什麼你們到底盤點了沒你不要扯東扯西你告訴我到底有多少"},{"start":173.584,"end":184.692,"text":"因為這個事務應該是要地方政府跟消防局方面阿你以為在這裡諮詢過你們,你們都沒有去盤點,沒有跟地方聯絡,你們醫政會都沒有去看一下所以在這裡告別人才會公認就沒有了嗎?你不是也質詢在這裡當一回事嗎?"},{"start":193.629,"end":200.994,"text":"你告訴我這個答案是什麼?立委從10月9號問你到現在將近一個月了,你們現在還是回答不出來?保證你是說什麼?還是沒有掌握?有類似病安或公安疑慮的,有管線問題有疏散動線問題這種公安疑慮的"},{"start":221.394,"end":224.536,"text":"我們當然很關心117家有幾家我們很關心醫院的一個保定你答非所問不要在這裡胡說八道我現在問你是一共有幾家有公安的疑慮啦這個恐怕要再調查一下10月9號問你到現在還在恐怕要調查10月9號諮詢過一次了勒所以這個是不曉得你們是"},{"start":250.953,"end":256.057,"text":"我們會去調查各個地方政府還有消防局他們所調查的結果對啦,什麼時候可以給答案一個月之內好了"},{"start":273.251,"end":280.354,"text":"好就再給你一個月希望在一個月裡面大家都平安那我現在不是要繼續談這個我現在要談的是說你們從去年7月1號去年衛福部調整了部分負擔的心智針對門診藥品部分負擔還有急診的部分負擔進行調整"},{"start":293.28,"end":315.094,"text":"你們的目的是說要落實分級醫療、珍惜健保資源事實上你們就是希望我們解決急診擁捨還有你們希望大家要分級醫療到地區醫院不要全部擠到這個教學醫院裡面來你們的目的啊就希望大家珍惜醫療資源期待就醫分流解決急診人馬為患的這個狀況然後讓穩定的慢性的病人鼓勵他們到急診診所"},{"start":321.138,"end":328.926,"text":"那在這種狀況裡面我來看一下這個部長實施一年以後已經一年了成效如何?成效如何?"},{"start":334.939,"end":363.012,"text":"實施了以後基層門診的就診案件的戰力從多了有多了不多啦0.22%那慢性病以及診所就醫率從大概增加了4.61%這個也是比較正面的一個成果的確是有改有進步第二個就是改善急診的用篩降幅大概有到達2.27到6.43那當然慢性病處方"},{"start":363.872,"end":369.755,"text":"來來部長我替你回答啦因為你現在照稿念嘛因為你們健保署發布新聞稿有五個觀察有初步的成效第一個促進了分級醫療啦第二個改善了急診擁捨啦第三個避免藥品的浪費啦第四改善付費公平性及健保財務啦第五持續保障弱勢啦這個是你們健保署的"},{"start":388.345,"end":401.569,"text":"新聞稿你們的新聞稿其實是來自於健保會第113年第9次的委員會會議資料就是第一案新制部分負擔監測指標的監測結果及成效檢討報告的內容部長你自己有看過嗎"},{"start":406.09,"end":417.414,"text":"新制的部分負擔你這樣子從你當立委到當部長這樣子一路走來這是一個大的政策因為就是長這個部分負擔嘛那你自己有沒有看過這麼重要的這麼重大的政策上的調整一年的有效還是沒有效你自己有看過這個報告嗎?"},{"start":429.582,"end":430.823,"text":"所以你們有改善來急診勇赦嗎?"},{"start":441.854,"end":467.808,"text":"一統計的數字是有進步來我就跟你分享這一些來來來來來來我自己在7月1號就質詢時就跟你分享有我的朋友的家人在急診區等很久一直遲遲等不到病床結果在急診的急診區直接進行插管治療而且除了我以外王正旭委員今年的"},{"start":468.368,"end":473.832,"text":"也特別提到好多急診量能滿載王委員很客氣然後國民黨的委員也講了那部長當時也有回答說如果你聽台大吳明顯院長講這個急診的時候後床是日常的事情那我們都知道說民眾要問的不是這樣子民眾要問的是要等多久"},{"start":495.146,"end":514.939,"text":"你們認為有改善急診的這個候診時間急診的泳色有改善那為什麼這一年來等待的時間卻越來越長然後呢調整部分負擔叫大家都不要去然後就說"},{"start":516.62,"end":530.011,"text":"一定會改善,而且你們報告說已經有改善,但事實真的那樣子嗎?這個根據健保署的報告,實施條長部分負擔以後,每個人負擔的金額比2022年,這個第一張"},{"start":539.502,"end":565.232,"text":"比2022年來比增加了149人價格調漲了沒有錯這一張來但是呢急診的平均每人就醫次數來到2019年來的歷史新高大概幾道急診裡面的次數創下歷史新高反而是負擔金額最低的2022年的平均每人就醫次數是相對低的"},{"start":566.152,"end":566.292,"text":"林淑芬議員"},{"start":581.049,"end":607.466,"text":"平均國人每人就醫到急診就醫的次數創歷史新高你漲了部分負擔了可是就醫的次數創新高那你們說要以價值量的這個政策手段你說是有效啦這個是有效嗎等待的時間增加錢付的更多品質更下降這個政策就是你們說的急診永設有改善嗎"},{"start":614.292,"end":634.35,"text":"謝謝委員指教我了解那個因為會有這樣的趨勢大幅上升阿你們說有效阿他的原因真的是要多元化來分析阿對多元化分析可以好這樣講阿所以你現在又有原因因為可能不是只有一個原因而且這個是不是說我們這樣我們過去也常常在談嘛你到底"},{"start":635.171,"end":640.433,"text":"你講得很好欸可是你們當時告訴人家我就是要以價製量啊我要給你漲部分負擔啊要以價製量一定可以控制急診勇社啊可以導引人民到正確的路上去分級醫療啊你們當時就這樣錢都漲了結果你們的政策目的是什麼漲價是手段欸"},{"start":661.539,"end":685.554,"text":"你是要大家解決急診涌射的狀況要分級醫療的政策能夠落實結果你的目的是這兩個政策有達到嗎?你的新聞稿說你們達到了所以我問你有達到嗎?你現在要說淡書了我想我們多年來一直在推展分級醫療改善體系我想...我原來...我不要說這個數據就好他提出這個...五年提出這個方法並不是我..."},{"start":693.119,"end":696.722,"text":"你不要為那個政策買單的意思?那你要調整嗎?不是,我應該是要改善加強基層..."},{"start":707.149,"end":710.211,"text":"我希望民眾真的要相信我們基層醫師基層醫師的能力基層醫療的可靠性然後信任感是叫人民相信就相信的嗎"},{"start":723.686,"end":752.38,"text":"你用什麼有效的手段然後再講下一張醫學中心的急診申報件數從疫情以來都是有增無減調整部分負擔以後急診申報件數也是創新高而相對的地區醫院從疫情以來的戰略卻來到新低所以你們自己說我們解決了其實你比較的年度是比較最差的你說你看綠色的地區醫院成長了你怎麼不比109年"},{"start":753.681,"end":768.943,"text":"你怎麼不比這個112年112年的去年沒有那個COVID-19的疫情啦他還是下降啊對地區醫院基層醫院他的就診率下降欸"},{"start":769.964,"end":783.864,"text":"所以你就要去醫學中心的、急診的、門診的部分負擔但是沒有人民沒有跑到這個急診醫院去反而你來看他粉紅色的醫學中心跟去年比還屢創新高"},{"start":786.698,"end":805.394,"text":"所以在這種狀況裡面難怪有這種民間團體在質疑啊你漲部分負擔只是為了填補這個健保財務空洞可是呢醫療品質沒有提升急診的等待時間越來越長越來越長所以你剛剛講不是漲價可以解決的漲價的手段你不能把它當成目的啊"},{"start":815.523,"end":817.664,"text":"沒有下降啊好再下一張那你們在講說急診減傷戰略你們講說你們有效解決你們剛才那個還報告說健保署還說你們已經解決了這個急診擁捨的狀況我們就來看一般急診我們在減傷一級跟二級我們就看他戰流時間"},{"start":841.345,"end":863.032,"text":"一級跟二級就是要命的啦 最急的可是它暫留的時間越來越長而你們自己都知道2019到2024醫學中心急診的相關指標就是減傷一級的急診病人要轉入病房要小於8小時減傷一級要幾分鐘以內馬上立即處理 來 沒錯 減傷一級是多嚴重"},{"start":869.097,"end":889.396,"text":"要立即處理他們要轉入病房內能夠在8個小時裡面轉入不管家戶病房還是什麼病房是時間停留時間他們可以8小時裡面就轉到病房的比例越來越少所以他們都暫留暫留的時間越來越多"},{"start":890.217,"end":895.32,"text":"所以這種狀況裡面急診暫留時間上升然後減傷一級在2024年上半年比2023年的下半年還要多出一個小時來到平均要15.43小時已經是你們建議的8小時的健保品質的兩倍的時間所以上不去所以才有我說的直接在急診區直接插管"},{"start":922.498,"end":939.141,"text":"這像話嗎?像話嗎?以前八小時裡面就轉到病房去然後馬上處理的以前至少五成而且是作五忘六你看作五忘六急診插管是在救命所以是常見的啊當然即使要上病床也要插管最好是沒有感染的風險啦等一下一堆人走到人來人往可以直接好啦沒關係啦你不要跟我說插管的轉移焦點啦"},{"start":947.583,"end":947.863,"text":"林淑芬議員"},{"start":977.723,"end":977.883,"text":"林淑芬"},{"start":997.028,"end":1012.763,"text":"那只是部分的一個策略而已,整體的策略才是重要的。好,下一張,來我們再看喔。所以我們來講一下啦齁,你們在這種狀況裡面部分負擔漲了、漲了、漲了,然後再下一張,不是這一張。"},{"start":1016.104,"end":1036.92,"text":"好,沒關係,我自己講結論好了啦在這種狀況裡面,調整部分募單的政策要以佳質量沒有發生那對分級醫療來講也沒有效,地區醫院、基層醫院看診的、就診的人數越來越少所以沒有發生啊,錢有啊,錢啊"},{"start":1038.661,"end":1038.721,"text":"林淑芬議員"},{"start":1058.364,"end":1058.924,"text":"我為了救我的親人我再沒錢我再窮"},{"start":1085.675,"end":1087.437,"text":"報告委員醫療界如果對於要增加人民負擔我們真的也都不忍心"},{"start":1112.739,"end":1132.049,"text":"所以大家講說部分負擔叫做殭屍理論啦長部分負擔就被人家稱之為是殭屍理論第二個最後講一個對分級醫療也無效我們剛剛已經講了就是說基層這個在基層門診的就醫建樹占有率在今年"},{"start":1133.029,"end":1156.988,"text":"﹗"},{"start":1157.288,"end":1173.313,"text":"聽了這篇新聞稿,調整了參考的年度,然後講了最有利自己的叉子抹粉的政策的有效性。那其實就是要去突顯說你們是有效的假象。這不是保險人應該有的這個應該有應有之局啊。所以部長你剛才講說這個手段恐怕是有問題的。"},{"start":1180.535,"end":1196.859,"text":"那如果有問題的話,你的檢討政策,你的手段跟結果之間的落差,那你要怎麼調整呢?報告委員,我不是說有問題,我是說在整體的各種策略裡面,它也是一個策略。我剛剛講已經告訴你沒有效啦。那我們都會檢討。我就跟你講,剛剛這些數據我們告訴你沒有效。"},{"start":1205.097,"end":1231.208,"text":"阿你只是讓人民的荷包變得更扁因為要改善醫療體系不是那麼一個簡單的對 非常複雜那你要拿出一個比較有效的手段而不是在那裡讓我們等了更久非常願意來拿出手段那這個要考慮阿你的手段是什麼考慮醫政考慮政府對啦你的手段可能我們在這裡聽一下我們可能的手段會是什麼錢都讓你漲了除了漲錢以外"},{"start":1232.108,"end":1258.825,"text":"你還有什麼有效的手段我們第一個一定要維護那個病人的品質第二個也要有醫療人員醫療人員也要好的工作環境啊他不是醫療人員也需要薪水也需要好的一個環境第三個醫療院所要你講的這個都是我們的理想你不用講這不是你的政策這個不是政策啦才會來一個一個來看怎麼去達到"},{"start":1261.207,"end":1266.111,"text":"我們部分負擔在急診從450讓你漲到750內,然後我們這個讓你漲到750,漲這麼多,啊你現在拿不出手段來,你就要趕快宣誓信再念一遍。"},{"start":1278.443,"end":1295.38,"text":"這不是在這裡虛偽行李如意的在那裡呼嚨立委嗎?好啦我們陳學生立委一直在趕了啦你都書面交一篇書面報告啦還有那個有公安疑慮的那些醫院的資料一個月內提供好沒問題謝謝"}]}}},"gazette":{"lineno":748,"blocks":[["林委員淑芬：（11時41分）謝謝主席。是不是請邱部長？"],["主席：部長請。"],["邱部長泰源：委員好。"],["林委員淑芬：部長，10月9日我在這裡質詢你，衛福部有沒有盤點目前有公安問題醫院有幾家？我當時就說，根據醫測會網站資料顯示，106年到112年醫院評鑑及教學醫院評鑑合格名單共有417家，而醫院評鑑效期在今年12月31日到期，要重新做評鑑的醫院有117家。換言之，有四分之一的家數將在今年年底做評鑑，甚至有的已經開始做了。如同我們之前所講的，失火的醫院都已經做了，所以你們到底有沒有掌握這117家醫院有沒有跟屏東失火的醫院一樣，有管線、疏散動線這種公安問題存在？如果有的話，已經有前車之鑑。我在10月9日談了一次，現在又談一次，那我要問你的是，到底有問題的有幾家？我沒有問你是哪幾家，我問的是一共有幾家，而評鑑結果出來以前，如果有一些問題，那你要如何處置？"],["邱部長泰源：謝謝委員的詢問。第一個，在相關的事件發生以後，我們當然就啟動了……"],["林委員淑芬：部長，你直接回答即可，到底有問題的有幾家？你們有沒有發現？為什麼要談這個你知道嗎？"],["邱部長泰源：有問題的有幾家……"],["林委員淑芬：你們從10月9日……"],["邱部長泰源：那是地方政府跟……"],["林委員淑芬：部長，請先聽我講。從10月9日我質詢你到現在，你們連回答都沒回答，將近1個月了，連書面的資料都沒有，你們當我們立法院是啥？我們在這裡問你，你沒有說，結束了質詢也沒有任何書面資料提供給我們，所以你們現在是裝睡的人叫不醒呢？還是說直接就不予理會，立法院立委的質詢直接忽略？所以今天在這裡我再問你一次，你到底能不能告訴我，一共有多少醫院有病安、有公安疑慮？而你的補強作為是什麼？你們到底盤點了沒？你不要扯東扯西，你告訴我到底有多少。"],["邱部長泰源：因為這個數目應該是地方政府跟消防局方面……"],["林委員淑芬：立委在這裡質詢過你們，你們都沒有去盤點？沒有跟地方聯絡？你們醫策會都沒有去看一下？所以在這裡連狗吠火車的功能都沒有嗎？立委在這裡的質詢你不當一回事？"],["邱部長泰源：我們的確也有啟動在醫策會……"],["林委員淑芬：你告訴我這個答案是什麼。"],["邱部長泰源：因為……"],["林委員淑芬：立委從10月9號問你，到現在將近一個月了，你們現在還是回答不出來！部長，你是說不出來？還是沒有掌握？有類似病安或公安疑慮的、有管線問題、有疏散動線問題，這種公安疑慮的……"],["邱部長泰源：我們當然很關心……"],["林委員淑芬：117家裡面有幾家？"],["邱部長泰源：我們很關心醫院的一個……"],["林委員淑芬：部長，你答非所問！不要在這裡胡說八道！我現在問你的是一共有幾家有公安的疑慮。"],["邱部長泰源：這個恐怕要再調查一下，再跟委員……"],["林委員淑芬：10月9號問你到現在還在說恐怕要調查？10月9號質詢過一次了耶！所以不曉得你們是沒聽到還是繼續裝睡，那你告訴我，你什麼時候可以給我答案？"],["邱部長泰源：我們會去調查各地方政府還有消防局他們所調查的結果。"],["林委員淑芬：對啦，什麼時候可以給答案？"],["邱部長泰源：收集起來，然後再跟您報告。"],["林委員淑芬：對啦，什麼時候？大概要多久？"],["邱部長泰源：一個月之內好了。"],["林委員淑芬：好，就再給你一個月，希望這一個月裡面大家都平安。"],["邱部長泰源：好。"],["林委員淑芬：我現在不是要繼續談這個，我現在要談的是，你們從去年7月1號，去年衛福部調整了部分負擔的新制，針對門診藥品的部分負擔還有急診的部分負擔來進行調整，你們的目的是說要落實分級醫療，珍惜健保資源。事實上，你們就是希望解決急診壅塞，還有你們希望大家要分級醫療，到地區醫院，不要全部擠到教學醫院，你們的目的就是希望大家珍惜醫療資源，期待就醫分流，解決急診人滿為患的狀況，然後讓穩定的慢性的病人，鼓勵他們到基層診所。在這種狀況裡面，我來看一下，部長，實施一年以後，已經一年了，成效如何？"],["邱部長泰源：我們實施了以後，基層門診就診案件的占率多了不多，增加0.22%；慢性病人於基層診所就醫率大概增加了4.61%，這個也是比較正面的成果，的確是有進步；第二個就是改善急診的壅塞，降幅自2.27%到6.43%，當然慢性病處方箋的藥費也從……"],["林委員淑芬：部長，我來替你回答啦！因為你現在是照稿念嘛，你們健保署發布了新聞稿，觀察有5個初步的成效，第一個，促進分級醫療；第二個，改善急診壅塞；第三個，避免藥品浪費；第四，改善付費公平性及健保財務；第五，持續保障弱勢。這個是你們健保署的新聞稿，OK？你們的新聞稿其實是來自於健保會113年第9次的委員會會議資料，就是第一案，新制部分負擔監測指標的監測結果及成效檢討報告的內容。部長，你自己有看過嗎？新制的部分負擔，從你當立委到當部長，這樣子一路走來，這是一個大的政策，因為就是漲部分負擔嘛，那你自己有沒有看過這麼重要的、這麼重大的政策上的調整，已經一年了，到底有效還是沒效？你自己有看過這份報告嗎？"],["邱部長泰源：由這些初步的成效來看，我認為是有改善啦，委員也知道我們……"],["林委員淑芬：所以你們有改善了急診壅塞嗎？"],["邱部長泰源：依統計的數字是有進步。"],["林委員淑芬：依統計的數字是有進步，來，我就跟你分享這些，來、來、來……"],["邱部長泰源：這個應該也是健保署客觀的數字。"],["林委員淑芬：我自己在7月1號質詢時就跟你分享，有我的朋友的家人在急診區等很久，一直遲遲等不到病床，結果在急診的急診區直接進行插管治療，而且除了我以外，王正旭委員今年也特別提到好多急診量能滿載，王委員很客氣，然後國民黨的委員也講了，部長當時也回答說，如果你聽臺大吳明賢院長講，急診候床是日常的事情。我們都知道民眾要問的不是這樣子，民眾要問的是要等多久？你們認為有改善急診的候診時間，急診的壅塞有改善，那為什麼這一年來，等待的時間卻越來越長？然後調整部分負擔，叫大家都不要去，然後就說一定會改善，而且你們的報告說已經有改善，但事實真的是那樣子嗎？","根據健保署的報告，調漲部分負擔以後，每個人負擔的金額比2022年增加了149元，價格調漲了沒有錯，但是急診的平均每人就醫次數來到2019年以來的歷史新高，大家擠到急診裡面的次數創下歷史新高，反而是負擔金額最低的2022年的平均每人就醫次數是相對低的，111年是1.46次，到今年次數創新高，是1.56次。然後有漲價啦，我們看得出來漲價啦，部長，漲價了是事實，但是平均國人每人就醫、到急診就醫的次數創歷史新高，你漲了部分負擔，可是就醫的次數創新高，你們說要以價制量的這個政策手段，你說是有效啦，這個是有效嗎？等待的時間增加、錢付得更多、品質更下降！這個政策就是你們說的急診壅塞有改善嗎？這張圖你自己看！"],["邱部長泰源：謝謝委員指教，我了解，因為會有這樣的趨勢……"],["林委員淑芬：大幅上升啊，你們說有效啊！"],["邱部長泰源：它的原因真的是要多元化來分析。"],["林委員淑芬：對，多元化分析，可以，好，這樣講，所以你現在又有原因……"],["邱部長泰源：因為可能不是只有一個原因，而且我們過去也常常在談以價來制量到底有沒有效？"],["林委員淑芬：你講得很好，可是你們當時告訴人家你們就是要以價制量，要漲部分負擔啊！要以價制量，一定可以控制急診壅塞，可以導引人民到正確的路上去分級醫療，你們當時就這樣做，錢都漲了，結果你們的政策目的是什麼？漲價是手段，你是要解決急診壅塞的狀況，要分級醫療的政策能夠落實，結果你的目的是這兩個政策，有達到嗎？你的新聞稿說你們達到了，所以我問你，有達到嗎？"],["邱部長泰源：報告委員，那是初步的成效。"],["林委員淑芬：你現在又說但書了。"],["邱部長泰源：我想我們多年來一直在推展分級醫療、改善體系，我想委員很清楚……"],["林委員淑芬：好啦，我不要說這個數據就好……"],["邱部長泰源：去年提出這個方法並不是我……"],["林委員淑芬：好、好、好……"],["邱部長泰源：但是我覺得只要有幫助……"],["林委員淑芬：你不要為那個政策買單的意思？"],["邱部長泰源：不是，我說只要……"],["林委員淑芬：那你要調整嗎？"],["邱部長泰源：那只是其中的一部分。"],["林委員淑芬：那你要調整嗎？"],["邱部長泰源：不是，我應該是要改善，加強基層……"],["林委員淑芬：錢都被你們漲了，我們花的錢都花更多了啦！"],["邱部長泰源：所以就是……"],["林委員淑芬：現在說沒有用、不是一個有效的手段？"],["邱部長泰源：那我也希望民眾真的要相信我們基層醫師，我們基層醫師都是很……"],["林委員淑芬：基層醫師的能力、基層醫療的可靠性，然後信任感，是叫人民相信就相信的嗎？你用什麼有效的手段？","好，我再講，醫學中心的急診申報件數從疫情以來都是有增無減，調整部分負擔以後，急診申報件數也是創新高，而相對的地區醫院從疫情以來的占率卻來到新低，所以你們自己說，我們解決了，其實你比較的年度是比較最差的，你看綠色的地區醫院成長了，你怎麼不比109年？你怎麼不比112年？112（去）年沒有COVID-19的疫情了，但它還是下降，地區醫院、基層醫院的就診率下降，所以你就要漲醫學中心急診、門診的部分負擔，但是人民沒有跑到基層醫院去，反而你來看粉紅色的醫學中心，跟去年比還屢創新高！所以在這種狀況裡面，難怪有民間團體在質疑，你漲部分負擔只是為了填補健保財務空洞，可是醫療品質沒有提升，急診的等待時間越來越長。所以你剛剛講不是漲價可以解決的，漲價的手段你不能把它當成目的，沒有下降啊！","你們在說急診檢傷占率，你們說你們有效解決，剛才健保署還說你們已經解決了急診壅塞的狀況，我們就來看一般急診在檢傷一級跟二級，我們就看他暫留時間，一級跟二級就是要命的啦！最急的！可是他暫留的時間越來越長，而你們自己都知道，2019到2024醫學中心急診的相關指標，就是檢傷一級的急診病人轉入病房要小於8小時，減傷一級要幾分鐘以內馬上立即處理？來，部長，檢傷一級是多嚴重？"],["邱部長泰源：檢傷一級要立即處理。"],["林委員淑芬：要立即處理，他們要能夠在8個小時以內轉入病房，不管加護病房還是什麼病房，他們可以8小時以內就轉到病房的比例越來越少，所以他們都暫留，暫留的時間越來越多。因此這種狀況底下急診暫留時間上升，然後檢傷一級在2024年上半年比2023年下半年還要多出1個小時，平均要15.43小時，已經是你們建議8小時健保品質的兩倍時間，所以上不去！所以才有我說的直接在急診區插管，這像話嗎？像話嗎？以前8小時以內就轉到病房去，然後馬上處理的，以前至少5成……"],["邱部長泰源：報告委員……"],["林委員淑芬：而且是坐五望六。"],["邱部長泰源：急診插管是在救命，所以是常見的啊！"],["林委員淑芬：好啦！沒關係。"],["邱部長泰源：急診要上病房也要插管穩定之後才……"],["林委員淑芬：好啦！最好是沒有感染的風險啦！在那裡一堆人在走道，人來人往，好啦！沒關係啦！"],["邱部長泰源：如果進來需要插管……"],["林委員淑芬：你不要跟我說插管的轉移焦點啦！我跟你講的是以前檢傷一級要馬上進到病房裡面，可以8小時以內就進到病房，至少都還有65%、55%，而到今年剩下47%，以前是坐五望六，現在要保四，不曉得能不能保得住四成，而這個現象都是急診壅塞的問題，已經不是說輕症的病人太多啦！其實它的原因很複雜，多重的成因包括床位管理的政策、醫院人力的管理問題、人力不足的問題。所以你們在這裡直接告訴我們說，漲價、漲部分負擔就可以解決急診壅塞，那是緣木求魚！而且還是自欺欺人！"],["邱部長泰源：那只是部分的一個策略而已，整體的策略才是重要的。"],["林委員淑芬：好，我們再看，所以我們來講一下，你們在這種狀況裡面部分負擔漲了，沒關係，我自己講結論好了，在這種狀況裡面，關於調整部分負擔的政策，要以價制量沒有發生，對分級醫療來講也沒有效，地區醫院、基層醫院就診的人數越來越少，所以沒有發生啊！錢有啊！錢增加啦！人民繳的錢增加啦！荷包扁了，民眾的荷包扁了，但是門診的負擔每年平均增加了299元，但門診就醫的次數也創下了2019年來的新高，比2022年增加了1.6人次，然後較疫情前增加0.9次。所以民間團體已經強調了，醫療是剛性需求，生病了還是一定會就醫，它跟一般消費行為不一樣，你叫他多付一點錢，然後去基層醫院，他不去就不去，我為了救我的親人，我再沒錢、我再窮、再經濟困難，我都一定花，對不對？所以這跟一般消費行為不一樣。改善醫療資源耗用的方法很多，而你們偏偏選一個卻最占人民便宜的──漲價，漲了以後，你的政策手段是無效，只有收人民的錢，人民的荷包扁了，可是你的政策手段是最沒用的。"],["邱部長泰源：報告委員，醫療界對於要增加人民負擔，我們真的也都不忍心，也都很不願意，也都很不希望這樣。"],["林委員淑芬：所以大家說部分負擔叫做僵屍理論，漲部分負擔就被人家稱之為是僵屍理論。","最後講一個，對分級醫療也無效，我們剛剛已經講了，就是說基層門診的就醫件數占有率在今年下半年之後有增加，但是實際上基層占率比疫前2019年以前、2020年上半年都還來得低，所以在這種狀況裡面，你們忽視了疫情造成的就醫量下滑，並用低標來當作年度的比較。在這種狀況裡面，我們來講健保署東拼西湊拼了這一篇新聞稿，調整了參考的年度，然後講了最有利自己、擦脂抹粉的政策有效性，其實就是要去凸顯你們是有效的假象！這不是保險人的應有之舉。","所以，部長，你剛才講這個手段恐怕是有問題的，如果有問題的話，你的檢討政策、你的手段跟結果之間的落差，那你要怎麼調整呢？"],["邱部長泰源：報告委員，我不是說有問題，我是說在整體的各種策略裡面，它也是一個策略。"],["林委員淑芬：我剛剛已經告訴你沒有效啦！"],["邱部長泰源：每執行一個策略，我們都會檢討。"],["林委員淑芬：我就跟你講，依剛剛這些數據，我們告訴你沒有效！你只是讓人民的荷包變得更扁。"],["邱部長泰源：因為要改善醫療體系不是那麼簡單。"],["林委員淑芬：對。"],["邱部長泰源：非常複雜。"],["林委員淑芬：那你要拿出一個比較有效的手段，而不是在那裡讓我們等得更久。"],["邱部長泰源：我們非常願意拿出手段，那這個要考慮……"],["林委員淑芬：你的手段是什麼？"],["邱部長泰源：考慮人民、考慮醫界、考慮政府……"],["林委員淑芬：對啦！你的手段……我們在這裡聽一下我們可能的手段會是什麼？錢都讓你漲了，除了漲錢以外，你還有什麼有效的手段？"],["邱部長泰源：我們第一個一定要維護病人的品質；第二個也要有醫療人員……"],["林委員淑芬：那個不是手段、也不是政策，這是宣示。"],["邱部長泰源：醫療人員要有好的工作環境，醫療人員也需要薪水、也需要好的一個環境；第三個，醫療院所……"],["林委員淑芬：你講的這個都是我們的理想，你不用講，這不是你的政策。"],["邱部長泰源：在理想之下……"],["林委員淑芬：這個不是政策啦！"],["邱部長泰源：才會一個一個來看怎麼去達到，我們健康台灣裡面的工作就一直在努力往這邊……"],["林委員淑芬：欸！我們的部分負擔在急診從450讓你漲到750餒！這個讓你漲到750，漲這麼多，你現在還拿不出手段來，你還要宣示性再念一遍，這不是在這裡虛與委蛇、行禮如儀地在那邊糊弄立委嗎？"],["邱部長泰源：報告委員，醫療院所、基層也都非常努力……"],["林委員淑芬：好啦！我們陳雪生立委一直在趕了，你交一篇書面報告來，還有……"],["邱部長泰源：感謝委員指教，我們……"],["林委員淑芬：還有那個有公安疑慮的那些醫院的資料，一個月內提供。"],["邱部長泰源：好，沒問題，謝謝。"],["主席：謝謝林委員、謝謝部長。","接續我們請賴士葆委員。"]],"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"}}}