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{\"word\": \"台\", \"start\": 87.745, \"end\": 88.066, \"score\": 0.721}, {\"word\": \"灣\"}, {\"word\": \"的\", \"start\": 88.066, \"end\": 88.286, \"score\": 0.891}, {\"word\": \"奇\", \"start\": 88.286, \"end\": 88.306, \"score\": 0.158}, {\"word\": \"蹟\"}]}, {\"start\": 89.366, \"end\": 116.794, \"text\": \"那為何現在疫情剛剛結束之後政府又開始鬆懈了呢其實台灣各醫院的急診擁設的問題早就是一個長期結構性的問題了所以結果我們主管機關衛福部不但沒有積極的想方法反而有點扯後腿那我想請問一下我們的衛福部長現在先把問題牽托到農曆過年太久了請問院長過去難道我們春節的假期沒有放過酒天的嗎\", \"words\": [{\"word\": \"那\", \"start\": 89.366, \"end\": 89.666, \"score\": 0.847}, {\"word\": \"為\"}, {\"word\": \"何\", \"start\": 89.666, \"end\": 89.966, \"score\": 0.885}, {\"word\": \"現\"}, {\"word\": \"在\", \"start\": 89.966, \"end\": 90.126, \"score\": 0.869}, {\"word\": \"疫\", \"start\": 90.126, \"end\": 90.306, \"score\": 0.869}, {\"word\": \"情\", \"start\": 90.306, \"end\": 91.086, \"score\": 0.92}, {\"word\": \"剛\"}, {\"word\": \"剛\"}, {\"word\": \"結\"}, {\"word\": \"束\", \"start\": 91.086, \"end\": 91.327, \"score\": 0.993}, 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{\"word\": \"假\", \"start\": 114.213, \"end\": 114.693, \"score\": 0.927}, {\"word\": \"期\", \"start\": 114.693, \"end\": 115.253, \"score\": 0.939}, {\"word\": \"沒\", \"start\": 115.253, \"end\": 115.473, \"score\": 0.896}, {\"word\": \"有\", \"start\": 115.473, \"end\": 115.733, \"score\": 0.997}, {\"word\": \"放\", \"start\": 115.733, \"end\": 116.274, \"score\": 0.93}, {\"word\": \"過\"}, {\"word\": \"酒\", \"start\": 116.274, \"end\": 116.534, \"score\": 0.925}, {\"word\": \"天\", \"start\": 116.534, \"end\": 116.774, \"score\": 0.996}, {\"word\": \"的\", \"start\": 116.774, \"end\": 116.794, \"score\": 0.996}, {\"word\": \"嗎\"}]}, {\"start\": 118.377, \"end\": 144.399, \"text\": \"應該都有吧我看2019、2022年連續都是放了9天而且2023年還放了10天的連續假期而且還有更離譜的是我們的衛福部的次長林靜儀更囂張竟然回嗆急診醫師的留言他說呵呵小腦袋引爆了全部醫界的憤怒那我想請問一下這些身為醫生的政府官員\", \"words\": [{\"word\": \"應\"}, {\"word\": \"該\"}, {\"word\": \"都\", \"start\": 118.377, \"end\": 118.517, \"score\": 0.977}, {\"word\": \"有\", \"start\": 118.517, \"end\": 118.738, \"score\": 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{\"word\": \"竟\", \"start\": 132.149, \"end\": 132.589, \"score\": 0.954}, {\"word\": \"然\", \"start\": 132.589, \"end\": 132.91, \"score\": 0.993}, {\"word\": \"回\", \"start\": 132.91, \"end\": 133.47, \"score\": 0.957}, {\"word\": \"嗆\"}, {\"word\": \"急\", \"start\": 133.47, \"end\": 134.271, \"score\": 0.89}, {\"word\": \"診\"}, {\"word\": \"醫\"}, {\"word\": \"師\"}, {\"word\": \"的\", \"start\": 134.271, \"end\": 134.391, \"score\": 0.995}, {\"word\": \"留\", \"start\": 134.391, \"end\": 134.671, \"score\": 0.969}, {\"word\": \"言\", \"start\": 134.671, \"end\": 135.192, \"score\": 0.996}, {\"word\": \"他\", \"start\": 135.192, \"end\": 135.732, \"score\": 0.924}, {\"word\": \"說\"}, {\"word\": \"呵\", \"start\": 135.732, \"end\": 135.892, \"score\": 0.862}, {\"word\": \"呵\", \"start\": 135.892, \"end\": 136.112, \"score\": 0.889}, {\"word\": \"小\", \"start\": 136.112, \"end\": 136.593, \"score\": 0.931}, {\"word\": \"腦\"}, {\"word\": \"袋\", \"start\": 136.593, \"end\": 136.993, \"score\": 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1375.7, \"text\": \"對不對 剛才院長講的也對啊 部長講的也對嘛我們想的都是對嘛 都是往前進嘛 對不對如果大家有這樣的公式 我們還要持續跟社會對話我剛剛說內外婦幼這四個科所以衛福部要想出方法啊要怎麼落實啊 如果能夠給他建立但是這個不能 因為這個會增加對這些實質上的支付所以我們還要平衡所以能夠農小病大家就不用保大病再來 大家就再沒煩惱然後從內外婦幼從這個不同工不同酬的給付來開始\", \"words\": [{\"word\": \"對\"}, {\"word\": \"不\", \"start\": 1346.884, \"end\": 1347.004, \"score\": 0.806}, {\"word\": \"對\"}, {\"word\": \"剛\"}, {\"word\": \"才\", \"start\": 1347.004, \"end\": 1347.485, \"score\": 0.958}, {\"word\": \"院\", \"start\": 1347.485, \"end\": 1347.925, \"score\": 0.801}, {\"word\": \"長\"}, {\"word\": \"講\"}, {\"word\": \"的\", \"start\": 1347.925, \"end\": 1348.025, \"score\": 0.907}, {\"word\": \"也\", \"start\": 1348.025, \"end\": 1348.345, \"score\": 0.886}, {\"word\": \"對\"}, {\"word\": \"啊\", \"start\": 1348.345, \"end\": 1348.645, \"score\": 0.944}, {\"word\": \"部\", \"start\": 1348.645, \"end\": 1348.805, \"score\": 0.643}, {\"word\": \"長\"}, {\"word\": \"講\"}, {\"word\": \"的\", \"start\": 1348.805, \"end\": 1349.085, \"score\": 0.83}, {\"word\": \"也\", 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\"的\", \"start\": 1553.73, \"end\": 1553.85, \"score\": 0.997}, {\"word\": \"工\", \"start\": 1553.85, \"end\": 1554.01, \"score\": 0.998}, {\"word\": \"程\", \"start\": 1554.01, \"end\": 1554.331, \"score\": 0.903}, {\"word\": \"進\"}, {\"word\": \"行\", \"start\": 1554.331, \"end\": 1554.491, \"score\": 1.0}, {\"word\": \"到\", \"start\": 1554.491, \"end\": 1554.651, \"score\": 0.997}, {\"word\": \"一\", \"start\": 1554.651, \"end\": 1554.851, \"score\": 0.903}, {\"word\": \"個\"}, {\"word\": \"程\", \"start\": 1554.851, \"end\": 1555.032, \"score\": 0.962}, {\"word\": \"度\", \"start\": 1555.032, \"end\": 1555.232, \"score\": 0.991}, {\"word\": \"它\", \"start\": 1555.232, \"end\": 1555.352, \"score\": 0.834}, {\"word\": \"就\", \"start\": 1555.352, \"end\": 1555.492, \"score\": 0.999}, {\"word\": \"停\", \"start\": 1555.492, \"end\": 1555.712, \"score\": 0.97}, {\"word\": \"下\", \"start\": 1555.712, \"end\": 1556.353, \"score\": 0.968}, {\"word\": \"來\"}, {\"word\": \"甚\", \"start\": 1556.353, \"end\": 1556.533, \"score\": 0.998}, {\"word\": \"至\", \"start\": 1556.533, \"end\": 1556.934, \"score\": 0.987}, {\"word\": \"又\", \"start\": 1556.934, \"end\": 1557.254, \"score\": 0.975}, {\"word\": \"往\", \"start\": 1557.254, \"end\": 1557.434, \"score\": 0.903}, {\"word\": \"後\", \"start\": 1557.434, \"end\": 1557.635, \"score\": 0.9}, {\"word\": \"延\", \"start\": 1557.635, \"end\": 1557.655, \"score\": 0.0}]}, {\"start\": 1558.208, \"end\": 1578.484, \"text\": \"那颱風又讓很多的觀光客又卻步了這是我們非常遺憾的事情我們總是希望說所有的補助的措施能夠徹底的落實那請問今年會不會再繼續補助呢像去年來我們執行不好的事情我們就把它加碼把它放寬那新年我相信交通部他又有一個其他的緊急的計畫在執行我們部長來說明\", \"words\": [{\"word\": \"那\", \"start\": 1558.208, \"end\": 1558.969, \"score\": 0.902}, {\"word\": \"颱\"}, {\"word\": \"風\"}, {\"word\": \"又\", \"start\": 1558.969, \"end\": 1559.689, \"score\": 0.956}, {\"word\": \"讓\"}, {\"word\": \"很\", \"start\": 1559.689, \"end\": 1559.889, \"score\": 1.0}, {\"word\": \"多\", \"start\": 1559.889, \"end\": 1560.07, \"score\": 1.0}, {\"word\": \"的\", \"start\": 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1575.402, \"end\": 1575.762, \"score\": 0.944}, {\"word\": \"交\", \"start\": 1575.762, \"end\": 1575.882, \"score\": 0.989}, {\"word\": \"通\", \"start\": 1575.882, \"end\": 1576.042, \"score\": 0.874}, {\"word\": \"部\", \"start\": 1576.042, \"end\": 1576.323, \"score\": 0.991}, {\"word\": \"他\", \"start\": 1576.323, \"end\": 1576.503, \"score\": 0.977}, {\"word\": \"又\", \"start\": 1576.503, \"end\": 1576.623, \"score\": 0.997}, {\"word\": \"有\", \"start\": 1576.623, \"end\": 1576.763, \"score\": 1.0}, {\"word\": \"一\", \"start\": 1576.763, \"end\": 1577.363, \"score\": 0.966}, {\"word\": \"個\"}, {\"word\": \"其\", \"start\": 1577.363, \"end\": 1577.504, \"score\": 0.998}, {\"word\": \"他\", \"start\": 1577.504, \"end\": 1577.624, \"score\": 0.958}, {\"word\": \"的\", \"start\": 1577.624, \"end\": 1577.924, \"score\": 0.89}, {\"word\": \"緊\"}, {\"word\": \"急\", \"start\": 1577.924, \"end\": 1578.084, \"score\": 0.973}, {\"word\": \"的\", \"start\": 1578.084, \"end\": 1578.224, \"score\": 0.998}, {\"word\": \"計\"}, {\"word\": \"畫\"}, {\"word\": \"在\", \"start\": 1578.224, \"end\": 1578.344, \"score\": 0.833}, {\"word\": \"執\"}, {\"word\": \"行\", \"start\": 1578.344, \"end\": 1578.424, \"score\": 0.75}, {\"word\": \"我\", \"start\": 1578.424, \"end\": 1578.444, \"score\": 0.0}, {\"word\": \"們\"}, {\"word\": \"部\", \"start\": 1578.444, \"end\": 1578.464, \"score\": 0.0}, {\"word\": \"長\"}, {\"word\": \"來\"}, {\"word\": \"說\"}, {\"word\": \"明\", \"start\": 1578.464, \"end\": 1578.484, \"score\": 0.0}]}, {\"start\": 1581.926, \"end\": 1603.271, \"text\": \"確實去年花蓮因為地震再加上好幾個颱風確實對觀光業影響非常大那您也非常關心交通建設的問題我們目前交通上升穩定目前最近比較沒有太大的雨所以上升穩定的狀況底下其實我們花蓮的觀光在11月份已經漸漸回到了112年的水準也就是說已經有復甦的狀況\", \"words\": [{\"word\": \"確\"}, {\"word\": \"實\"}, {\"word\": \"去\", \"start\": 1581.926, \"end\": 1582.146, \"score\": 0.976}, {\"word\": \"年\", \"start\": 1582.146, \"end\": 1582.826, \"score\": 0.973}, {\"word\": \"花\", \"start\": 1582.826, \"end\": 1583.107, \"score\": 0.902}, {\"word\": \"蓮\"}, {\"word\": \"因\", \"start\": 1583.107, \"end\": 1583.387, \"score\": 0.905}, {\"word\": \"為\"}, {\"word\": \"地\", \"start\": 1583.387, \"end\": 1583.567, \"score\": 0.891}, {\"word\": \"震\", \"start\": 1583.567, \"end\": 1583.767, \"score\": 0.908}, {\"word\": \"再\", \"start\": 1583.767, \"end\": 1583.927, \"score\": 0.88}, {\"word\": \"加\", \"start\": 1583.927, \"end\": 1584.067, \"score\": 0.996}, {\"word\": \"上\", \"start\": 1584.067, \"end\": 1584.207, \"score\": 0.975}, {\"word\": \"好\", \"start\": 1584.207, \"end\": 1585.247, \"score\": 0.874}, {\"word\": \"幾\"}, {\"word\": \"個\"}, {\"word\": \"颱\"}, {\"word\": \"風\"}, {\"word\": \"確\"}, {\"word\": \"實\"}, {\"word\": \"對\"}, {\"word\": \"觀\"}, {\"word\": \"光\", \"start\": 1585.247, \"end\": 1585.627, \"score\": 0.939}, {\"word\": \"業\"}, {\"word\": \"影\", \"start\": 1585.627, \"end\": 1585.987, \"score\": 0.906}, {\"word\": \"響\"}, {\"word\": \"非\", \"start\": 1585.987, \"end\": 1586.127, \"score\": 0.901}, {\"word\": \"常\", \"start\": 1586.127, \"end\": 1586.427, \"score\": 0.989}, {\"word\": \"大\", \"start\": 1586.427, \"end\": 1587.207, \"score\": 0.993}, {\"word\": \"那\", \"start\": 1587.207, \"end\": 1587.327, \"score\": 0.89}, {\"word\": \"您\", \"start\": 1587.327, \"end\": 1587.467, \"score\": 0.856}, {\"word\": \"也\", \"start\": 1587.467, \"end\": 1587.627, \"score\": 0.999}, {\"word\": \"非\", \"start\": 1587.627, \"end\": 1587.768, \"score\": 0.959}, {\"word\": \"常\", \"start\": 1587.768, \"end\": 1588.128, \"score\": 0.944}, {\"word\": \"關\"}, {\"word\": \"心\", \"start\": 1588.128, \"end\": 1588.288, \"score\": 0.879}, {\"word\": \"交\", \"start\": 1588.288, \"end\": 1588.428, \"score\": 0.998}, {\"word\": \"通\", \"start\": 1588.428, \"end\": 1588.608, \"score\": 0.995}, {\"word\": \"建\", \"start\": 1588.608, \"end\": 1588.968, \"score\": 0.916}, {\"word\": \"設\"}, {\"word\": \"的\", \"start\": 1588.968, \"end\": 1589.068, \"score\": 0.995}, {\"word\": \"問\"}, {\"word\": \"題\"}, {\"word\": \"我\", 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\"狀\"}, {\"word\": \"況\"}, {\"word\": \"底\", \"start\": 1595.989, \"end\": 1596.429, \"score\": 0.915}, {\"word\": \"下\", \"start\": 1596.429, \"end\": 1596.609, \"score\": 0.889}, {\"word\": \"其\", \"start\": 1596.609, \"end\": 1596.849, \"score\": 0.875}, {\"word\": \"實\"}, {\"word\": \"我\", \"start\": 1596.849, \"end\": 1597.169, \"score\": 0.885}, {\"word\": \"們\"}, {\"word\": \"花\", \"start\": 1597.169, \"end\": 1597.53, \"score\": 0.928}, {\"word\": \"蓮\"}, {\"word\": \"的\", \"start\": 1597.53, \"end\": 1597.81, \"score\": 0.924}, {\"word\": \"觀\"}, {\"word\": \"光\", \"start\": 1597.81, \"end\": 1598.25, \"score\": 0.998}, {\"word\": \"在\", \"start\": 1598.25, \"end\": 1598.81, \"score\": 0.928}, {\"word\": \"1\"}, {\"word\": \"1\"}, {\"word\": \"月\", \"start\": 1598.81, \"end\": 1599.13, \"score\": 0.95}, {\"word\": \"份\", \"start\": 1599.13, \"end\": 1599.59, \"score\": 0.984}, {\"word\": \"已\", \"start\": 1599.59, \"end\": 1600.25, \"score\": 0.909}, {\"word\": \"經\"}, {\"word\": \"漸\"}, {\"word\": \"漸\"}, {\"word\": \"回\", \"start\": 1600.25, \"end\": 1600.45, \"score\": 0.999}, {\"word\": \"到\", \"start\": 1600.45, \"end\": 1600.61, \"score\": 0.999}, {\"word\": \"了\", \"start\": 1600.61, \"end\": 1601.43, \"score\": 0.872}, {\"word\": \"1\"}, {\"word\": \"1\"}, {\"word\": \"2\"}, {\"word\": \"年\", \"start\": 1601.43, \"end\": 1601.63, \"score\": 0.999}, {\"word\": \"的\", \"start\": 1601.63, \"end\": 1601.81, \"score\": 0.999}, {\"word\": \"水\", \"start\": 1601.81, \"end\": 1602.051, \"score\": 0.998}, {\"word\": \"準\", \"start\": 1602.051, \"end\": 1602.511, \"score\": 0.956}, {\"word\": \"也\", \"start\": 1602.511, \"end\": 1602.611, \"score\": 0.804}, {\"word\": \"就\", \"start\": 1602.611, \"end\": 1602.811, \"score\": 0.946}, {\"word\": \"是\", \"start\": 1602.811, \"end\": 1602.951, \"score\": 0.857}, {\"word\": \"說\"}, {\"word\": \"已\", \"start\": 1602.951, \"end\": 1603.151, \"score\": 0.899}, {\"word\": \"經\"}, {\"word\": \"有\", \"start\": 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我們去年確實也有加碼在針對僑胞去避免返國的時候本來我們一般都補助三千塊那麼如果特別到花東去旅遊的我們就補助三千六百塊那這樣子做當然有多少增加一些誘因成效怎麼樣呢\", \"words\": [{\"word\": \"也\", \"start\": 1647.597, \"end\": 1647.757, \"score\": 0.973}, {\"word\": \"召\", \"start\": 1647.757, \"end\": 1647.937, \"score\": 0.823}, {\"word\": \"集\", \"start\": 1647.937, \"end\": 1648.017, \"score\": 0.757}, {\"word\": \"了\", \"start\": 1648.017, \"end\": 1648.297, \"score\": 0.787}, {\"word\": \"業\"}, {\"word\": \"者\", \"start\": 1648.297, \"end\": 1648.597, \"score\": 0.907}, {\"word\": \"大\", \"start\": 1648.597, \"end\": 1648.737, \"score\": 0.863}, {\"word\": \"家\", \"start\": 1648.737, \"end\": 1648.857, \"score\": 0.882}, {\"word\": \"也\", \"start\": 1648.857, \"end\": 1648.977, \"score\": 0.9}, {\"word\": \"提\", \"start\": 1648.977, \"end\": 1649.137, \"score\": 0.923}, {\"word\": \"出\", \"start\": 1649.137, \"end\": 1649.257, \"score\": 0.649}, {\"word\": \"了\", \"start\": 1649.257, \"end\": 1649.438, \"score\": 0.752}, {\"word\": \"相\", \"start\": 1649.438, 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\"end\": 1863.39, \"score\": 0.9}, {\"word\": \"員\"}, {\"word\": \"質\"}, {\"word\": \"詢\"}, {\"word\": \",\"}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"卓\", \"start\": 1863.39, \"end\": 1863.49, \"score\": 0.8}, {\"word\": \"院\", \"start\": 1863.49, \"end\": 1863.61, \"score\": 0.833}, {\"word\": \"長\"}, {\"word\": \"的\", \"start\": 1863.61, \"end\": 1863.67, \"score\": 0.667}, {\"word\": \"備\"}, {\"word\": \"詢\"}, {\"word\": \"接\", \"start\": 1863.67, \"end\": 1863.83, \"score\": 0.875}, {\"word\": \"下\", \"start\": 1863.83, \"end\": 1863.93, \"score\": 0.8}, {\"word\": \"來\"}, {\"word\": \"我\", \"start\": 1863.93, \"end\": 1863.95, \"score\": 0.0}, {\"word\": \"們\"}, {\"word\": \"請\"}, {\"word\": \"莊\"}, {\"word\": \"瑞\", \"start\": 1863.95, \"end\": 1864.01, \"score\": 0.667}, {\"word\": \"雄\", \"start\": 1864.01, \"end\": 1864.13, \"score\": 0.833}, {\"word\": \"委\", \"start\": 1864.13, \"end\": 1864.15, \"score\": 0.0}, {\"word\": \"員\"}, {\"word\": \"請\"}, {\"word\": \"質\"}, {\"word\": \"詢\"}], \"language\": \"zh\"}","srt":"1\n00:00:16,138 --> 00:00:19,361\n謝謝主席有請院長麻煩再請卓院長備詢議員好院長好\n\n2\n00:00:35,872 --> 00:00:59,615\n最近全台爆發急診擁捨的問題不斷的在延燒醫護短缺的問題也是日漸的嚴峻讓我們台灣的醫療環境困境再度的凸顯那其實落實分級醫療還有讓醫療的資源合理的分配都是解決急診擁捨問題最基本的解決的方案但是本席也身為醫藥背景的專業人員但是對衛福部\n\n3\n00:01:00,195 --> 00:01:28,306\n現在的許多的政策其實我有時候都是物理看花啦不是什麼完全看不懂啦為什麼我們衛福部現在都是有時候有些政策不願意跟國際趨勢接軌呢像上次政府都是常常的自豪的說台灣是國際醫療的自由神尤其是COVID-19的時候那個時候我們的全國的醫藥護理人員共同的協力然後創造了台灣的奇蹟\n\n4\n00:01:29,366 --> 00:01:56,794\n那為何現在疫情剛剛結束之後政府又開始鬆懈了呢其實台灣各醫院的急診擁設的問題早就是一個長期結構性的問題了所以結果我們主管機關衛福部不但沒有積極的想方法反而有點扯後腿那我想請問一下我們的衛福部長現在先把問題牽托到農曆過年太久了請問院長過去難道我們春節的假期沒有放過酒天的嗎\n\n5\n00:01:58,377 --> 00:02:24,399\n應該都有吧我看2019、2022年連續都是放了9天而且2023年還放了10天的連續假期而且還有更離譜的是我們的衛福部的次長林靜儀更囂張竟然回嗆急診醫師的留言他說呵呵小腦袋引爆了全部醫界的憤怒那我想請問一下這些身為醫生的政府官員\n\n6\n00:02:25,200 --> 00:02:38,583\n竟然沒有一絲絲的同理心遇到什麼事情就先推完全沒有傾聽基層的聲音甚至不負責任緬滅人性的發言你們覺得這樣是對的嗎還有看在我們衛福部部長和次長這樣如果你們大家是身為我們醫療的大家長的情況下應該是要針對問題來找解方才是嘛對不對而且我再請問一下院長就是說你認為所謂的吵架失言專業\n\n7\n00:02:54,207 --> 00:03:17,438\n專業嗆民眾專業嗆醫護這樣的適合擔任我們主管醫藥專業的官員嗎這樣這種人在你的行政院的整個團隊中這樣的人是適任的嗎跟委員抱歉這個整個事件我已經對外表示過了政務人員政府的官員務必要謹言正行嗆民眾嗆醫護這個都不是專業應該有的行為\n\n8\n00:03:21,024 --> 00:03:48,593\n春節九天過去也有過那九天比較長的連假這只是今天我們在分析整個這個急診擁塞的情形的一個條件而已一個狀況而已其他它還有諾羅病毒還有天候的變化等等但無論什麼樣的原因啊我想部長也好次長也好我們所有的從政的同仁都應該用同理心不要用這種方式去跟民眾對話我再度的向大家表示歉意\n\n9\n00:03:50,289 --> 00:04:08,418\n好因為這個問題並不是一次而已是連續好幾次的也引發民眾還有一些的反應那我希望院長可以在這方面多注意一下我們會多多的要求跟約束謝謝謝謝委員提醒現在急診庸塞和長期醫療人力不足的問題其實已經罄竹然書了啦說真的\n\n10\n00:04:08,818 --> 00:04:31,093\n各界其實大家都是一直在討論其實都是有在想要幫政府想一些及時廣義想一些提供一些正確的想法要給政府看什麼樣的做法但是請問一下衛福部為什麼現在都不願意買單解決現在我們正在惡化的醫療現場呢例如我們要重新檢討健保制度還有落實\n\n11\n00:04:33,595 --> 00:04:59,050\n醫療分級這方面還有強化宣導輕症自我照護小小病自我要療的照護的觀念其實這些都是先進的國家在做的國民健康的政策但是為什麼衛福部你現在對這些意見都視而不見呢還有甚至背道而馳呢因為我看院長部長你們看其實你們知道衛福部其實從103年開始就開始推動了自我照護\n\n12\n00:05:00,191 --> 00:05:28,040\n這些自我照護連續幾年都有出國考察而且他們都是針對考察這些針對自我用藥法規專家的會議還有世界自我用藥的聯會的會議所以但是一下子10年11年就過去了但是都沒有看到成效所以健保的財政的情況還是無解而且現在衍生出來了急診擁捨的問題那請教院長你知道每年的7月24號是什麼日子嗎\n\n13\n00:05:32,554 --> 00:05:47,453\n你知道每年的7月24號是什麼日子嗎那其實是那是WHO為了提倡自我照護觀念他將每年7月24號定做國際自我照護日\n\n14\n00:05:48,334 --> 00:06:13,730\n就是說一週有7天一天有24小時其實他是鼓勵大家來積極行動來改善我們自己維護自我的身心上面的健康所以院長你相信最近那麼多的急診篩報的問題其主要的原因也是因為我們台灣現在的整體的醫療的體系出問題然後失衡還有人力不足我相信你都知道的然後面對台灣現在超高齡的社會來臨\n\n15\n00:06:14,651 --> 00:06:39,462\n其實台灣在積極想要加入WHO的同時其實我們要怎麼樣加強我們人民自我照護的意識還有呼應WHO所提倡的自我照護的觀念所以我們要強化輕症病人的自我照護避免輕症的這些病患湧入急診不會造成急診的擁捨的問題然後小小病就到藥局去\n\n16\n00:06:40,442 --> 00:06:59,198\n然後小病到診所還是到地區醫院然後大病再到醫院而且要落實轉診整個的制度強化分級醫療其實這個是讓醫療資源能夠用在真正的集中症的上面並不是全部的人一有問題全部擠到大醫院裡面去\n\n17\n00:06:59,778 --> 00:07:18,404\n所以我覺得這個也是解決急診擁捨一個簡單的解方之一啦所以也是解決健保財政虧損的方式之一所以有時候我們對這些問題我們可能要正視這個問題想方法去解決然後也根據了歐洲自我照護的產業我也發現了2023年的5月我發現了他們發布了一個調查的報告指出\n\n18\n00:07:23,726 --> 00:07:44,810\n歐洲每年有12億的異例的小病痛這些小病痛他們透過非處方藥的自我照護不用到醫院到藥局去自我藥療就可以省下360億的歐元的醫藥上面的支出然後美國也調查民眾的自我照護可以為美國醫療省下1670億的美元的費用\n\n19\n00:07:49,671 --> 00:08:17,723\n所以根據我們的健保署上面也有統計我們國人只要減少一次的就醫的情況我們一年估計可以為健保省下340億元所以表示自我照護自我要了這個觀念其實對於節省珍貴的健保資源是有非常顯著的效益的那我想請教衛福部部長你可以將自我照護明確的落實嗎你是否同意呢\n\n20\n00:08:19,344 --> 00:08:41,190\n好謝謝委員的指教那我想自我照顧跟分級醫療是我們這幾十年來政府一直在推動的在一二十年前何勝茂署長當署長的時候我就是編一個健康達人125教導全國民眾怎麼樣自我照顧的主編\n\n21\n00:08:42,472 --> 00:09:03,493\n那當然我也過去多年來在醫療網裡面推動分級醫療所以我想非常敬佩我們委員提出的這兩個觀念那我想這個一定要去落實那在民眾的照顧方面當然最好是能防病於未然那麼在因此在我們健康台灣的工作上面其實\n\n22\n00:09:04,437 --> 00:09:21,418\n特別重視在前端的在運動營養生活形態的一個改善的一個宣導跟教育我相信不管是哪一個醫事人員尤其是社區的藥局應該在這個部分可以一起來努力我想那個\n\n23\n00:09:23,716 --> 00:09:39,611\n再加上我們藥師的同仁其實都有很好的臨床的信念臨床藥師的信念所以基本上在給病人做擁有指示用藥的協助所以應該是可以共同來照護病人那目前\n\n24\n00:09:40,734 --> 00:10:04,630\n其實台灣也在推動社區整合型的照護體系裡面最重要的是一個家庭醫師的團隊所謂家庭醫師不是只有醫師他藥師、物理治療師、職能治療師共同組成一個團隊讓民眾在社區就有一個很堅強的團隊有什麼問題就來看他我相信這個就是分級醫療的第一點也是我們台灣很珍貴的一個\n\n25\n00:10:06,249 --> 00:10:26,090\n家庭醫師整合型照顧體系未來我相信醫師、藥師各種醫師等等這樣的合作起來一定可以落實分級醫療也讓我們現在很頭痛的一個急診或醫院的用事可以得到很好的環節所以我們一起來努力也感謝我們委員的指導\n\n26\n00:10:26,741 --> 00:10:40,976\n其實我覺得政府有很多政策這方面的其實都是很好的包括轉診制度、分級醫療上面還有自我醫療上面但是我覺得一直都沒有落實就是沒有落實才可以激到變成急診、庸塞的問題所以這個我可能要麻煩部長的話要多費心一點\n\n27\n00:10:47,483 --> 00:10:59,978\n好接下來問題就是全民健康保險法第51條規定只是藥品也是屬於不列入健保給付的範圍之一的項目是嗎部長是的\n\n28\n00:11:02,017 --> 00:11:25,248\n所以我想請教一下就是院長和部長既然你們都認為健保改革我們同意要先從民眾的自我照護開始這個觀念開始的話那是不是應該利用一些比較部分安全無虞的這些藥品把處方藥轉為指示用藥還有加速指示藥退出健保這樣我們才能解決健保要價的黑洞然後也\n\n29\n00:11:26,248 --> 00:11:42,576\n也解決了以藥養醫的弊病而且部長你知道審計部嗎他針對了現在的814項非屬健保規定給付的指示用藥仍未退出健保給付的問題有提出一個總決算的審核報告\n\n30\n00:11:44,398 --> 00:11:58,416\n112年度中央政府總決算的審核報告裡面有指出有841項指示用藥列入給付的範圍然後檢討進度太慢了要求衛福部以督促落實檢討指示用藥\n\n31\n00:12:01,259 --> 00:12:19,170\n以提高健保資源利用的效率也就是說我們現在簡單的說就是只是用要列入健保給付的範圍在健保給付藥物的比例達到27.3意思是使健保給付的藥物中有四分之一的項目是違法給付\n\n32\n00:12:19,830 --> 00:12:45,450\n更耗費了20億的公帑所以院長請問一下衛福部是不是應該要根據審計部的審核的報告意見提出檢討改善方案落實全民健康保險法第51條的規定只是要比也是屬於不列入健保給付範圍之一的項目所以請問一下何時可以給出改善的方案何時我們可以落實\n\n33\n00:12:46,857 --> 00:13:08,332\n謝謝委員的指教我想不管是健保署或者是食藥署針對我們的指示用藥都非常的用心也會依照那個審計部或相關的單位的一個要求來改善那對於處方藥品長期使用經驗上\n\n34\n00:13:10,803 --> 00:13:32,216\n安全無虞的藥品既有安全性那用以緩解輕症且在至少有三個醫藥先進國家以指示藥品在管理者經食藥署評估並邀請醫藥等領域專家共同討論後得轉類為指示用藥指示藥品那剛才不知道你說幾個國家一直都在努力三個國家而已嗎\n\n35\n00:13:33,889 --> 00:13:38,035\n至少有三個醫藥先進國家至少三個那我下一個問題還有一個問題要問你先回答這一個\n\n36\n00:13:40,506 --> 00:14:03,724\n好我想這個部分會一直在努力我想這幾天來所以這個只是要退出健保其實是因為我們怕健保的財政受虧損所以現在健保其實也健保局也不好做健保局也不好做所以我們是希望人民用藥的方便性所以在醫藥跟人民當中我們當然以人民為\n\n37\n00:14:06,327 --> 00:14:30,747\n對這個剛才我是一整串的問題對一整串的問題是都一直有連貫性的以人民的權益為優先之下醫藥共同來商討我想都可以來解決對就是安全無虞的處方用藥盡量先退成只是用藥只是用藥的話再來退出健保基礎都有一直在往前走是謝謝委員指教\n\n38\n00:14:31,567 --> 00:14:52,653\n那剛才部長有提到那個三個國家的問題來這就是下一個就是接著為了不讓健保財政一直在虧損中非必要的醫生處方藥是不是要轉為指示用藥嗎剛才部長還說是三個嘛像緊急事後避孕藥這個現在我們先來講確保女性的生育的自主權\n\n39\n00:14:54,013 --> 00:15:22,139\n讓女性把握緊急避孕的機會我想說部長也是醫生也知道這一種藥它有黃金的時間可能12小時72小時以內一定要服用的有時候到診所到醫院去他們不見得說或許大家在休診也都有可能可能會錯過了這個時間而且現在確保女性生育的自主權的話現在是想生的卻不能生但是非自願的不想生的要避孕的那會\n\n40\n00:15:23,079 --> 00:15:48,691\n會不會衛福部管太多了對不對部長上回其實我已經有請教過你了嘛衛福部要正視女性的自主權還有用藥權益對緊急事後病因要開放變更為指示藥品確保女性生育的自主權但是衛福部都沒有給一個北溪的一個回應所以我現在就是說剛才有談到三個國家現在全球已經有\n\n41\n00:15:50,212 --> 00:16:04,020\n88個國家將事後避孕藥列為非處方用藥了而且在2023年日本也可以在社區藥局販賣禁忌避孕藥其實這個我們現在還沒有做到對不對\n\n42\n00:16:04,640 --> 00:16:30,229\n所以根據WHO的報告將事後病因藥轉成非處方藥是讓女性方便的取得這個藥物不僅可以減少女性因為懷孕而面臨的風險也可以降低因意外懷孕所帶來的社會還有經濟上面的負擔而且包括連我們現在知名的女權團體在2024年的10月份的時候有對於這個\n\n43\n00:16:32,270 --> 00:16:54,589\n事後病藥是否開放來做了一個調查線上的調查結果有六成五的民眾支持開放而且2016年調查七成的幾乎完全七成人都支持而且希望能夠方便及時取得而且藥局即可購買還有提高女性自主所以我想部長針對這個問題的話我想說\n\n44\n00:16:58,812 --> 00:17:07,041\n您應該也是會很重視這個問題所以在2016年的時候我有去看過2016年的時候有針對這個問題討論過廚房藥改成民眾在藥局購買的指示用藥也已經衛福部通過了\n\n45\n00:17:15,515 --> 00:17:36,329\n也發佈在緊急事後避孕藥變更為指示藥品的說明所以據本席了解指示藥品陳藥主已經開過會討論過了將緊急事後避孕藥從醫生處方藥轉列為指示用藥但是這個會議中也做成了會議記錄所以為什麼食藥署到現在還說醫生團體\n\n46\n00:17:39,991 --> 00:18:05,466\n還評估還沒有共識呢而且部長你知道我們的衛福部的政策為什麼擱置到現在還沒有共識呢對不對而且這個不是2016年早有共識了嗎還是有人不同意呢是不是有人刻意去修改了整個的會議紀錄你衛福部要不要調查一下當時的情況啊照我是這樣看的是因為會議背後有一隻看不到的手\n\n47\n00:18:06,306 --> 00:18:35,826\n所以我想部長你針對這個問題你可能要去了解一下在2016年那時候發生的事情而且你身為醫生你醫者人心我拜託你千萬不要讓女性生育權被自主權被剝奪了政府你現在不是在營造整個友善的生育環境嗎你是不是要讓女性能夠安心而且自由的選擇自己何時要懷孕這個我想這個也是政府的重要的責任\n\n48\n00:18:37,487 --> 00:18:50,495\n報告委員謝謝委員的指教有關於這個事後必應要轉捩為非處方藥品管理的議題其實從剛剛您所說的從2016年其實那個時候就開始有討論\n\n49\n00:18:51,482 --> 00:19:10,537\n那我在當立委的期間也開過不少次的協調會議因為就是醫藥有不同的看法那我想我們不管是醫跟藥我聽起來都是為了人民的權利在努力那我個人都非常的感動但是因為有不同的專業的看法所以\n\n50\n00:19:11,206 --> 00:19:26,148\n也是涉及的層面比較廣泛那因為在有一些醫事的團體專業團體他們認為尤其特別會照顧到婦女懷孕生產的科別他們在這個部分是很有\n\n51\n00:19:27,225 --> 00:19:53,628\n對部長你剛才講三個國家同意這個有八十八個國家我們台灣要不要跟國際接軌啊我們一直在走倒退路嗎他還是一種和我們啦他還是會影響到現在都是醫界在擋這一個啊不是嗎這個明明就是國際上已經八十八個國家這樣做了啊對不對部長你不能不公欸你現在全部人都是醫生你這樣是不是太不公了啊\n\n52\n00:19:55,269 --> 00:20:06,458\n你要為全國的民眾想啊全部的女性的自主權對不對他們生育的自主權大家都等著你們而且2012年的時候你先去看看是不是有人篡改會議紀錄\n\n53\n00:20:09,057 --> 00:20:13,339\n我們去了解本部的食藥署已經將114.36號召開緊急事後避孕完轉為醫師藥師現在整個會議全部都是醫生請問一下這樣怎麼會公平呢這個讓部長\n\n54\n00:20:29,625 --> 00:20:50,935\n去做好好的協調我想從醫藥分業之後我們的醫藥關係一直是在一個比較是是院長是沒錯但是安全無虞的藥品我已經非常這個比較合理的使用安全無虞的藥品這個東西已經安全無虞了而且88個國家都已經這樣做了現在只有台灣沒有這樣做\n\n55\n00:20:51,795 --> 00:21:19,768\n我要求部長盡快跟醫界、藥界達成共識大家能夠在安全無虞的合理使用狀況下當時我也要請委員能夠支持因為委員的專業非常注重健保今年健保30年我常說健保30年保障國人的健康現在是我們回頭保障健保的時代30年前我就一直主張小病不用保大病沒煩惱這種小病集中到醫學中心去\n\n56\n00:21:21,343 --> 00:21:49,629\n用那麼少的這個代價致富額他就能夠得到他應該讓他到診所去用他完全來負擔這個就是落實分級醫療嗎分級醫療轉診制度如果我們觀念能夠轉過來小病不用保大病就沒煩惱讓那個可以傾家蕩產的病讓政府全力來照顧他讓那個影響到整個公共衛生的病政府全力來遏止他政府應該做這個東西小病讓他自己來做另外我們的內外婦兒這四顆\n\n57\n00:21:50,929 --> 00:22:16,448\n醫事人員的減少我們也必須大家觀念轉變我們再落實一個就是不同工不同酬的醫療給付讓醫院醫事人員的工作尊嚴能夠得到保障如果這個觀念能夠同期的建立我們可以再創30年50年更好的健保制度所以我們是不是大家有這樣的一個責任來面對健保的實質改革而不是在討論錢多錢少該不該提保費的問題我們從基本上來討論\n\n58\n00:22:20,292 --> 00:22:25,553\n沒錯啊所以我覺得大家的政策大家的想法我覺得都是正確但是完全沒有落實啊\n\n59\n00:22:26,884 --> 00:22:55,700\n對不對剛才院長講的也對啊部長講的也對嘛我們想的都是對嘛都是往前進嘛對不對如果大家有這樣的公式我們還要持續跟社會對話我剛剛說內外婦幼這四個科所以衛福部要想出方法啊要怎麼落實啊如果能夠給他建立但是這個不能因為這個會增加對這些實質上的支付所以我們還要平衡所以能夠農小病大家就不用保大病再來大家就再沒煩惱然後從內外婦幼從這個不同工不同酬的給付來開始\n\n60\n00:22:56,520 --> 00:23:22,029\n我想這個社會的觀念如果建立起來剛開始也許會遭受很多很多的討論但是我相信如果提出這樣的討論對社會是正面的其實也不是院長不是提出這樣的討論這個事情已經做很久了我想部長也是知道只是沒有做得很徹底沒有做得很成功所以我覺得我們還是要用心在這一塊啦好不好那一些修法的部分可能我們就要有共識才能來進行\n\n61\n00:23:23,767 --> 00:23:45,973\n這個已經在實施了對只是沒有落實我想自我照顧跟分級醫療我們一定繼續來推那醫藥方面在某些專業的互動我們一定持續來溝通醫藥本是一家要攜手共同來照顧人民的健康我們一起來努力也謝謝委員的啟示跟指教好謝謝部長那我有請交通部長\n\n62\n00:23:59,022 --> 00:24:25,209\n好那我就因為時間不多這樣我還是先靜緩講一下就是院長你知道零四零三強震開米颱風其實重創了花蓮的觀光業者都是一直在覺得去年是從業三十年來最慘的一天一次地震發生花蓮的旅宿還有餐飲其實已經都停業上百家了這是本心還是持續的關心我們花蓮的觀光和交通\n\n63\n00:24:25,689 --> 00:24:53,854\n因為對花蓮來講其實最重要的就是要怎麼樣活下去所以去年113年花蓮的遊客是近年五年來最低的還比起前一年112年的時候已經下降了一半那我想院長也是很認真每個月當初都說有你都有允諾說要每個月都要下去花蓮勘查整個情況所以我想院長你應該很了解花蓮現在的困境是什麼\n\n64\n00:24:54,634 --> 00:25:02,782\n所以也很感謝你振興花蓮的觀光而努力所以在去年針對0403的地震的時候振興花蓮觀光產業我們也放寬了公務人員的國旅卡休假補助費的整個措施那請問去年的實施是如何呢我想應該是成效不佳吧因為花蓮現在的店家和民眾還是無感\n\n65\n00:25:17,597 --> 00:25:41,263\n所以光是觀光人數接到上面的觀光客其實我們都看出來其實真的觀光的人數是非常非常的少而且非常非常的慘淡那院長那為什麼實施到去年今年就補助了呢沒有補助了呢還是你覺得說今年有更好的規劃呢還是有什麼特別加碼的規劃呢可以振興我們花蓮的觀光\n\n66\n00:25:42,657 --> 00:25:57,655\n我簡單的先向委員說不敢說認真兩個字這是我們團隊應該做的事情只是很遺憾的是去年0403之後7月好幾次的颱風當我們的工程進行到一個程度它就停下來甚至又往後延\n\n67\n00:25:58,208 --> 00:26:18,484\n那颱風又讓很多的觀光客又卻步了這是我們非常遺憾的事情我們總是希望說所有的補助的措施能夠徹底的落實那請問今年會不會再繼續補助呢像去年來我們執行不好的事情我們就把它加碼把它放寬那新年我相信交通部他又有一個其他的緊急的計畫在執行我們部長來說明\n\n68\n00:26:21,926 --> 00:26:43,271\n確實去年花蓮因為地震再加上好幾個颱風確實對觀光業影響非常大那您也非常關心交通建設的問題我們目前交通上升穩定目前最近比較沒有太大的雨所以上升穩定的狀況底下其實我們花蓮的觀光在11月份已經漸漸回到了112年的水準也就是說已經有復甦的狀況\n\n69\n00:26:44,551 --> 00:27:11,472\n那去年我們主要是因為403的地震那沒關係我想知道說這個有沒有更好的規劃振興花蓮的觀光有沒有什麼加碼的還是有一個做一個更好的規劃我先知道這個因為我後面還有一些問題要問去年是因為地震的原因所以用一個救急的方案來補助有補助的方案但是我剛剛有提到就是說現在的觀光的狀況已經比較穩定了所以我們大概不會用可是我們還是很慘淡啊\n\n70\n00:27:12,212 --> 00:27:13,553\n現在除了剛剛委員說的橋尾會有這樣的方式之外我們去年年底副院長還主持了觀光的諮詢會議\n\n71\n00:27:27,597 --> 00:27:55,465\n也召集了業者大家也提出了相當的問題所以僑委會是不是有這樣的一個對我想說僑胞回台的時候他們社會應該需要可以去看看可不可以結合報告委員我們去年確實也有加碼在針對僑胞去避免返國的時候本來我們一般都補助三千塊那麼如果特別到花東去旅遊的我們就補助三千六百塊那這樣子做當然有多少增加一些誘因成效怎麼樣呢\n\n72\n00:27:57,205 --> 00:28:24,224\n如同剛剛交通部所報告的就是說因為去年一直不斷有颱風跟地震的因素影響所以最終真的去到花東旅遊的人數那我想請問一下今年會不會再有補助今年我們會繼續比照就是說增加我們的花東觀光特約商店以及再增加一樣3600的補助那今年就是還會有然後做更好的規劃然後再加碼\n\n73\n00:28:24,944 --> 00:28:34,313\n另外我再跟您補充一下現在我們有香港飛花蓮的班機那也是一個班機一個包機補助28萬這個部分有在努力\n\n74\n00:28:35,011 --> 00:28:47,937\n院長也有特別交代我們希望禮拜一到禮拜天每一天都有台北飛花蓮的班機那這個部分已經在進行當中所以每個禮拜一到禮拜天每一天都有班機飛花蓮台北到花蓮我再問一下部長一個問題有關於花蓮鐵路高架化的交通的問題\n\n75\n00:28:56,361 --> 00:29:16,926\n這個台灣的東部在花蓮市和吉安鄉這邊有七個平面的平交道其實他是穿越花蓮市和吉安鄉的鬧區所以針對這個時候之前民怨的情況下據我了解這個計畫來來回回的修了好幾次而且112年4月的時候那時候前交通部長已經同意了\n\n76\n00:29:18,026 --> 00:29:36,780\n將花東地區鐵路雙軌電氣化的計畫工程納入花蓮站和甘城站七個鐵路平交道的高價立體化辦理並且全額的負擔而且那時候我看是4562億餘元編到哪就做到哪然後114年編了600億那我想請問一下\n\n77\n00:29:40,816 --> 00:30:06,066\n根據我現在看那台鐵花蓮和吉安甘城站的高架工程那哪時候可以規劃動工呢而且據我最近了解我也覺得很奇怪就是目前計畫書送到行政院的石層大海音訊全無是不是改以鐵路平交道與環境改善設施的周邊土地的計畫審查要點審查就是中央已經不全額的負擔費用了那我想請教一下院長\n\n78\n00:30:06,826 --> 00:30:20,599\n中央不全額負擔的原因是什麼而且目前計畫書是不是已經到行政院了那如果到行政院了可以加速審核嗎報告委員您剛所提的這個高價化的部分目前因為它的合理性\n\n79\n00:30:21,072 --> 00:30:37,056\n我們還有一些質疑啦因為其他的縣市的高價化他不是放在雙軌電機那是112年4月的時候交通部長前交通部長王國才就正面回應了他就說這個他會全部列入而且答應全額負擔你要騙我們花蓮人啊\n\n80\n00:31:02,810 --> 00:31:04,150\n謝謝林益君委員質詢,謝謝卓院長的備詢接下來我們請莊瑞雄委員請質詢\n\n","tsv":"start\tend\ttext\n16138\t19361\t謝謝主席有請院長麻煩再請卓院長備詢議員好院長好\n35872\t59615\t最近全台爆發急診擁捨的問題不斷的在延燒醫護短缺的問題也是日漸的嚴峻讓我們台灣的醫療環境困境再度的凸顯那其實落實分級醫療還有讓醫療的資源合理的分配都是解決急診擁捨問題最基本的解決的方案但是本席也身為醫藥背景的專業人員但是對衛福部\n60195\t88306\t現在的許多的政策其實我有時候都是物理看花啦不是什麼完全看不懂啦為什麼我們衛福部現在都是有時候有些政策不願意跟國際趨勢接軌呢像上次政府都是常常的自豪的說台灣是國際醫療的自由神尤其是COVID-19的時候那個時候我們的全國的醫藥護理人員共同的協力然後創造了台灣的奇蹟\n89366\t116794\t那為何現在疫情剛剛結束之後政府又開始鬆懈了呢其實台灣各醫院的急診擁設的問題早就是一個長期結構性的問題了所以結果我們主管機關衛福部不但沒有積極的想方法反而有點扯後腿那我想請問一下我們的衛福部長現在先把問題牽托到農曆過年太久了請問院長過去難道我們春節的假期沒有放過酒天的嗎\n118377\t144399\t應該都有吧我看2019、2022年連續都是放了9天而且2023年還放了10天的連續假期而且還有更離譜的是我們的衛福部的次長林靜儀更囂張竟然回嗆急診醫師的留言他說呵呵小腦袋引爆了全部醫界的憤怒那我想請問一下這些身為醫生的政府官員\n145200\t158583\t竟然沒有一絲絲的同理心遇到什麼事情就先推完全沒有傾聽基層的聲音甚至不負責任緬滅人性的發言你們覺得這樣是對的嗎還有看在我們衛福部部長和次長這樣如果你們大家是身為我們醫療的大家長的情況下應該是要針對問題來找解方才是嘛對不對而且我再請問一下院長就是說你認為所謂的吵架失言專業\n174207\t197438\t專業嗆民眾 專業嗆醫護這樣的適合擔任我們主管醫藥專業的官員嗎這樣這種人在你的行政院的整個團隊中這樣的人是適任的嗎跟委員抱歉這個整個事件我已經對外表示過了政務人員 政府的官員務必要謹言正行嗆民眾 嗆醫護這個都不是專業應該有的行為\n201024\t228593\t春節九天過去也有過那九天比較長的連假這只是今天我們在分析整個這個急診擁塞的情形的一個條件而已一個狀況而已其他它還有諾羅病毒還有天候的變化等等但無論什麼樣的原因啊我想部長也好 次長也好我們所有的從政的同仁都應該用同理心不要用這種方式去跟民眾對話我再度的向大家表示歉意\n230289\t248418\t好 因為這個問題並不是一次而已是連續好幾次的也引發民眾還有一些的反應那我希望院長可以在這方面多注意一下我們會多多的要求跟約束 謝謝謝謝委員提醒現在急診 庸塞和長期醫療人力不足的問題其實已經罄竹然書了啦 說真的\n248818\t271093\t各界其實大家都是一直在討論其實都是有在想要幫政府想一些及時廣義想一些提供一些正確的想法要給政府看什麼樣的做法但是請問一下衛福部為什麼現在都不願意買單解決現在我們正在惡化的醫療現場呢例如我們要重新檢討健保制度還有落實\n273595\t299050\t醫療分級這方面還有強化宣導輕症自我照護小小病自我要療的照護的觀念其實這些都是先進的國家在做的國民健康的政策但是為什麼衛福部你現在對這些意見都視而不見呢還有甚至背道而馳呢因為我看 院長 部長你們看其實你們知道衛福部其實從103年開始就開始推動了自我照護\n300191\t328040\t這些自我照護連續幾年都有出國考察而且他們都是針對考察這些針對自我用藥法規專家的會議還有世界自我用藥的聯會的會議所以但是一下子10年11年就過去了但是都沒有看到成效所以健保的財政的情況還是無解而且現在衍生出來了急診擁捨的問題那請教院長你知道每年的7月24號是什麼日子嗎\n332554\t347453\t你知道每年的7月24號是什麼日子嗎那其實是那是WHO為了提倡自我照護觀念他將每年7月24號定做國際自我照護日\n348334\t373730\t就是說一週有7天一天有24小時其實他是鼓勵大家來積極行動來改善我們自己維護自我的身心上面的健康所以院長你相信最近那麼多的急診篩報的問題其主要的原因也是因為我們台灣現在的整體的醫療的體系出問題然後失衡還有人力不足我相信你都知道的然後面對台灣現在超高齡的社會來臨\n374651\t399462\t其實台灣在積極想要加入WHO的同時其實我們要怎麼樣加強我們人民自我照護的意識還有呼應WHO所提倡的自我照護的觀念所以我們要強化輕症病人的自我照護避免輕症的這些病患湧入急診不會造成急診的擁捨的問題然後小小病就到藥局去\n400442\t419198\t然後小病到診所還是到地區醫院然後大病再到醫院而且要落實轉診整個的制度強化分級醫療其實這個是讓醫療資源能夠用在真正的集中症的上面並不是全部的人一有問題全部擠到大醫院裡面去\n419778\t438404\t所以我覺得這個也是解決急診擁捨一個簡單的解方之一啦所以也是解決健保財政虧損的方式之一所以有時候我們對這些問題我們可能要正視這個問題想方法去解決然後也根據了歐洲自我照護的產業我也發現了2023年的5月我發現了他們發布了一個調查的報告指出\n443726\t464810\t歐洲每年有12億的異例的小病痛這些小病痛他們透過非處方藥的自我照護不用到醫院到藥局去自我藥療就可以省下360億的歐元的醫藥上面的支出然後美國也調查民眾的自我照護可以為美國醫療省下1670億的美元的費用\n469671\t497723\t所以根據我們的健保署上面也有統計我們國人只要減少一次的就醫的情況我們一年估計可以為健保省下340億元所以表示自我照護自我要了這個觀念其實對於節省珍貴的健保資源是有非常顯著的效益的那我想請教衛福部部長你可以將自我照護明確的落實嗎你是否同意呢\n499344\t521190\t好 謝謝委員的指教那我想自我照顧跟分級醫療是我們這幾十年來政府一直在推動的在一二十年前何勝茂署長當署長的時候我就是編一個健康達人125教導全國民眾怎麼樣自我照顧的主編\n522472\t543493\t那當然我也過去多年來在醫療網裡面推動分級醫療所以我想非常敬佩我們委員提出的這兩個觀念那我想這個一定要去落實那在民眾的照顧方面當然最好是能防病於未然那麼在因此在我們健康台灣的工作上面其實\n544437\t561418\t特別重視在前端的在運動營養生活形態的一個改善的一個宣導跟教育我相信不管是哪一個醫事人員尤其是社區的藥局應該在這個部分可以一起來努力我想那個\n563716\t579611\t再加上我們藥師的同仁其實都有很好的臨床的信念臨床藥師的信念所以基本上在給病人做擁有指示用藥的協助所以應該是可以共同來照護病人那目前\n580734\t604630\t其實台灣也在推動社區整合型的照護體系裡面最重要的是一個家庭醫師的團隊所謂家庭醫師不是只有醫師他藥師、物理治療師、職能治療師共同組成一個團隊讓民眾在社區就有一個很堅強的團隊有什麼問題就來看他我相信這個就是分級醫療的第一點也是我們台灣很珍貴的一個\n606249\t626090\t家庭醫師整合型照顧體系未來我相信醫師、藥師各種醫師等等這樣的合作起來一定可以落實分級醫療也讓我們現在很頭痛的一個急診或醫院的用事可以得到很好的環節所以我們一起來努力也感謝我們委員的指導\n626741\t640976\t其實我覺得政府有很多政策這方面的其實都是很好的包括轉診制度、分級醫療上面還有自我醫療上面但是我覺得一直都沒有落實就是沒有落實才可以激到變成急診、庸塞的問題所以這個我可能要麻煩部長的話要多費心一點\n647483\t659978\t好 接下來問題就是全民健康保險法第51條規定只是藥品也是屬於不列入健保給付的範圍之一的項目是嗎 部長是的\n662017\t685248\t所以我想請教一下就是院長和部長既然你們都認為健保改革我們同意要先從民眾的自我照護開始這個觀念開始的話那是不是應該利用一些比較部分安全無虞的這些藥品把處方藥轉為指示用藥還有加速指示藥退出健保這樣我們才能解決健保要價的黑洞然後也\n686248\t702576\t也解決了以藥養醫的弊病而且部長你知道審計部嗎他針對了現在的814項非屬健保規定給付的指示用藥仍未退出健保給付的問題有提出一個總決算的審核報告\n704398\t718416\t112年度中央政府總決算的審核報告裡面有指出有841項指示用藥列入給付的範圍然後檢討進度太慢了要求衛福部以督促落實檢討指示用藥\n721259\t739170\t以提高健保資源利用的效率也就是說我們現在簡單的說就是只是用要列入健保給付的範圍在健保給付藥物的比例達到27.3意思是使健保給付的藥物中有四分之一的項目是違法給付\n739830\t765450\t更耗費了20億的公帑所以院長請問一下衛福部是不是應該要根據審計部的審核的報告意見提出檢討改善方案落實全民健康保險法第51條的規定只是要比也是屬於不列入健保給付範圍之一的項目所以請問一下何時可以給出改善的方案何時我們可以落實\n766857\t788332\t謝謝委員的指教我想不管是健保署或者是食藥署針對我們的指示用藥都非常的用心也會依照那個審計部或相關的單位的一個要求來改善那對於處方藥品長期使用經驗上\n790803\t812216\t安全無虞的藥品既有安全性那用以緩解輕症且在至少有三個醫藥先進國家以指示藥品在管理者經食藥署評估並邀請醫藥等領域專家共同討論後得轉類為指示用藥指示藥品那剛才不知道你說幾個國家一直都在努力三個國家而已嗎\n813889\t818035\t至少有三個醫藥先進國家至少三個那我下一個問題還有一個問題要問你先回答這一個\n820506\t843724\t好 我想這個部分會一直在努力我想這幾天來所以這個只是要退出健保其實是因為我們怕健保的財政受虧損所以現在健保其實也健保局也不好做健保局也不好做所以我們是希望人民用藥的方便性所以在醫藥跟人民當中我們當然以人民為\n846327\t870747\t對 這個剛才我是一整串的問題對 一整串的問題是都一直有連貫性的以人民的權益為優先之下醫藥共同來商討我想都可以來解決對 就是安全無虞的處方用藥盡量先退成只是用藥只是用藥的話再來退出健保基礎都有一直在往前走是 謝謝委員指教\n871567\t892653\t那剛才部長有提到那個三個國家的問題來這就是下一個就是接著為了不讓健保財政一直在虧損中非必要的醫生處方藥是不是要轉為指示用藥嗎剛才部長還說是三個嘛像緊急事後避孕藥這個現在我們先來講確保女性的生育的自主權\n894013\t922139\t讓女性把握緊急避孕的機會我想說部長也是醫生也知道這一種藥它有黃金的時間可能12小時72小時以內一定要服用的有時候到診所到醫院去他們不見得說或許大家在休診也都有可能可能會錯過了這個時間而且現在確保女性生育的自主權的話現在是想生的卻不能生但是非自願的不想生的要避孕的那會\n923079\t948691\t會不會衛福部管太多了對不對部長上回其實我已經有請教過你了嘛衛福部要正視女性的自主權還有用藥權益對緊急事後病因要開放變更為指示藥品確保女性生育的自主權但是衛福部都沒有給一個北溪的一個回應所以我現在就是說剛才有談到三個國家現在全球已經有\n950212\t964020\t88個國家將事後避孕藥列為非處方用藥了而且在2023年日本也可以在社區藥局販賣禁忌避孕藥其實這個我們現在還沒有做到對不對\n964640\t990229\t所以根據WHO的報告將事後病因藥轉成非處方藥是讓女性方便的取得這個藥物不僅可以減少女性因為懷孕而面臨的風險也可以降低因意外懷孕所帶來的社會還有經濟上面的負擔而且包括連我們現在知名的女權團體在2024年的10月份的時候有對於這個\n992270\t1014589\t事後病藥是否開放來做了一個調查線上的調查結果有六成五的民眾支持開放而且2016年調查七成的幾乎完全七成人都支持而且希望能夠方便及時取得而且藥局即可購買還有提高女性自主所以我想部長針對這個問題的話我想說\n1018812\t1027041\t您應該也是會很重視這個問題所以在2016年的時候我有去看過2016年的時候有針對這個問題討論過廚房藥改成民眾在藥局購買的指示用藥也已經衛福部通過了\n1035515\t1056329\t也發佈在緊急事後避孕藥變更為指示藥品的說明所以據本席了解指示藥品陳藥主已經開過會討論過了將緊急事後避孕藥從醫生處方藥轉列為指示用藥但是這個會議中也做成了會議記錄所以為什麼食藥署到現在還說醫生團體\n1059991\t1085466\t還評估還沒有共識呢而且部長你知道我們的衛福部的政策為什麼擱置到現在還沒有共識呢對不對而且這個不是2016年早有共識了嗎還是有人不同意呢是不是有人刻意去修改了整個的會議紀錄你衛福部要不要調查一下當時的情況啊照我是這樣看的是因為會議背後有一隻看不到的手\n1086306\t1115826\t所以我想部長你針對這個問題你可能要去了解一下在2016年那時候發生的事情而且你身為醫生你醫者人心我拜託你千萬不要讓女性生育權被自主權被剝奪了政府你現在不是在營造整個友善的生育環境嗎你是不是要讓女性能夠安心而且自由的選擇自己何時要懷孕這個我想這個也是政府的重要的責任\n1117487\t1130495\t報告委員謝謝委員的指教有關於這個事後必應要轉捩為非處方藥品管理的議題其實從剛剛您所說的從2016年其實那個時候就開始有討論\n1131482\t1150537\t那我在當立委的期間也開過不少次的協調會議因為就是醫藥有不同的看法那我想我們不管是醫跟藥我聽起來都是為了人民的權利在努力那我個人都非常的感動但是因為有不同的專業的看法所以\n1151206\t1166148\t也是涉及的層面比較廣泛那因為在有一些醫事的團體專業團體他們認為尤其特別會照顧到婦女懷孕生產的科別他們在這個部分是很有\n1167225\t1193628\t對 部長 你剛才講三個國家同意這個有八十八個國家我們台灣要不要跟國際接軌啊我們一直在走倒退路嗎他還是一種和我們啦他還是會影響到現在都是醫界在擋這一個啊不是嗎這個明明就是國際上已經八十八個國家這樣做了啊對不對部長你不能不公欸你現在全部人都是醫生你這樣是不是太不公了啊\n1195269\t1206458\t你要為全國的民眾想啊 全部的女性的自主權 對不對他們生育的自主權大家都等著你們而且2012年的時候你先去看看是不是有人篡改會議紀錄\n1209057\t1213339\t我們去了解本部的食藥署已經將114.36號召開緊急事後避孕完轉為醫師藥師現在整個會議全部都是醫生請問一下這樣怎麼會公平呢這個讓部長\n1229625\t1250935\t去做好好的協調我想從醫藥分業之後我們的醫藥關係一直是在一個比較是是院長是沒錯但是安全無虞的藥品我已經非常這個比較合理的使用安全無虞的藥品這個東西已經安全無虞了而且88個國家都已經這樣做了現在只有台灣沒有這樣做\n1251795\t1279768\t我要求部長盡快跟醫界、藥界達成共識大家能夠在安全無虞的合理使用狀況下當時我也要請委員能夠支持因為委員的專業非常注重健保今年健保30年我常說健保30年保障國人的健康現在是我們回頭保障健保的時代30年前我就一直主張小病不用保大病沒煩惱這種小病集中到醫學中心去\n1281343\t1309629\t用那麼少的這個代價 致富額他就能夠得到他應該讓他到診所去用他完全來負擔這個就是落實分級醫療嗎分級醫療 轉診制度如果我們觀念能夠轉過來小病不用保 大病就沒煩惱讓那個可以傾家蕩產的病讓政府全力來照顧他讓那個影響到整個公共衛生的病政府全力來遏止他政府應該做這個東西小病讓他自己來做另外我們的內外婦兒這四顆\n1310929\t1336448\t醫事人員的減少我們也必須大家觀念轉變我們再落實一個就是不同工不同酬的醫療給付讓醫院醫事人員的工作尊嚴能夠得到保障如果這個觀念能夠同期的建立我們可以再創30年50年更好的健保制度所以我們是不是大家有這樣的一個責任來面對健保的實質改革而不是在討論錢多錢少該不該提保費的問題我們從基本上來討論\n1340292\t1345553\t沒錯啊 所以我覺得大家的政策 大家的想法我覺得都是正確 但是完全沒有落實啊\n1346884\t1375700\t對不對 剛才院長講的也對啊 部長講的也對嘛我們想的都是對嘛 都是往前進嘛 對不對如果大家有這樣的公式 我們還要持續跟社會對話我剛剛說內外婦幼這四個科所以衛福部要想出方法啊要怎麼落實啊 如果能夠給他建立但是這個不能 因為這個會增加對這些實質上的支付所以我們還要平衡所以能夠農小病大家就不用保大病再來 大家就再沒煩惱然後從內外婦幼從這個不同工不同酬的給付來開始\n1376520\t1402029\t我想這個社會的觀念如果建立起來剛開始也許會遭受很多很多的討論但是我相信如果提出這樣的討論對社會是正面的其實也不是院長不是提出這樣的討論這個事情已經做很久了我想部長也是知道只是沒有做得很徹底沒有做得很成功所以我覺得我們還是要用心在這一塊啦好不好那一些修法的部分可能我們就要有共識才能來進行\n1403767\t1425973\t這個已經在實施了對 只是沒有落實我想自我照顧跟分級醫療我們一定繼續來推那醫藥方面在某些專業的互動我們一定持續來溝通醫藥本是一家要攜手共同來照顧人民的健康我們一起來努力也謝謝委員的啟示跟指教好 謝謝部長那我有請交通部長\n1439022\t1465209\t好 那我就因為時間不多 這樣我還是先靜緩講一下就是院長 你知道零四零三強震開米颱風其實重創了花蓮的觀光業者都是一直在覺得去年是從業三十年來最慘的一天一次地震發生 花蓮的旅宿還有餐飲其實已經都停業上百家了這是本心還是持續的關心我們花蓮的觀光和交通\n1465689\t1493854\t因為對花蓮來講其實最重要的就是要怎麼樣活下去所以去年113年花蓮的遊客是近年五年來最低的還比起前一年112年的時候已經下降了一半那我想院長也是很認真每個月當初都說有你都有允諾說要每個月都要下去花蓮勘查整個情況所以我想院長你應該很了解花蓮現在的困境是什麼\n1494634\t1502782\t所以也很感謝你振興花蓮的觀光而努力所以在去年針對0403的地震的時候振興花蓮觀光產業我們也放寬了公務人員的國旅卡休假補助費的整個措施那請問去年的實施是如何呢我想應該是成效不佳吧因為花蓮現在的店家和民眾還是無感\n1517597\t1541263\t所以光是觀光人數接到上面的觀光客其實我們都看出來其實真的觀光的人數是非常非常的少而且非常非常的慘淡那院長那為什麼實施到去年今年就補助了呢沒有補助了呢還是你覺得說今年有更好的規劃呢還是有什麼特別加碼的規劃呢可以振興我們花蓮的觀光\n1542657\t1557655\t我簡單的先向委員說不敢說認真兩個字這是我們團隊應該做的事情只是很遺憾的是去年0403之後7月好幾次的颱風當我們的工程進行到一個程度它就停下來甚至又往後延\n1558208\t1578484\t那颱風又讓很多的觀光客又卻步了這是我們非常遺憾的事情我們總是希望說所有的補助的措施能夠徹底的落實那請問今年會不會再繼續補助呢像去年來我們執行不好的事情我們就把它加碼把它放寬那新年我相信交通部他又有一個其他的緊急的計畫在執行我們部長來說明\n1581926\t1603271\t確實去年花蓮因為地震再加上好幾個颱風確實對觀光業影響非常大那您也非常關心交通建設的問題我們目前交通上升穩定目前最近比較沒有太大的雨所以上升穩定的狀況底下其實我們花蓮的觀光在11月份已經漸漸回到了112年的水準也就是說已經有復甦的狀況\n1604551\t1631472\t那去年我們主要是因為403的地震那沒關係我想知道說這個有沒有更好的規劃振興花蓮的觀光有沒有什麼加碼的還是有一個做一個更好的規劃我先知道這個因為我後面還有一些問題要問去年是因為地震的原因所以用一個救急的方案來補助有補助的方案但是我剛剛有提到就是說現在的觀光的狀況已經比較穩定了所以我們大概不會用可是我們還是很慘淡啊\n1632212\t1633553\t現在除了剛剛委員說的橋尾會有這樣的方式之外我們去年年底副院長還主持了觀光的諮詢會議\n1647597\t1675465\t也召集了業者 大家也提出了相當的問題所以僑委會是不是有這樣的一個對 我想說僑胞回台的時候他們社會應該需要可以去看看 可不可以結合報告委員 我們去年確實也有加碼在針對僑胞去避免返國的時候本來我們一般都補助三千塊那麼如果特別到花東去旅遊的我們就補助三千六百塊那這樣子做當然有多少增加一些誘因成效怎麼樣呢\n1677205\t1704224\t如同剛剛交通部所報告的就是說因為去年一直不斷有颱風跟地震的因素影響所以最終真的去到花東旅遊的人數那我想請問一下今年會不會再有補助今年我們會繼續比照就是說增加我們的花東觀光特約商店以及再增加一樣3600的補助那今年就是還會有然後做更好的規劃然後再加碼\n1704944\t1714313\t另外我再跟您補充一下現在我們有香港飛花蓮的班機那也是一個班機一個包機補助28萬這個部分有在努力\n1715011\t1727937\t院長也有特別交代我們希望禮拜一到禮拜天每一天都有台北飛花蓮的班機那這個部分已經在進行當中所以每個禮拜一到禮拜天每一天都有班機飛花蓮台北到花蓮我再問一下部長一個問題有關於花蓮鐵路高架化的交通的問題\n1736361\t1756926\t這個台灣的東部在花蓮市和吉安鄉這邊有七個平面的平交道其實他是穿越花蓮市和吉安鄉的鬧區所以針對這個時候之前民怨的情況下據我了解這個計畫來來回回的修了好幾次而且112年4月的時候那時候前交通部長已經同意了\n1758026\t1776780\t將花東地區鐵路雙軌電氣化的計畫工程納入花蓮站和甘城站七個鐵路平交道的高價立體化辦理並且全額的負擔而且那時候我看是4562億餘元編到哪就做到哪然後114年編了600億那我想請問一下\n1780816\t1806066\t根據我現在看那台鐵花蓮和吉安甘城站的高架工程那哪時候可以規劃動工呢而且據我最近了解我也覺得很奇怪就是目前計畫書送到行政院的石層大海音訊全無是不是改以鐵路平交道與環境改善設施的周邊土地的計畫審查要點審查就是中央已經不全額的負擔費用了那我想請教一下院長\n1806826\t1820599\t中央不全額負擔的原因是什麼而且目前計畫書是不是已經到行政院了那如果到行政院了可以加速審核嗎報告委員您剛所提的這個高價化的部分目前因為它的合理性\n1821072\t1837056\t我們還有一些質疑啦因為其他的縣市的高價化他不是放在雙軌電機那是112年4月的時候交通部長 前交通部長王國才就正面回應了他就說這個他會全部列入而且答應全額負擔你要騙我們花蓮人啊\n1862810\t1864150\t謝謝林益君委員質詢,謝謝卓院長的備詢接下來我們請莊瑞雄委員請質詢\n","txt":"謝謝主席有請院長麻煩再請卓院長備詢議員好院長好\n最近全台爆發急診擁捨的問題不斷的在延燒醫護短缺的問題也是日漸的嚴峻讓我們台灣的醫療環境困境再度的凸顯那其實落實分級醫療還有讓醫療的資源合理的分配都是解決急診擁捨問題最基本的解決的方案但是本席也身為醫藥背景的專業人員但是對衛福部\n現在的許多的政策其實我有時候都是物理看花啦不是什麼完全看不懂啦為什麼我們衛福部現在都是有時候有些政策不願意跟國際趨勢接軌呢像上次政府都是常常的自豪的說台灣是國際醫療的自由神尤其是COVID-19的時候那個時候我們的全國的醫藥護理人員共同的協力然後創造了台灣的奇蹟\n那為何現在疫情剛剛結束之後政府又開始鬆懈了呢其實台灣各醫院的急診擁設的問題早就是一個長期結構性的問題了所以結果我們主管機關衛福部不但沒有積極的想方法反而有點扯後腿那我想請問一下我們的衛福部長現在先把問題牽托到農曆過年太久了請問院長過去難道我們春節的假期沒有放過酒天的嗎\n應該都有吧我看2019、2022年連續都是放了9天而且2023年還放了10天的連續假期而且還有更離譜的是我們的衛福部的次長林靜儀更囂張竟然回嗆急診醫師的留言他說呵呵小腦袋引爆了全部醫界的憤怒那我想請問一下這些身為醫生的政府官員\n竟然沒有一絲絲的同理心遇到什麼事情就先推完全沒有傾聽基層的聲音甚至不負責任緬滅人性的發言你們覺得這樣是對的嗎還有看在我們衛福部部長和次長這樣如果你們大家是身為我們醫療的大家長的情況下應該是要針對問題來找解方才是嘛對不對而且我再請問一下院長就是說你認為所謂的吵架失言專業\n專業嗆民眾 專業嗆醫護這樣的適合擔任我們主管醫藥專業的官員嗎這樣這種人在你的行政院的整個團隊中這樣的人是適任的嗎跟委員抱歉這個整個事件我已經對外表示過了政務人員 政府的官員務必要謹言正行嗆民眾 嗆醫護這個都不是專業應該有的行為\n春節九天過去也有過那九天比較長的連假這只是今天我們在分析整個這個急診擁塞的情形的一個條件而已一個狀況而已其他它還有諾羅病毒還有天候的變化等等但無論什麼樣的原因啊我想部長也好 次長也好我們所有的從政的同仁都應該用同理心不要用這種方式去跟民眾對話我再度的向大家表示歉意\n好 因為這個問題並不是一次而已是連續好幾次的也引發民眾還有一些的反應那我希望院長可以在這方面多注意一下我們會多多的要求跟約束 謝謝謝謝委員提醒現在急診 庸塞和長期醫療人力不足的問題其實已經罄竹然書了啦 說真的\n各界其實大家都是一直在討論其實都是有在想要幫政府想一些及時廣義想一些提供一些正確的想法要給政府看什麼樣的做法但是請問一下衛福部為什麼現在都不願意買單解決現在我們正在惡化的醫療現場呢例如我們要重新檢討健保制度還有落實\n醫療分級這方面還有強化宣導輕症自我照護小小病自我要療的照護的觀念其實這些都是先進的國家在做的國民健康的政策但是為什麼衛福部你現在對這些意見都視而不見呢還有甚至背道而馳呢因為我看 院長 部長你們看其實你們知道衛福部其實從103年開始就開始推動了自我照護\n這些自我照護連續幾年都有出國考察而且他們都是針對考察這些針對自我用藥法規專家的會議還有世界自我用藥的聯會的會議所以但是一下子10年11年就過去了但是都沒有看到成效所以健保的財政的情況還是無解而且現在衍生出來了急診擁捨的問題那請教院長你知道每年的7月24號是什麼日子嗎\n你知道每年的7月24號是什麼日子嗎那其實是那是WHO為了提倡自我照護觀念他將每年7月24號定做國際自我照護日\n就是說一週有7天一天有24小時其實他是鼓勵大家來積極行動來改善我們自己維護自我的身心上面的健康所以院長你相信最近那麼多的急診篩報的問題其主要的原因也是因為我們台灣現在的整體的醫療的體系出問題然後失衡還有人力不足我相信你都知道的然後面對台灣現在超高齡的社會來臨\n其實台灣在積極想要加入WHO的同時其實我們要怎麼樣加強我們人民自我照護的意識還有呼應WHO所提倡的自我照護的觀念所以我們要強化輕症病人的自我照護避免輕症的這些病患湧入急診不會造成急診的擁捨的問題然後小小病就到藥局去\n然後小病到診所還是到地區醫院然後大病再到醫院而且要落實轉診整個的制度強化分級醫療其實這個是讓醫療資源能夠用在真正的集中症的上面並不是全部的人一有問題全部擠到大醫院裡面去\n所以我覺得這個也是解決急診擁捨一個簡單的解方之一啦所以也是解決健保財政虧損的方式之一所以有時候我們對這些問題我們可能要正視這個問題想方法去解決然後也根據了歐洲自我照護的產業我也發現了2023年的5月我發現了他們發布了一個調查的報告指出\n歐洲每年有12億的異例的小病痛這些小病痛他們透過非處方藥的自我照護不用到醫院到藥局去自我藥療就可以省下360億的歐元的醫藥上面的支出然後美國也調查民眾的自我照護可以為美國醫療省下1670億的美元的費用\n所以根據我們的健保署上面也有統計我們國人只要減少一次的就醫的情況我們一年估計可以為健保省下340億元所以表示自我照護自我要了這個觀念其實對於節省珍貴的健保資源是有非常顯著的效益的那我想請教衛福部部長你可以將自我照護明確的落實嗎你是否同意呢\n好 謝謝委員的指教那我想自我照顧跟分級醫療是我們這幾十年來政府一直在推動的在一二十年前何勝茂署長當署長的時候我就是編一個健康達人125教導全國民眾怎麼樣自我照顧的主編\n那當然我也過去多年來在醫療網裡面推動分級醫療所以我想非常敬佩我們委員提出的這兩個觀念那我想這個一定要去落實那在民眾的照顧方面當然最好是能防病於未然那麼在因此在我們健康台灣的工作上面其實\n特別重視在前端的在運動營養生活形態的一個改善的一個宣導跟教育我相信不管是哪一個醫事人員尤其是社區的藥局應該在這個部分可以一起來努力我想那個\n再加上我們藥師的同仁其實都有很好的臨床的信念臨床藥師的信念所以基本上在給病人做擁有指示用藥的協助所以應該是可以共同來照護病人那目前\n其實台灣也在推動社區整合型的照護體系裡面最重要的是一個家庭醫師的團隊所謂家庭醫師不是只有醫師他藥師、物理治療師、職能治療師共同組成一個團隊讓民眾在社區就有一個很堅強的團隊有什麼問題就來看他我相信這個就是分級醫療的第一點也是我們台灣很珍貴的一個\n家庭醫師整合型照顧體系未來我相信醫師、藥師各種醫師等等這樣的合作起來一定可以落實分級醫療也讓我們現在很頭痛的一個急診或醫院的用事可以得到很好的環節所以我們一起來努力也感謝我們委員的指導\n其實我覺得政府有很多政策這方面的其實都是很好的包括轉診制度、分級醫療上面還有自我醫療上面但是我覺得一直都沒有落實就是沒有落實才可以激到變成急診、庸塞的問題所以這個我可能要麻煩部長的話要多費心一點\n好 接下來問題就是全民健康保險法第51條規定只是藥品也是屬於不列入健保給付的範圍之一的項目是嗎 部長是的\n所以我想請教一下就是院長和部長既然你們都認為健保改革我們同意要先從民眾的自我照護開始這個觀念開始的話那是不是應該利用一些比較部分安全無虞的這些藥品把處方藥轉為指示用藥還有加速指示藥退出健保這樣我們才能解決健保要價的黑洞然後也\n也解決了以藥養醫的弊病而且部長你知道審計部嗎他針對了現在的814項非屬健保規定給付的指示用藥仍未退出健保給付的問題有提出一個總決算的審核報告\n112年度中央政府總決算的審核報告裡面有指出有841項指示用藥列入給付的範圍然後檢討進度太慢了要求衛福部以督促落實檢討指示用藥\n以提高健保資源利用的效率也就是說我們現在簡單的說就是只是用要列入健保給付的範圍在健保給付藥物的比例達到27.3意思是使健保給付的藥物中有四分之一的項目是違法給付\n更耗費了20億的公帑所以院長請問一下衛福部是不是應該要根據審計部的審核的報告意見提出檢討改善方案落實全民健康保險法第51條的規定只是要比也是屬於不列入健保給付範圍之一的項目所以請問一下何時可以給出改善的方案何時我們可以落實\n謝謝委員的指教我想不管是健保署或者是食藥署針對我們的指示用藥都非常的用心也會依照那個審計部或相關的單位的一個要求來改善那對於處方藥品長期使用經驗上\n安全無虞的藥品既有安全性那用以緩解輕症且在至少有三個醫藥先進國家以指示藥品在管理者經食藥署評估並邀請醫藥等領域專家共同討論後得轉類為指示用藥指示藥品那剛才不知道你說幾個國家一直都在努力三個國家而已嗎\n至少有三個醫藥先進國家至少三個那我下一個問題還有一個問題要問你先回答這一個\n好 我想這個部分會一直在努力我想這幾天來所以這個只是要退出健保其實是因為我們怕健保的財政受虧損所以現在健保其實也健保局也不好做健保局也不好做所以我們是希望人民用藥的方便性所以在醫藥跟人民當中我們當然以人民為\n對 這個剛才我是一整串的問題對 一整串的問題是都一直有連貫性的以人民的權益為優先之下醫藥共同來商討我想都可以來解決對 就是安全無虞的處方用藥盡量先退成只是用藥只是用藥的話再來退出健保基礎都有一直在往前走是 謝謝委員指教\n那剛才部長有提到那個三個國家的問題來這就是下一個就是接著為了不讓健保財政一直在虧損中非必要的醫生處方藥是不是要轉為指示用藥嗎剛才部長還說是三個嘛像緊急事後避孕藥這個現在我們先來講確保女性的生育的自主權\n讓女性把握緊急避孕的機會我想說部長也是醫生也知道這一種藥它有黃金的時間可能12小時72小時以內一定要服用的有時候到診所到醫院去他們不見得說或許大家在休診也都有可能可能會錯過了這個時間而且現在確保女性生育的自主權的話現在是想生的卻不能生但是非自願的不想生的要避孕的那會\n會不會衛福部管太多了對不對部長上回其實我已經有請教過你了嘛衛福部要正視女性的自主權還有用藥權益對緊急事後病因要開放變更為指示藥品確保女性生育的自主權但是衛福部都沒有給一個北溪的一個回應所以我現在就是說剛才有談到三個國家現在全球已經有\n88個國家將事後避孕藥列為非處方用藥了而且在2023年日本也可以在社區藥局販賣禁忌避孕藥其實這個我們現在還沒有做到對不對\n所以根據WHO的報告將事後病因藥轉成非處方藥是讓女性方便的取得這個藥物不僅可以減少女性因為懷孕而面臨的風險也可以降低因意外懷孕所帶來的社會還有經濟上面的負擔而且包括連我們現在知名的女權團體在2024年的10月份的時候有對於這個\n事後病藥是否開放來做了一個調查線上的調查結果有六成五的民眾支持開放而且2016年調查七成的幾乎完全七成人都支持而且希望能夠方便及時取得而且藥局即可購買還有提高女性自主所以我想部長針對這個問題的話我想說\n您應該也是會很重視這個問題所以在2016年的時候我有去看過2016年的時候有針對這個問題討論過廚房藥改成民眾在藥局購買的指示用藥也已經衛福部通過了\n也發佈在緊急事後避孕藥變更為指示藥品的說明所以據本席了解指示藥品陳藥主已經開過會討論過了將緊急事後避孕藥從醫生處方藥轉列為指示用藥但是這個會議中也做成了會議記錄所以為什麼食藥署到現在還說醫生團體\n還評估還沒有共識呢而且部長你知道我們的衛福部的政策為什麼擱置到現在還沒有共識呢對不對而且這個不是2016年早有共識了嗎還是有人不同意呢是不是有人刻意去修改了整個的會議紀錄你衛福部要不要調查一下當時的情況啊照我是這樣看的是因為會議背後有一隻看不到的手\n所以我想部長你針對這個問題你可能要去了解一下在2016年那時候發生的事情而且你身為醫生你醫者人心我拜託你千萬不要讓女性生育權被自主權被剝奪了政府你現在不是在營造整個友善的生育環境嗎你是不是要讓女性能夠安心而且自由的選擇自己何時要懷孕這個我想這個也是政府的重要的責任\n報告委員謝謝委員的指教有關於這個事後必應要轉捩為非處方藥品管理的議題其實從剛剛您所說的從2016年其實那個時候就開始有討論\n那我在當立委的期間也開過不少次的協調會議因為就是醫藥有不同的看法那我想我們不管是醫跟藥我聽起來都是為了人民的權利在努力那我個人都非常的感動但是因為有不同的專業的看法所以\n也是涉及的層面比較廣泛那因為在有一些醫事的團體專業團體他們認為尤其特別會照顧到婦女懷孕生產的科別他們在這個部分是很有\n對 部長 你剛才講三個國家同意這個有八十八個國家我們台灣要不要跟國際接軌啊我們一直在走倒退路嗎他還是一種和我們啦他還是會影響到現在都是醫界在擋這一個啊不是嗎這個明明就是國際上已經八十八個國家這樣做了啊對不對部長你不能不公欸你現在全部人都是醫生你這樣是不是太不公了啊\n你要為全國的民眾想啊 全部的女性的自主權 對不對他們生育的自主權大家都等著你們而且2012年的時候你先去看看是不是有人篡改會議紀錄\n我們去了解本部的食藥署已經將114.36號召開緊急事後避孕完轉為醫師藥師現在整個會議全部都是醫生請問一下這樣怎麼會公平呢這個讓部長\n去做好好的協調我想從醫藥分業之後我們的醫藥關係一直是在一個比較是是院長是沒錯但是安全無虞的藥品我已經非常這個比較合理的使用安全無虞的藥品這個東西已經安全無虞了而且88個國家都已經這樣做了現在只有台灣沒有這樣做\n我要求部長盡快跟醫界、藥界達成共識大家能夠在安全無虞的合理使用狀況下當時我也要請委員能夠支持因為委員的專業非常注重健保今年健保30年我常說健保30年保障國人的健康現在是我們回頭保障健保的時代30年前我就一直主張小病不用保大病沒煩惱這種小病集中到醫學中心去\n用那麼少的這個代價 致富額他就能夠得到他應該讓他到診所去用他完全來負擔這個就是落實分級醫療嗎分級醫療 轉診制度如果我們觀念能夠轉過來小病不用保 大病就沒煩惱讓那個可以傾家蕩產的病讓政府全力來照顧他讓那個影響到整個公共衛生的病政府全力來遏止他政府應該做這個東西小病讓他自己來做另外我們的內外婦兒這四顆\n醫事人員的減少我們也必須大家觀念轉變我們再落實一個就是不同工不同酬的醫療給付讓醫院醫事人員的工作尊嚴能夠得到保障如果這個觀念能夠同期的建立我們可以再創30年50年更好的健保制度所以我們是不是大家有這樣的一個責任來面對健保的實質改革而不是在討論錢多錢少該不該提保費的問題我們從基本上來討論\n沒錯啊 所以我覺得大家的政策 大家的想法我覺得都是正確 但是完全沒有落實啊\n對不對 剛才院長講的也對啊 部長講的也對嘛我們想的都是對嘛 都是往前進嘛 對不對如果大家有這樣的公式 我們還要持續跟社會對話我剛剛說內外婦幼這四個科所以衛福部要想出方法啊要怎麼落實啊 如果能夠給他建立但是這個不能 因為這個會增加對這些實質上的支付所以我們還要平衡所以能夠農小病大家就不用保大病再來 大家就再沒煩惱然後從內外婦幼從這個不同工不同酬的給付來開始\n我想這個社會的觀念如果建立起來剛開始也許會遭受很多很多的討論但是我相信如果提出這樣的討論對社會是正面的其實也不是院長不是提出這樣的討論這個事情已經做很久了我想部長也是知道只是沒有做得很徹底沒有做得很成功所以我覺得我們還是要用心在這一塊啦好不好那一些修法的部分可能我們就要有共識才能來進行\n這個已經在實施了對 只是沒有落實我想自我照顧跟分級醫療我們一定繼續來推那醫藥方面在某些專業的互動我們一定持續來溝通醫藥本是一家要攜手共同來照顧人民的健康我們一起來努力也謝謝委員的啟示跟指教好 謝謝部長那我有請交通部長\n好 那我就因為時間不多 這樣我還是先靜緩講一下就是院長 你知道零四零三強震開米颱風其實重創了花蓮的觀光業者都是一直在覺得去年是從業三十年來最慘的一天一次地震發生 花蓮的旅宿還有餐飲其實已經都停業上百家了這是本心還是持續的關心我們花蓮的觀光和交通\n因為對花蓮來講其實最重要的就是要怎麼樣活下去所以去年113年花蓮的遊客是近年五年來最低的還比起前一年112年的時候已經下降了一半那我想院長也是很認真每個月當初都說有你都有允諾說要每個月都要下去花蓮勘查整個情況所以我想院長你應該很了解花蓮現在的困境是什麼\n所以也很感謝你振興花蓮的觀光而努力所以在去年針對0403的地震的時候振興花蓮觀光產業我們也放寬了公務人員的國旅卡休假補助費的整個措施那請問去年的實施是如何呢我想應該是成效不佳吧因為花蓮現在的店家和民眾還是無感\n所以光是觀光人數接到上面的觀光客其實我們都看出來其實真的觀光的人數是非常非常的少而且非常非常的慘淡那院長那為什麼實施到去年今年就補助了呢沒有補助了呢還是你覺得說今年有更好的規劃呢還是有什麼特別加碼的規劃呢可以振興我們花蓮的觀光\n我簡單的先向委員說不敢說認真兩個字這是我們團隊應該做的事情只是很遺憾的是去年0403之後7月好幾次的颱風當我們的工程進行到一個程度它就停下來甚至又往後延\n那颱風又讓很多的觀光客又卻步了這是我們非常遺憾的事情我們總是希望說所有的補助的措施能夠徹底的落實那請問今年會不會再繼續補助呢像去年來我們執行不好的事情我們就把它加碼把它放寬那新年我相信交通部他又有一個其他的緊急的計畫在執行我們部長來說明\n確實去年花蓮因為地震再加上好幾個颱風確實對觀光業影響非常大那您也非常關心交通建設的問題我們目前交通上升穩定目前最近比較沒有太大的雨所以上升穩定的狀況底下其實我們花蓮的觀光在11月份已經漸漸回到了112年的水準也就是說已經有復甦的狀況\n那去年我們主要是因為403的地震那沒關係我想知道說這個有沒有更好的規劃振興花蓮的觀光有沒有什麼加碼的還是有一個做一個更好的規劃我先知道這個因為我後面還有一些問題要問去年是因為地震的原因所以用一個救急的方案來補助有補助的方案但是我剛剛有提到就是說現在的觀光的狀況已經比較穩定了所以我們大概不會用可是我們還是很慘淡啊\n現在除了剛剛委員說的橋尾會有這樣的方式之外我們去年年底副院長還主持了觀光的諮詢會議\n也召集了業者 大家也提出了相當的問題所以僑委會是不是有這樣的一個對 我想說僑胞回台的時候他們社會應該需要可以去看看 可不可以結合報告委員 我們去年確實也有加碼在針對僑胞去避免返國的時候本來我們一般都補助三千塊那麼如果特別到花東去旅遊的我們就補助三千六百塊那這樣子做當然有多少增加一些誘因成效怎麼樣呢\n如同剛剛交通部所報告的就是說因為去年一直不斷有颱風跟地震的因素影響所以最終真的去到花東旅遊的人數那我想請問一下今年會不會再有補助今年我們會繼續比照就是說增加我們的花東觀光特約商店以及再增加一樣3600的補助那今年就是還會有然後做更好的規劃然後再加碼\n另外我再跟您補充一下現在我們有香港飛花蓮的班機那也是一個班機一個包機補助28萬這個部分有在努力\n院長也有特別交代我們希望禮拜一到禮拜天每一天都有台北飛花蓮的班機那這個部分已經在進行當中所以每個禮拜一到禮拜天每一天都有班機飛花蓮台北到花蓮我再問一下部長一個問題有關於花蓮鐵路高架化的交通的問題\n這個台灣的東部在花蓮市和吉安鄉這邊有七個平面的平交道其實他是穿越花蓮市和吉安鄉的鬧區所以針對這個時候之前民怨的情況下據我了解這個計畫來來回回的修了好幾次而且112年4月的時候那時候前交通部長已經同意了\n將花東地區鐵路雙軌電氣化的計畫工程納入花蓮站和甘城站七個鐵路平交道的高價立體化辦理並且全額的負擔而且那時候我看是4562億餘元編到哪就做到哪然後114年編了600億那我想請問一下\n根據我現在看那台鐵花蓮和吉安甘城站的高架工程那哪時候可以規劃動工呢而且據我最近了解我也覺得很奇怪就是目前計畫書送到行政院的石層大海音訊全無是不是改以鐵路平交道與環境改善設施的周邊土地的計畫審查要點審查就是中央已經不全額的負擔費用了那我想請教一下院長\n中央不全額負擔的原因是什麼而且目前計畫書是不是已經到行政院了那如果到行政院了可以加速審核嗎報告委員您剛所提的這個高價化的部分目前因為它的合理性\n我們還有一些質疑啦因為其他的縣市的高價化他不是放在雙軌電機那是112年4月的時候交通部長 前交通部長王國才就正面回應了他就說這個他會全部列入而且答應全額負擔你要騙我們花蓮人啊\n謝謝林益君委員質詢,謝謝卓院長的備詢接下來我們請莊瑞雄委員請質詢\n","vtt":"WEBVTT\n\n00:16.138 --> 00:19.361\n謝謝主席有請院長麻煩再請卓院長備詢議員好院長好\n\n00:35.872 --> 00:59.615\n最近全台爆發急診擁捨的問題不斷的在延燒醫護短缺的問題也是日漸的嚴峻讓我們台灣的醫療環境困境再度的凸顯那其實落實分級醫療還有讓醫療的資源合理的分配都是解決急診擁捨問題最基本的解決的方案但是本席也身為醫藥背景的專業人員但是對衛福部\n\n01:00.195 --> 01:28.306\n現在的許多的政策其實我有時候都是物理看花啦不是什麼完全看不懂啦為什麼我們衛福部現在都是有時候有些政策不願意跟國際趨勢接軌呢像上次政府都是常常的自豪的說台灣是國際醫療的自由神尤其是COVID-19的時候那個時候我們的全國的醫藥護理人員共同的協力然後創造了台灣的奇蹟\n\n01:29.366 --> 01:56.794\n那為何現在疫情剛剛結束之後政府又開始鬆懈了呢其實台灣各醫院的急診擁設的問題早就是一個長期結構性的問題了所以結果我們主管機關衛福部不但沒有積極的想方法反而有點扯後腿那我想請問一下我們的衛福部長現在先把問題牽托到農曆過年太久了請問院長過去難道我們春節的假期沒有放過酒天的嗎\n\n01:58.377 --> 02:24.399\n應該都有吧我看2019、2022年連續都是放了9天而且2023年還放了10天的連續假期而且還有更離譜的是我們的衛福部的次長林靜儀更囂張竟然回嗆急診醫師的留言他說呵呵小腦袋引爆了全部醫界的憤怒那我想請問一下這些身為醫生的政府官員\n\n02:25.200 --> 02:38.583\n竟然沒有一絲絲的同理心遇到什麼事情就先推完全沒有傾聽基層的聲音甚至不負責任緬滅人性的發言你們覺得這樣是對的嗎還有看在我們衛福部部長和次長這樣如果你們大家是身為我們醫療的大家長的情況下應該是要針對問題來找解方才是嘛對不對而且我再請問一下院長就是說你認為所謂的吵架失言專業\n\n02:54.207 --> 03:17.438\n專業嗆民眾專業嗆醫護這樣的適合擔任我們主管醫藥專業的官員嗎這樣這種人在你的行政院的整個團隊中這樣的人是適任的嗎跟委員抱歉這個整個事件我已經對外表示過了政務人員政府的官員務必要謹言正行嗆民眾嗆醫護這個都不是專業應該有的行為\n\n03:21.024 --> 03:48.593\n春節九天過去也有過那九天比較長的連假這只是今天我們在分析整個這個急診擁塞的情形的一個條件而已一個狀況而已其他它還有諾羅病毒還有天候的變化等等但無論什麼樣的原因啊我想部長也好次長也好我們所有的從政的同仁都應該用同理心不要用這種方式去跟民眾對話我再度的向大家表示歉意\n\n03:50.289 --> 04:08.418\n好因為這個問題並不是一次而已是連續好幾次的也引發民眾還有一些的反應那我希望院長可以在這方面多注意一下我們會多多的要求跟約束謝謝謝謝委員提醒現在急診庸塞和長期醫療人力不足的問題其實已經罄竹然書了啦說真的\n\n04:08.818 --> 04:31.093\n各界其實大家都是一直在討論其實都是有在想要幫政府想一些及時廣義想一些提供一些正確的想法要給政府看什麼樣的做法但是請問一下衛福部為什麼現在都不願意買單解決現在我們正在惡化的醫療現場呢例如我們要重新檢討健保制度還有落實\n\n04:33.595 --> 04:59.050\n醫療分級這方面還有強化宣導輕症自我照護小小病自我要療的照護的觀念其實這些都是先進的國家在做的國民健康的政策但是為什麼衛福部你現在對這些意見都視而不見呢還有甚至背道而馳呢因為我看院長部長你們看其實你們知道衛福部其實從103年開始就開始推動了自我照護\n\n05:00.191 --> 05:28.040\n這些自我照護連續幾年都有出國考察而且他們都是針對考察這些針對自我用藥法規專家的會議還有世界自我用藥的聯會的會議所以但是一下子10年11年就過去了但是都沒有看到成效所以健保的財政的情況還是無解而且現在衍生出來了急診擁捨的問題那請教院長你知道每年的7月24號是什麼日子嗎\n\n05:32.554 --> 05:47.453\n你知道每年的7月24號是什麼日子嗎那其實是那是WHO為了提倡自我照護觀念他將每年7月24號定做國際自我照護日\n\n05:48.334 --> 06:13.730\n就是說一週有7天一天有24小時其實他是鼓勵大家來積極行動來改善我們自己維護自我的身心上面的健康所以院長你相信最近那麼多的急診篩報的問題其主要的原因也是因為我們台灣現在的整體的醫療的體系出問題然後失衡還有人力不足我相信你都知道的然後面對台灣現在超高齡的社會來臨\n\n06:14.651 --> 06:39.462\n其實台灣在積極想要加入WHO的同時其實我們要怎麼樣加強我們人民自我照護的意識還有呼應WHO所提倡的自我照護的觀念所以我們要強化輕症病人的自我照護避免輕症的這些病患湧入急診不會造成急診的擁捨的問題然後小小病就到藥局去\n\n06:40.442 --> 06:59.198\n然後小病到診所還是到地區醫院然後大病再到醫院而且要落實轉診整個的制度強化分級醫療其實這個是讓醫療資源能夠用在真正的集中症的上面並不是全部的人一有問題全部擠到大醫院裡面去\n\n06:59.778 --> 07:18.404\n所以我覺得這個也是解決急診擁捨一個簡單的解方之一啦所以也是解決健保財政虧損的方式之一所以有時候我們對這些問題我們可能要正視這個問題想方法去解決然後也根據了歐洲自我照護的產業我也發現了2023年的5月我發現了他們發布了一個調查的報告指出\n\n07:23.726 --> 07:44.810\n歐洲每年有12億的異例的小病痛這些小病痛他們透過非處方藥的自我照護不用到醫院到藥局去自我藥療就可以省下360億的歐元的醫藥上面的支出然後美國也調查民眾的自我照護可以為美國醫療省下1670億的美元的費用\n\n07:49.671 --> 08:17.723\n所以根據我們的健保署上面也有統計我們國人只要減少一次的就醫的情況我們一年估計可以為健保省下340億元所以表示自我照護自我要了這個觀念其實對於節省珍貴的健保資源是有非常顯著的效益的那我想請教衛福部部長你可以將自我照護明確的落實嗎你是否同意呢\n\n08:19.344 --> 08:41.190\n好謝謝委員的指教那我想自我照顧跟分級醫療是我們這幾十年來政府一直在推動的在一二十年前何勝茂署長當署長的時候我就是編一個健康達人125教導全國民眾怎麼樣自我照顧的主編\n\n08:42.472 --> 09:03.493\n那當然我也過去多年來在醫療網裡面推動分級醫療所以我想非常敬佩我們委員提出的這兩個觀念那我想這個一定要去落實那在民眾的照顧方面當然最好是能防病於未然那麼在因此在我們健康台灣的工作上面其實\n\n09:04.437 --> 09:21.418\n特別重視在前端的在運動營養生活形態的一個改善的一個宣導跟教育我相信不管是哪一個醫事人員尤其是社區的藥局應該在這個部分可以一起來努力我想那個\n\n09:23.716 --> 09:39.611\n再加上我們藥師的同仁其實都有很好的臨床的信念臨床藥師的信念所以基本上在給病人做擁有指示用藥的協助所以應該是可以共同來照護病人那目前\n\n09:40.734 --> 10:04.630\n其實台灣也在推動社區整合型的照護體系裡面最重要的是一個家庭醫師的團隊所謂家庭醫師不是只有醫師他藥師、物理治療師、職能治療師共同組成一個團隊讓民眾在社區就有一個很堅強的團隊有什麼問題就來看他我相信這個就是分級醫療的第一點也是我們台灣很珍貴的一個\n\n10:06.249 --> 10:26.090\n家庭醫師整合型照顧體系未來我相信醫師、藥師各種醫師等等這樣的合作起來一定可以落實分級醫療也讓我們現在很頭痛的一個急診或醫院的用事可以得到很好的環節所以我們一起來努力也感謝我們委員的指導\n\n10:26.741 --> 10:40.976\n其實我覺得政府有很多政策這方面的其實都是很好的包括轉診制度、分級醫療上面還有自我醫療上面但是我覺得一直都沒有落實就是沒有落實才可以激到變成急診、庸塞的問題所以這個我可能要麻煩部長的話要多費心一點\n\n10:47.483 --> 10:59.978\n好接下來問題就是全民健康保險法第51條規定只是藥品也是屬於不列入健保給付的範圍之一的項目是嗎部長是的\n\n11:02.017 --> 11:25.248\n所以我想請教一下就是院長和部長既然你們都認為健保改革我們同意要先從民眾的自我照護開始這個觀念開始的話那是不是應該利用一些比較部分安全無虞的這些藥品把處方藥轉為指示用藥還有加速指示藥退出健保這樣我們才能解決健保要價的黑洞然後也\n\n11:26.248 --> 11:42.576\n也解決了以藥養醫的弊病而且部長你知道審計部嗎他針對了現在的814項非屬健保規定給付的指示用藥仍未退出健保給付的問題有提出一個總決算的審核報告\n\n11:44.398 --> 11:58.416\n112年度中央政府總決算的審核報告裡面有指出有841項指示用藥列入給付的範圍然後檢討進度太慢了要求衛福部以督促落實檢討指示用藥\n\n12:01.259 --> 12:19.170\n以提高健保資源利用的效率也就是說我們現在簡單的說就是只是用要列入健保給付的範圍在健保給付藥物的比例達到27.3意思是使健保給付的藥物中有四分之一的項目是違法給付\n\n12:19.830 --> 12:45.450\n更耗費了20億的公帑所以院長請問一下衛福部是不是應該要根據審計部的審核的報告意見提出檢討改善方案落實全民健康保險法第51條的規定只是要比也是屬於不列入健保給付範圍之一的項目所以請問一下何時可以給出改善的方案何時我們可以落實\n\n12:46.857 --> 13:08.332\n謝謝委員的指教我想不管是健保署或者是食藥署針對我們的指示用藥都非常的用心也會依照那個審計部或相關的單位的一個要求來改善那對於處方藥品長期使用經驗上\n\n13:10.803 --> 13:32.216\n安全無虞的藥品既有安全性那用以緩解輕症且在至少有三個醫藥先進國家以指示藥品在管理者經食藥署評估並邀請醫藥等領域專家共同討論後得轉類為指示用藥指示藥品那剛才不知道你說幾個國家一直都在努力三個國家而已嗎\n\n13:33.889 --> 13:38.035\n至少有三個醫藥先進國家至少三個那我下一個問題還有一個問題要問你先回答這一個\n\n13:40.506 --> 14:03.724\n好我想這個部分會一直在努力我想這幾天來所以這個只是要退出健保其實是因為我們怕健保的財政受虧損所以現在健保其實也健保局也不好做健保局也不好做所以我們是希望人民用藥的方便性所以在醫藥跟人民當中我們當然以人民為\n\n14:06.327 --> 14:30.747\n對這個剛才我是一整串的問題對一整串的問題是都一直有連貫性的以人民的權益為優先之下醫藥共同來商討我想都可以來解決對就是安全無虞的處方用藥盡量先退成只是用藥只是用藥的話再來退出健保基礎都有一直在往前走是謝謝委員指教\n\n14:31.567 --> 14:52.653\n那剛才部長有提到那個三個國家的問題來這就是下一個就是接著為了不讓健保財政一直在虧損中非必要的醫生處方藥是不是要轉為指示用藥嗎剛才部長還說是三個嘛像緊急事後避孕藥這個現在我們先來講確保女性的生育的自主權\n\n14:54.013 --> 15:22.139\n讓女性把握緊急避孕的機會我想說部長也是醫生也知道這一種藥它有黃金的時間可能12小時72小時以內一定要服用的有時候到診所到醫院去他們不見得說或許大家在休診也都有可能可能會錯過了這個時間而且現在確保女性生育的自主權的話現在是想生的卻不能生但是非自願的不想生的要避孕的那會\n\n15:23.079 --> 15:48.691\n會不會衛福部管太多了對不對部長上回其實我已經有請教過你了嘛衛福部要正視女性的自主權還有用藥權益對緊急事後病因要開放變更為指示藥品確保女性生育的自主權但是衛福部都沒有給一個北溪的一個回應所以我現在就是說剛才有談到三個國家現在全球已經有\n\n15:50.212 --> 16:04.020\n88個國家將事後避孕藥列為非處方用藥了而且在2023年日本也可以在社區藥局販賣禁忌避孕藥其實這個我們現在還沒有做到對不對\n\n16:04.640 --> 16:30.229\n所以根據WHO的報告將事後病因藥轉成非處方藥是讓女性方便的取得這個藥物不僅可以減少女性因為懷孕而面臨的風險也可以降低因意外懷孕所帶來的社會還有經濟上面的負擔而且包括連我們現在知名的女權團體在2024年的10月份的時候有對於這個\n\n16:32.270 --> 16:54.589\n事後病藥是否開放來做了一個調查線上的調查結果有六成五的民眾支持開放而且2016年調查七成的幾乎完全七成人都支持而且希望能夠方便及時取得而且藥局即可購買還有提高女性自主所以我想部長針對這個問題的話我想說\n\n16:58.812 --> 17:07.041\n您應該也是會很重視這個問題所以在2016年的時候我有去看過2016年的時候有針對這個問題討論過廚房藥改成民眾在藥局購買的指示用藥也已經衛福部通過了\n\n17:15.515 --> 17:36.329\n也發佈在緊急事後避孕藥變更為指示藥品的說明所以據本席了解指示藥品陳藥主已經開過會討論過了將緊急事後避孕藥從醫生處方藥轉列為指示用藥但是這個會議中也做成了會議記錄所以為什麼食藥署到現在還說醫生團體\n\n17:39.991 --> 18:05.466\n還評估還沒有共識呢而且部長你知道我們的衛福部的政策為什麼擱置到現在還沒有共識呢對不對而且這個不是2016年早有共識了嗎還是有人不同意呢是不是有人刻意去修改了整個的會議紀錄你衛福部要不要調查一下當時的情況啊照我是這樣看的是因為會議背後有一隻看不到的手\n\n18:06.306 --> 18:35.826\n所以我想部長你針對這個問題你可能要去了解一下在2016年那時候發生的事情而且你身為醫生你醫者人心我拜託你千萬不要讓女性生育權被自主權被剝奪了政府你現在不是在營造整個友善的生育環境嗎你是不是要讓女性能夠安心而且自由的選擇自己何時要懷孕這個我想這個也是政府的重要的責任\n\n18:37.487 --> 18:50.495\n報告委員謝謝委員的指教有關於這個事後必應要轉捩為非處方藥品管理的議題其實從剛剛您所說的從2016年其實那個時候就開始有討論\n\n18:51.482 --> 19:10.537\n那我在當立委的期間也開過不少次的協調會議因為就是醫藥有不同的看法那我想我們不管是醫跟藥我聽起來都是為了人民的權利在努力那我個人都非常的感動但是因為有不同的專業的看法所以\n\n19:11.206 --> 19:26.148\n也是涉及的層面比較廣泛那因為在有一些醫事的團體專業團體他們認為尤其特別會照顧到婦女懷孕生產的科別他們在這個部分是很有\n\n19:27.225 --> 19:53.628\n對部長你剛才講三個國家同意這個有八十八個國家我們台灣要不要跟國際接軌啊我們一直在走倒退路嗎他還是一種和我們啦他還是會影響到現在都是醫界在擋這一個啊不是嗎這個明明就是國際上已經八十八個國家這樣做了啊對不對部長你不能不公欸你現在全部人都是醫生你這樣是不是太不公了啊\n\n19:55.269 --> 20:06.458\n你要為全國的民眾想啊全部的女性的自主權對不對他們生育的自主權大家都等著你們而且2012年的時候你先去看看是不是有人篡改會議紀錄\n\n20:09.057 --> 20:13.339\n我們去了解本部的食藥署已經將114.36號召開緊急事後避孕完轉為醫師藥師現在整個會議全部都是醫生請問一下這樣怎麼會公平呢這個讓部長\n\n20:29.625 --> 20:50.935\n去做好好的協調我想從醫藥分業之後我們的醫藥關係一直是在一個比較是是院長是沒錯但是安全無虞的藥品我已經非常這個比較合理的使用安全無虞的藥品這個東西已經安全無虞了而且88個國家都已經這樣做了現在只有台灣沒有這樣做\n\n20:51.795 --> 21:19.768\n我要求部長盡快跟醫界、藥界達成共識大家能夠在安全無虞的合理使用狀況下當時我也要請委員能夠支持因為委員的專業非常注重健保今年健保30年我常說健保30年保障國人的健康現在是我們回頭保障健保的時代30年前我就一直主張小病不用保大病沒煩惱這種小病集中到醫學中心去\n\n21:21.343 --> 21:49.629\n用那麼少的這個代價致富額他就能夠得到他應該讓他到診所去用他完全來負擔這個就是落實分級醫療嗎分級醫療轉診制度如果我們觀念能夠轉過來小病不用保大病就沒煩惱讓那個可以傾家蕩產的病讓政府全力來照顧他讓那個影響到整個公共衛生的病政府全力來遏止他政府應該做這個東西小病讓他自己來做另外我們的內外婦兒這四顆\n\n21:50.929 --> 22:16.448\n醫事人員的減少我們也必須大家觀念轉變我們再落實一個就是不同工不同酬的醫療給付讓醫院醫事人員的工作尊嚴能夠得到保障如果這個觀念能夠同期的建立我們可以再創30年50年更好的健保制度所以我們是不是大家有這樣的一個責任來面對健保的實質改革而不是在討論錢多錢少該不該提保費的問題我們從基本上來討論\n\n22:20.292 --> 22:25.553\n沒錯啊所以我覺得大家的政策大家的想法我覺得都是正確但是完全沒有落實啊\n\n22:26.884 --> 22:55.700\n對不對剛才院長講的也對啊部長講的也對嘛我們想的都是對嘛都是往前進嘛對不對如果大家有這樣的公式我們還要持續跟社會對話我剛剛說內外婦幼這四個科所以衛福部要想出方法啊要怎麼落實啊如果能夠給他建立但是這個不能因為這個會增加對這些實質上的支付所以我們還要平衡所以能夠農小病大家就不用保大病再來大家就再沒煩惱然後從內外婦幼從這個不同工不同酬的給付來開始\n\n22:56.520 --> 23:22.029\n我想這個社會的觀念如果建立起來剛開始也許會遭受很多很多的討論但是我相信如果提出這樣的討論對社會是正面的其實也不是院長不是提出這樣的討論這個事情已經做很久了我想部長也是知道只是沒有做得很徹底沒有做得很成功所以我覺得我們還是要用心在這一塊啦好不好那一些修法的部分可能我們就要有共識才能來進行\n\n23:23.767 --> 23:45.973\n這個已經在實施了對只是沒有落實我想自我照顧跟分級醫療我們一定繼續來推那醫藥方面在某些專業的互動我們一定持續來溝通醫藥本是一家要攜手共同來照顧人民的健康我們一起來努力也謝謝委員的啟示跟指教好謝謝部長那我有請交通部長\n\n23:59.022 --> 24:25.209\n好那我就因為時間不多這樣我還是先靜緩講一下就是院長你知道零四零三強震開米颱風其實重創了花蓮的觀光業者都是一直在覺得去年是從業三十年來最慘的一天一次地震發生花蓮的旅宿還有餐飲其實已經都停業上百家了這是本心還是持續的關心我們花蓮的觀光和交通\n\n24:25.689 --> 24:53.854\n因為對花蓮來講其實最重要的就是要怎麼樣活下去所以去年113年花蓮的遊客是近年五年來最低的還比起前一年112年的時候已經下降了一半那我想院長也是很認真每個月當初都說有你都有允諾說要每個月都要下去花蓮勘查整個情況所以我想院長你應該很了解花蓮現在的困境是什麼\n\n24:54.634 --> 25:02.782\n所以也很感謝你振興花蓮的觀光而努力所以在去年針對0403的地震的時候振興花蓮觀光產業我們也放寬了公務人員的國旅卡休假補助費的整個措施那請問去年的實施是如何呢我想應該是成效不佳吧因為花蓮現在的店家和民眾還是無感\n\n25:17.597 --> 25:41.263\n所以光是觀光人數接到上面的觀光客其實我們都看出來其實真的觀光的人數是非常非常的少而且非常非常的慘淡那院長那為什麼實施到去年今年就補助了呢沒有補助了呢還是你覺得說今年有更好的規劃呢還是有什麼特別加碼的規劃呢可以振興我們花蓮的觀光\n\n25:42.657 --> 25:57.655\n我簡單的先向委員說不敢說認真兩個字這是我們團隊應該做的事情只是很遺憾的是去年0403之後7月好幾次的颱風當我們的工程進行到一個程度它就停下來甚至又往後延\n\n25:58.208 --> 26:18.484\n那颱風又讓很多的觀光客又卻步了這是我們非常遺憾的事情我們總是希望說所有的補助的措施能夠徹底的落實那請問今年會不會再繼續補助呢像去年來我們執行不好的事情我們就把它加碼把它放寬那新年我相信交通部他又有一個其他的緊急的計畫在執行我們部長來說明\n\n26:21.926 --> 26:43.271\n確實去年花蓮因為地震再加上好幾個颱風確實對觀光業影響非常大那您也非常關心交通建設的問題我們目前交通上升穩定目前最近比較沒有太大的雨所以上升穩定的狀況底下其實我們花蓮的觀光在11月份已經漸漸回到了112年的水準也就是說已經有復甦的狀況\n\n26:44.551 --> 27:11.472\n那去年我們主要是因為403的地震那沒關係我想知道說這個有沒有更好的規劃振興花蓮的觀光有沒有什麼加碼的還是有一個做一個更好的規劃我先知道這個因為我後面還有一些問題要問去年是因為地震的原因所以用一個救急的方案來補助有補助的方案但是我剛剛有提到就是說現在的觀光的狀況已經比較穩定了所以我們大概不會用可是我們還是很慘淡啊\n\n27:12.212 --> 27:13.553\n現在除了剛剛委員說的橋尾會有這樣的方式之外我們去年年底副院長還主持了觀光的諮詢會議\n\n27:27.597 --> 27:55.465\n也召集了業者大家也提出了相當的問題所以僑委會是不是有這樣的一個對我想說僑胞回台的時候他們社會應該需要可以去看看可不可以結合報告委員我們去年確實也有加碼在針對僑胞去避免返國的時候本來我們一般都補助三千塊那麼如果特別到花東去旅遊的我們就補助三千六百塊那這樣子做當然有多少增加一些誘因成效怎麼樣呢\n\n27:57.205 --> 28:24.224\n如同剛剛交通部所報告的就是說因為去年一直不斷有颱風跟地震的因素影響所以最終真的去到花東旅遊的人數那我想請問一下今年會不會再有補助今年我們會繼續比照就是說增加我們的花東觀光特約商店以及再增加一樣3600的補助那今年就是還會有然後做更好的規劃然後再加碼\n\n28:24.944 --> 28:34.313\n另外我再跟您補充一下現在我們有香港飛花蓮的班機那也是一個班機一個包機補助28萬這個部分有在努力\n\n28:35.011 --> 28:47.937\n院長也有特別交代我們希望禮拜一到禮拜天每一天都有台北飛花蓮的班機那這個部分已經在進行當中所以每個禮拜一到禮拜天每一天都有班機飛花蓮台北到花蓮我再問一下部長一個問題有關於花蓮鐵路高架化的交通的問題\n\n28:56.361 --> 29:16.926\n這個台灣的東部在花蓮市和吉安鄉這邊有七個平面的平交道其實他是穿越花蓮市和吉安鄉的鬧區所以針對這個時候之前民怨的情況下據我了解這個計畫來來回回的修了好幾次而且112年4月的時候那時候前交通部長已經同意了\n\n29:18.026 --> 29:36.780\n將花東地區鐵路雙軌電氣化的計畫工程納入花蓮站和甘城站七個鐵路平交道的高價立體化辦理並且全額的負擔而且那時候我看是4562億餘元編到哪就做到哪然後114年編了600億那我想請問一下\n\n29:40.816 --> 30:06.066\n根據我現在看那台鐵花蓮和吉安甘城站的高架工程那哪時候可以規劃動工呢而且據我最近了解我也覺得很奇怪就是目前計畫書送到行政院的石層大海音訊全無是不是改以鐵路平交道與環境改善設施的周邊土地的計畫審查要點審查就是中央已經不全額的負擔費用了那我想請教一下院長\n\n30:06.826 --> 30:20.599\n中央不全額負擔的原因是什麼而且目前計畫書是不是已經到行政院了那如果到行政院了可以加速審核嗎報告委員您剛所提的這個高價化的部分目前因為它的合理性\n\n30:21.072 --> 30:37.056\n我們還有一些質疑啦因為其他的縣市的高價化他不是放在雙軌電機那是112年4月的時候交通部長前交通部長王國才就正面回應了他就說這個他會全部列入而且答應全額負擔你要騙我們花蓮人啊\n\n31:02.810 --> 31:04.150\n謝謝林益君委員質詢,謝謝卓院長的備詢接下來我們請莊瑞雄委員請質詢\n\n","segments":[{"start":16.138,"end":19.361,"text":"謝謝主席有請院長麻煩再請卓院長備詢議員好院長好"},{"start":35.872,"end":59.615,"text":"最近全台爆發急診擁捨的問題不斷的在延燒醫護短缺的問題也是日漸的嚴峻讓我們台灣的醫療環境困境再度的凸顯那其實落實分級醫療還有讓醫療的資源合理的分配都是解決急診擁捨問題最基本的解決的方案但是本席也身為醫藥背景的專業人員但是對衛福部"},{"start":60.195,"end":88.306,"text":"現在的許多的政策其實我有時候都是物理看花啦不是什麼完全看不懂啦為什麼我們衛福部現在都是有時候有些政策不願意跟國際趨勢接軌呢像上次政府都是常常的自豪的說台灣是國際醫療的自由神尤其是COVID-19的時候那個時候我們的全國的醫藥護理人員共同的協力然後創造了台灣的奇蹟"},{"start":89.366,"end":116.794,"text":"那為何現在疫情剛剛結束之後政府又開始鬆懈了呢其實台灣各醫院的急診擁設的問題早就是一個長期結構性的問題了所以結果我們主管機關衛福部不但沒有積極的想方法反而有點扯後腿那我想請問一下我們的衛福部長現在先把問題牽托到農曆過年太久了請問院長過去難道我們春節的假期沒有放過酒天的嗎"},{"start":118.377,"end":144.399,"text":"應該都有吧我看2019、2022年連續都是放了9天而且2023年還放了10天的連續假期而且還有更離譜的是我們的衛福部的次長林靜儀更囂張竟然回嗆急診醫師的留言他說呵呵小腦袋引爆了全部醫界的憤怒那我想請問一下這些身為醫生的政府官員"},{"start":145.2,"end":158.583,"text":"竟然沒有一絲絲的同理心遇到什麼事情就先推完全沒有傾聽基層的聲音甚至不負責任緬滅人性的發言你們覺得這樣是對的嗎還有看在我們衛福部部長和次長這樣如果你們大家是身為我們醫療的大家長的情況下應該是要針對問題來找解方才是嘛對不對而且我再請問一下院長就是說你認為所謂的吵架失言專業"},{"start":174.207,"end":197.438,"text":"專業嗆民眾 專業嗆醫護這樣的適合擔任我們主管醫藥專業的官員嗎這樣這種人在你的行政院的整個團隊中這樣的人是適任的嗎跟委員抱歉這個整個事件我已經對外表示過了政務人員 政府的官員務必要謹言正行嗆民眾 嗆醫護這個都不是專業應該有的行為"},{"start":201.024,"end":228.593,"text":"春節九天過去也有過那九天比較長的連假這只是今天我們在分析整個這個急診擁塞的情形的一個條件而已一個狀況而已其他它還有諾羅病毒還有天候的變化等等但無論什麼樣的原因啊我想部長也好 次長也好我們所有的從政的同仁都應該用同理心不要用這種方式去跟民眾對話我再度的向大家表示歉意"},{"start":230.289,"end":248.418,"text":"好 因為這個問題並不是一次而已是連續好幾次的也引發民眾還有一些的反應那我希望院長可以在這方面多注意一下我們會多多的要求跟約束 謝謝謝謝委員提醒現在急診 庸塞和長期醫療人力不足的問題其實已經罄竹然書了啦 說真的"},{"start":248.818,"end":271.093,"text":"各界其實大家都是一直在討論其實都是有在想要幫政府想一些及時廣義想一些提供一些正確的想法要給政府看什麼樣的做法但是請問一下衛福部為什麼現在都不願意買單解決現在我們正在惡化的醫療現場呢例如我們要重新檢討健保制度還有落實"},{"start":273.595,"end":299.05,"text":"醫療分級這方面還有強化宣導輕症自我照護小小病自我要療的照護的觀念其實這些都是先進的國家在做的國民健康的政策但是為什麼衛福部你現在對這些意見都視而不見呢還有甚至背道而馳呢因為我看 院長 部長你們看其實你們知道衛福部其實從103年開始就開始推動了自我照護"},{"start":300.191,"end":328.04,"text":"這些自我照護連續幾年都有出國考察而且他們都是針對考察這些針對自我用藥法規專家的會議還有世界自我用藥的聯會的會議所以但是一下子10年11年就過去了但是都沒有看到成效所以健保的財政的情況還是無解而且現在衍生出來了急診擁捨的問題那請教院長你知道每年的7月24號是什麼日子嗎"},{"start":332.554,"end":347.453,"text":"你知道每年的7月24號是什麼日子嗎那其實是那是WHO為了提倡自我照護觀念他將每年7月24號定做國際自我照護日"},{"start":348.334,"end":373.73,"text":"就是說一週有7天一天有24小時其實他是鼓勵大家來積極行動來改善我們自己維護自我的身心上面的健康所以院長你相信最近那麼多的急診篩報的問題其主要的原因也是因為我們台灣現在的整體的醫療的體系出問題然後失衡還有人力不足我相信你都知道的然後面對台灣現在超高齡的社會來臨"},{"start":374.651,"end":399.462,"text":"其實台灣在積極想要加入WHO的同時其實我們要怎麼樣加強我們人民自我照護的意識還有呼應WHO所提倡的自我照護的觀念所以我們要強化輕症病人的自我照護避免輕症的這些病患湧入急診不會造成急診的擁捨的問題然後小小病就到藥局去"},{"start":400.442,"end":419.198,"text":"然後小病到診所還是到地區醫院然後大病再到醫院而且要落實轉診整個的制度強化分級醫療其實這個是讓醫療資源能夠用在真正的集中症的上面並不是全部的人一有問題全部擠到大醫院裡面去"},{"start":419.778,"end":438.404,"text":"所以我覺得這個也是解決急診擁捨一個簡單的解方之一啦所以也是解決健保財政虧損的方式之一所以有時候我們對這些問題我們可能要正視這個問題想方法去解決然後也根據了歐洲自我照護的產業我也發現了2023年的5月我發現了他們發布了一個調查的報告指出"},{"start":443.726,"end":464.81,"text":"歐洲每年有12億的異例的小病痛這些小病痛他們透過非處方藥的自我照護不用到醫院到藥局去自我藥療就可以省下360億的歐元的醫藥上面的支出然後美國也調查民眾的自我照護可以為美國醫療省下1670億的美元的費用"},{"start":469.671,"end":497.723,"text":"所以根據我們的健保署上面也有統計我們國人只要減少一次的就醫的情況我們一年估計可以為健保省下340億元所以表示自我照護自我要了這個觀念其實對於節省珍貴的健保資源是有非常顯著的效益的那我想請教衛福部部長你可以將自我照護明確的落實嗎你是否同意呢"},{"start":499.344,"end":521.19,"text":"好 謝謝委員的指教那我想自我照顧跟分級醫療是我們這幾十年來政府一直在推動的在一二十年前何勝茂署長當署長的時候我就是編一個健康達人125教導全國民眾怎麼樣自我照顧的主編"},{"start":522.472,"end":543.493,"text":"那當然我也過去多年來在醫療網裡面推動分級醫療所以我想非常敬佩我們委員提出的這兩個觀念那我想這個一定要去落實那在民眾的照顧方面當然最好是能防病於未然那麼在因此在我們健康台灣的工作上面其實"},{"start":544.437,"end":561.418,"text":"特別重視在前端的在運動營養生活形態的一個改善的一個宣導跟教育我相信不管是哪一個醫事人員尤其是社區的藥局應該在這個部分可以一起來努力我想那個"},{"start":563.716,"end":579.611,"text":"再加上我們藥師的同仁其實都有很好的臨床的信念臨床藥師的信念所以基本上在給病人做擁有指示用藥的協助所以應該是可以共同來照護病人那目前"},{"start":580.734,"end":604.63,"text":"其實台灣也在推動社區整合型的照護體系裡面最重要的是一個家庭醫師的團隊所謂家庭醫師不是只有醫師他藥師、物理治療師、職能治療師共同組成一個團隊讓民眾在社區就有一個很堅強的團隊有什麼問題就來看他我相信這個就是分級醫療的第一點也是我們台灣很珍貴的一個"},{"start":606.249,"end":626.09,"text":"家庭醫師整合型照顧體系未來我相信醫師、藥師各種醫師等等這樣的合作起來一定可以落實分級醫療也讓我們現在很頭痛的一個急診或醫院的用事可以得到很好的環節所以我們一起來努力也感謝我們委員的指導"},{"start":626.741,"end":640.976,"text":"其實我覺得政府有很多政策這方面的其實都是很好的包括轉診制度、分級醫療上面還有自我醫療上面但是我覺得一直都沒有落實就是沒有落實才可以激到變成急診、庸塞的問題所以這個我可能要麻煩部長的話要多費心一點"},{"start":647.483,"end":659.978,"text":"好 接下來問題就是全民健康保險法第51條規定只是藥品也是屬於不列入健保給付的範圍之一的項目是嗎 部長是的"},{"start":662.017,"end":685.248,"text":"所以我想請教一下就是院長和部長既然你們都認為健保改革我們同意要先從民眾的自我照護開始這個觀念開始的話那是不是應該利用一些比較部分安全無虞的這些藥品把處方藥轉為指示用藥還有加速指示藥退出健保這樣我們才能解決健保要價的黑洞然後也"},{"start":686.248,"end":702.576,"text":"也解決了以藥養醫的弊病而且部長你知道審計部嗎他針對了現在的814項非屬健保規定給付的指示用藥仍未退出健保給付的問題有提出一個總決算的審核報告"},{"start":704.398,"end":718.416,"text":"112年度中央政府總決算的審核報告裡面有指出有841項指示用藥列入給付的範圍然後檢討進度太慢了要求衛福部以督促落實檢討指示用藥"},{"start":721.259,"end":739.17,"text":"以提高健保資源利用的效率也就是說我們現在簡單的說就是只是用要列入健保給付的範圍在健保給付藥物的比例達到27.3意思是使健保給付的藥物中有四分之一的項目是違法給付"},{"start":739.83,"end":765.45,"text":"更耗費了20億的公帑所以院長請問一下衛福部是不是應該要根據審計部的審核的報告意見提出檢討改善方案落實全民健康保險法第51條的規定只是要比也是屬於不列入健保給付範圍之一的項目所以請問一下何時可以給出改善的方案何時我們可以落實"},{"start":766.857,"end":788.332,"text":"謝謝委員的指教我想不管是健保署或者是食藥署針對我們的指示用藥都非常的用心也會依照那個審計部或相關的單位的一個要求來改善那對於處方藥品長期使用經驗上"},{"start":790.803,"end":812.216,"text":"安全無虞的藥品既有安全性那用以緩解輕症且在至少有三個醫藥先進國家以指示藥品在管理者經食藥署評估並邀請醫藥等領域專家共同討論後得轉類為指示用藥指示藥品那剛才不知道你說幾個國家一直都在努力三個國家而已嗎"},{"start":813.889,"end":818.035,"text":"至少有三個醫藥先進國家至少三個那我下一個問題還有一個問題要問你先回答這一個"},{"start":820.506,"end":843.724,"text":"好 我想這個部分會一直在努力我想這幾天來所以這個只是要退出健保其實是因為我們怕健保的財政受虧損所以現在健保其實也健保局也不好做健保局也不好做所以我們是希望人民用藥的方便性所以在醫藥跟人民當中我們當然以人民為"},{"start":846.327,"end":870.747,"text":"對 這個剛才我是一整串的問題對 一整串的問題是都一直有連貫性的以人民的權益為優先之下醫藥共同來商討我想都可以來解決對 就是安全無虞的處方用藥盡量先退成只是用藥只是用藥的話再來退出健保基礎都有一直在往前走是 謝謝委員指教"},{"start":871.567,"end":892.653,"text":"那剛才部長有提到那個三個國家的問題來這就是下一個就是接著為了不讓健保財政一直在虧損中非必要的醫生處方藥是不是要轉為指示用藥嗎剛才部長還說是三個嘛像緊急事後避孕藥這個現在我們先來講確保女性的生育的自主權"},{"start":894.013,"end":922.139,"text":"讓女性把握緊急避孕的機會我想說部長也是醫生也知道這一種藥它有黃金的時間可能12小時72小時以內一定要服用的有時候到診所到醫院去他們不見得說或許大家在休診也都有可能可能會錯過了這個時間而且現在確保女性生育的自主權的話現在是想生的卻不能生但是非自願的不想生的要避孕的那會"},{"start":923.079,"end":948.691,"text":"會不會衛福部管太多了對不對部長上回其實我已經有請教過你了嘛衛福部要正視女性的自主權還有用藥權益對緊急事後病因要開放變更為指示藥品確保女性生育的自主權但是衛福部都沒有給一個北溪的一個回應所以我現在就是說剛才有談到三個國家現在全球已經有"},{"start":950.212,"end":964.02,"text":"88個國家將事後避孕藥列為非處方用藥了而且在2023年日本也可以在社區藥局販賣禁忌避孕藥其實這個我們現在還沒有做到對不對"},{"start":964.64,"end":990.229,"text":"所以根據WHO的報告將事後病因藥轉成非處方藥是讓女性方便的取得這個藥物不僅可以減少女性因為懷孕而面臨的風險也可以降低因意外懷孕所帶來的社會還有經濟上面的負擔而且包括連我們現在知名的女權團體在2024年的10月份的時候有對於這個"},{"start":992.27,"end":1014.589,"text":"事後病藥是否開放來做了一個調查線上的調查結果有六成五的民眾支持開放而且2016年調查七成的幾乎完全七成人都支持而且希望能夠方便及時取得而且藥局即可購買還有提高女性自主所以我想部長針對這個問題的話我想說"},{"start":1018.812,"end":1027.041,"text":"您應該也是會很重視這個問題所以在2016年的時候我有去看過2016年的時候有針對這個問題討論過廚房藥改成民眾在藥局購買的指示用藥也已經衛福部通過了"},{"start":1035.515,"end":1056.329,"text":"也發佈在緊急事後避孕藥變更為指示藥品的說明所以據本席了解指示藥品陳藥主已經開過會討論過了將緊急事後避孕藥從醫生處方藥轉列為指示用藥但是這個會議中也做成了會議記錄所以為什麼食藥署到現在還說醫生團體"},{"start":1059.991,"end":1085.466,"text":"還評估還沒有共識呢而且部長你知道我們的衛福部的政策為什麼擱置到現在還沒有共識呢對不對而且這個不是2016年早有共識了嗎還是有人不同意呢是不是有人刻意去修改了整個的會議紀錄你衛福部要不要調查一下當時的情況啊照我是這樣看的是因為會議背後有一隻看不到的手"},{"start":1086.306,"end":1115.826,"text":"所以我想部長你針對這個問題你可能要去了解一下在2016年那時候發生的事情而且你身為醫生你醫者人心我拜託你千萬不要讓女性生育權被自主權被剝奪了政府你現在不是在營造整個友善的生育環境嗎你是不是要讓女性能夠安心而且自由的選擇自己何時要懷孕這個我想這個也是政府的重要的責任"},{"start":1117.487,"end":1130.495,"text":"報告委員謝謝委員的指教有關於這個事後必應要轉捩為非處方藥品管理的議題其實從剛剛您所說的從2016年其實那個時候就開始有討論"},{"start":1131.482,"end":1150.537,"text":"那我在當立委的期間也開過不少次的協調會議因為就是醫藥有不同的看法那我想我們不管是醫跟藥我聽起來都是為了人民的權利在努力那我個人都非常的感動但是因為有不同的專業的看法所以"},{"start":1151.206,"end":1166.148,"text":"也是涉及的層面比較廣泛那因為在有一些醫事的團體專業團體他們認為尤其特別會照顧到婦女懷孕生產的科別他們在這個部分是很有"},{"start":1167.225,"end":1193.628,"text":"對 部長 你剛才講三個國家同意這個有八十八個國家我們台灣要不要跟國際接軌啊我們一直在走倒退路嗎他還是一種和我們啦他還是會影響到現在都是醫界在擋這一個啊不是嗎這個明明就是國際上已經八十八個國家這樣做了啊對不對部長你不能不公欸你現在全部人都是醫生你這樣是不是太不公了啊"},{"start":1195.269,"end":1206.458,"text":"你要為全國的民眾想啊 全部的女性的自主權 對不對他們生育的自主權大家都等著你們而且2012年的時候你先去看看是不是有人篡改會議紀錄"},{"start":1209.057,"end":1213.339,"text":"我們去了解本部的食藥署已經將114.36號召開緊急事後避孕完轉為醫師藥師現在整個會議全部都是醫生請問一下這樣怎麼會公平呢這個讓部長"},{"start":1229.625,"end":1250.935,"text":"去做好好的協調我想從醫藥分業之後我們的醫藥關係一直是在一個比較是是院長是沒錯但是安全無虞的藥品我已經非常這個比較合理的使用安全無虞的藥品這個東西已經安全無虞了而且88個國家都已經這樣做了現在只有台灣沒有這樣做"},{"start":1251.795,"end":1279.768,"text":"我要求部長盡快跟醫界、藥界達成共識大家能夠在安全無虞的合理使用狀況下當時我也要請委員能夠支持因為委員的專業非常注重健保今年健保30年我常說健保30年保障國人的健康現在是我們回頭保障健保的時代30年前我就一直主張小病不用保大病沒煩惱這種小病集中到醫學中心去"},{"start":1281.343,"end":1309.629,"text":"用那麼少的這個代價 致富額他就能夠得到他應該讓他到診所去用他完全來負擔這個就是落實分級醫療嗎分級醫療 轉診制度如果我們觀念能夠轉過來小病不用保 大病就沒煩惱讓那個可以傾家蕩產的病讓政府全力來照顧他讓那個影響到整個公共衛生的病政府全力來遏止他政府應該做這個東西小病讓他自己來做另外我們的內外婦兒這四顆"},{"start":1310.929,"end":1336.448,"text":"醫事人員的減少我們也必須大家觀念轉變我們再落實一個就是不同工不同酬的醫療給付讓醫院醫事人員的工作尊嚴能夠得到保障如果這個觀念能夠同期的建立我們可以再創30年50年更好的健保制度所以我們是不是大家有這樣的一個責任來面對健保的實質改革而不是在討論錢多錢少該不該提保費的問題我們從基本上來討論"},{"start":1340.292,"end":1345.553,"text":"沒錯啊 所以我覺得大家的政策 大家的想法我覺得都是正確 但是完全沒有落實啊"},{"start":1346.884,"end":1375.7,"text":"對不對 剛才院長講的也對啊 部長講的也對嘛我們想的都是對嘛 都是往前進嘛 對不對如果大家有這樣的公式 我們還要持續跟社會對話我剛剛說內外婦幼這四個科所以衛福部要想出方法啊要怎麼落實啊 如果能夠給他建立但是這個不能 因為這個會增加對這些實質上的支付所以我們還要平衡所以能夠農小病大家就不用保大病再來 大家就再沒煩惱然後從內外婦幼從這個不同工不同酬的給付來開始"},{"start":1376.52,"end":1402.029,"text":"我想這個社會的觀念如果建立起來剛開始也許會遭受很多很多的討論但是我相信如果提出這樣的討論對社會是正面的其實也不是院長不是提出這樣的討論這個事情已經做很久了我想部長也是知道只是沒有做得很徹底沒有做得很成功所以我覺得我們還是要用心在這一塊啦好不好那一些修法的部分可能我們就要有共識才能來進行"},{"start":1403.767,"end":1425.973,"text":"這個已經在實施了對 只是沒有落實我想自我照顧跟分級醫療我們一定繼續來推那醫藥方面在某些專業的互動我們一定持續來溝通醫藥本是一家要攜手共同來照顧人民的健康我們一起來努力也謝謝委員的啟示跟指教好 謝謝部長那我有請交通部長"},{"start":1439.022,"end":1465.209,"text":"好 那我就因為時間不多 這樣我還是先靜緩講一下就是院長 你知道零四零三強震開米颱風其實重創了花蓮的觀光業者都是一直在覺得去年是從業三十年來最慘的一天一次地震發生 花蓮的旅宿還有餐飲其實已經都停業上百家了這是本心還是持續的關心我們花蓮的觀光和交通"},{"start":1465.689,"end":1493.854,"text":"因為對花蓮來講其實最重要的就是要怎麼樣活下去所以去年113年花蓮的遊客是近年五年來最低的還比起前一年112年的時候已經下降了一半那我想院長也是很認真每個月當初都說有你都有允諾說要每個月都要下去花蓮勘查整個情況所以我想院長你應該很了解花蓮現在的困境是什麼"},{"start":1494.634,"end":1502.782,"text":"所以也很感謝你振興花蓮的觀光而努力所以在去年針對0403的地震的時候振興花蓮觀光產業我們也放寬了公務人員的國旅卡休假補助費的整個措施那請問去年的實施是如何呢我想應該是成效不佳吧因為花蓮現在的店家和民眾還是無感"},{"start":1517.597,"end":1541.263,"text":"所以光是觀光人數接到上面的觀光客其實我們都看出來其實真的觀光的人數是非常非常的少而且非常非常的慘淡那院長那為什麼實施到去年今年就補助了呢沒有補助了呢還是你覺得說今年有更好的規劃呢還是有什麼特別加碼的規劃呢可以振興我們花蓮的觀光"},{"start":1542.657,"end":1557.655,"text":"我簡單的先向委員說不敢說認真兩個字這是我們團隊應該做的事情只是很遺憾的是去年0403之後7月好幾次的颱風當我們的工程進行到一個程度它就停下來甚至又往後延"},{"start":1558.208,"end":1578.484,"text":"那颱風又讓很多的觀光客又卻步了這是我們非常遺憾的事情我們總是希望說所有的補助的措施能夠徹底的落實那請問今年會不會再繼續補助呢像去年來我們執行不好的事情我們就把它加碼把它放寬那新年我相信交通部他又有一個其他的緊急的計畫在執行我們部長來說明"},{"start":1581.926,"end":1603.271,"text":"確實去年花蓮因為地震再加上好幾個颱風確實對觀光業影響非常大那您也非常關心交通建設的問題我們目前交通上升穩定目前最近比較沒有太大的雨所以上升穩定的狀況底下其實我們花蓮的觀光在11月份已經漸漸回到了112年的水準也就是說已經有復甦的狀況"},{"start":1604.551,"end":1631.472,"text":"那去年我們主要是因為403的地震那沒關係我想知道說這個有沒有更好的規劃振興花蓮的觀光有沒有什麼加碼的還是有一個做一個更好的規劃我先知道這個因為我後面還有一些問題要問去年是因為地震的原因所以用一個救急的方案來補助有補助的方案但是我剛剛有提到就是說現在的觀光的狀況已經比較穩定了所以我們大概不會用可是我們還是很慘淡啊"},{"start":1632.212,"end":1633.553,"text":"現在除了剛剛委員說的橋尾會有這樣的方式之外我們去年年底副院長還主持了觀光的諮詢會議"},{"start":1647.597,"end":1675.465,"text":"也召集了業者 大家也提出了相當的問題所以僑委會是不是有這樣的一個對 我想說僑胞回台的時候他們社會應該需要可以去看看 可不可以結合報告委員 我們去年確實也有加碼在針對僑胞去避免返國的時候本來我們一般都補助三千塊那麼如果特別到花東去旅遊的我們就補助三千六百塊那這樣子做當然有多少增加一些誘因成效怎麼樣呢"},{"start":1677.205,"end":1704.224,"text":"如同剛剛交通部所報告的就是說因為去年一直不斷有颱風跟地震的因素影響所以最終真的去到花東旅遊的人數那我想請問一下今年會不會再有補助今年我們會繼續比照就是說增加我們的花東觀光特約商店以及再增加一樣3600的補助那今年就是還會有然後做更好的規劃然後再加碼"},{"start":1704.944,"end":1714.313,"text":"另外我再跟您補充一下現在我們有香港飛花蓮的班機那也是一個班機一個包機補助28萬這個部分有在努力"},{"start":1715.011,"end":1727.937,"text":"院長也有特別交代我們希望禮拜一到禮拜天每一天都有台北飛花蓮的班機那這個部分已經在進行當中所以每個禮拜一到禮拜天每一天都有班機飛花蓮台北到花蓮我再問一下部長一個問題有關於花蓮鐵路高架化的交通的問題"},{"start":1736.361,"end":1756.926,"text":"這個台灣的東部在花蓮市和吉安鄉這邊有七個平面的平交道其實他是穿越花蓮市和吉安鄉的鬧區所以針對這個時候之前民怨的情況下據我了解這個計畫來來回回的修了好幾次而且112年4月的時候那時候前交通部長已經同意了"},{"start":1758.026,"end":1776.78,"text":"將花東地區鐵路雙軌電氣化的計畫工程納入花蓮站和甘城站七個鐵路平交道的高價立體化辦理並且全額的負擔而且那時候我看是4562億餘元編到哪就做到哪然後114年編了600億那我想請問一下"},{"start":1780.816,"end":1806.066,"text":"根據我現在看那台鐵花蓮和吉安甘城站的高架工程那哪時候可以規劃動工呢而且據我最近了解我也覺得很奇怪就是目前計畫書送到行政院的石層大海音訊全無是不是改以鐵路平交道與環境改善設施的周邊土地的計畫審查要點審查就是中央已經不全額的負擔費用了那我想請教一下院長"},{"start":1806.826,"end":1820.599,"text":"中央不全額負擔的原因是什麼而且目前計畫書是不是已經到行政院了那如果到行政院了可以加速審核嗎報告委員您剛所提的這個高價化的部分目前因為它的合理性"},{"start":1821.072,"end":1837.056,"text":"我們還有一些質疑啦因為其他的縣市的高價化他不是放在雙軌電機那是112年4月的時候交通部長 前交通部長王國才就正面回應了他就說這個他會全部列入而且答應全額負擔你要騙我們花蓮人啊"},{"start":1862.81,"end":1864.15,"text":"謝謝林益君委員質詢,謝謝卓院長的備詢接下來我們請莊瑞雄委員請質詢"}]}}},"gazette":{"lineno":172,"blocks":[["林委員憶君：（15時18分）謝謝主席，有請院長。"],["主席：麻煩再請卓院長備詢。"],["卓院長榮泰：林委員好。"],["林委員憶君：院長好。最近全臺爆發急診壅塞的問題不斷地在延燒，醫護短缺的問題也是日漸嚴峻，讓臺灣的醫療環境困境再度凸顯，其實落實分級醫療及讓醫療資源合理分配都是解決急診壅塞問題最基本的解決方案。本席也身為醫藥背景的專業人員，但是對衛福部現在的許多政策，其實我有時候都是霧裡看花，也是「霧煞煞」，完全看不懂。為什麼衛福部現在有時候有些政策不願意跟國際趨勢接軌呢？像政府都常常自豪的說，臺灣是國際醫療的資優生，尤其是COVID-19的時候，我們全國的醫藥護理人員共同協力，創造了臺灣的奇蹟，為何現在疫情剛結束之後，政府又開始鬆懈了呢？其實臺灣各醫院急診壅塞，早就是一個長期結構性的問題了，結果主管機關衛福部不但沒有積極的想方法，反而有點扯後腿。","我想請問一下，衛福部長現在把問題牽拖到農曆過年太久了，請問院長，過去難道我們春節的假期沒有放過9天的嗎？應該都有吧！我看2019、2022年都是連續放了9天，而且2023年還放了10天的連續假期。還有，更離譜的是，衛福部的次長林靜儀更囂張，竟然回嗆急診醫師的留言，他說：呵呵，小腦袋，引爆了全部醫界的憤怒。我想請問一下，這些身為醫生的政府官員，竟然沒有一絲絲的同理心，遇到什麼事情就先推，完全沒有傾聽基層的聲音，甚至不負責任，泯滅人性地發言，你們覺得這樣是對的嗎？還有，看我們衛福部部長和次長這樣，在你們身為我們醫療大家長的情況下，應該是要針對問題來找解方才是，對不對？而且我再請問一下院長，你認為所謂的吵架、失言、專業嗆民眾、專業嗆醫護，這樣的人適合擔任我們主管醫藥專業的官員嗎？在你行政院的整個團隊中，這樣的人是適任的嗎？"],["卓院長榮泰：跟委員抱歉，這整個事件我已經對外表示過了，政務人員、政府的官員務必要謹言慎行，嗆民眾、嗆醫護，這個都不是專業應該有的行為。春節9天，過去也有過，9天比較長的連假，這只是今天我們在分析整個急診壅塞情形的一個條件、一個狀況而已，其他還有諾羅病毒，還有天候的變化等等，但無論什麼樣的原因，我想部長也好，次長也好，我們所有的從政同仁都應該要有同理心，不要用這種方式去跟民眾對話，我再度地向大家表示歉意。"],["林委員憶君：好，因為這個問題並不是發生一次而已，是連續好幾次的，也引發民眾還有一些反映，我希望院長可以在這方面多注意一下。"],["卓院長榮泰：我們會多多地要求跟約束，謝謝委員提醒。"],["林委員憶君：好，現在急診壅塞和長期醫療人力不足的問題其實已經罄竹難書了，說真的，其實各界都是一直在討論，都是想要幫政府集思廣益想一些辦法，提供一些正確的想法給政府，看什麼樣的作法可行，但是請問一下，衛福部為什麼現在都不願意買單，解決現在我們正在惡化的醫療現場呢？例如我們要重新檢討健保制度，落實醫療分級這方面，還有強化宣導輕症自我照護、小小病自我藥療的照護觀念，其實這些都是先進國家在做的國民健康政策，但是為什麼衛福部現在對這些意見都視而不見，甚至背道而馳呢？院長和部長你們看，其實你們知道衛福部從103年就開始推動自我照護，這些自我照護連續幾年都有出國考察，而且他們都是考察這些針對自我用藥、法規專家的會議，還有世界自我用藥年會的會議，一下子10年、11年就過去了，但是都沒有看到成效，所以健保財政的情況還是無解，而且現在還衍生出急診壅塞的問題。請教院長，你知道每年的7月24號是什麼日子嗎？"],["卓院長榮泰：7月24號？請委員指示。"],["林委員憶君：好，其實是WHO為了提倡自我照護觀念，將每年7月24號訂為國際自我照護日，就是說一週有7天，1天有24小時，其實它是鼓勵大家積極行動來改善我們自己，維護自我身心上面的健康。所以院長，最近那麼多急診塞爆的問題，其主要的原因，也是因為臺灣現在整體的醫療體系出問題然後失衡，還有人力不足，我相信你都知道的。","面對臺灣現在超高齡的社會來臨，在積極想要加入WHO的同時，我們要怎麼樣加強人民自我照護的意識，還有呼應WHO所提倡的自我照護觀念？我們要強化輕症病人的自我照護，避免輕症的這些病患湧入急診，才不會造成急診壅塞的問題，小小病就到藥局去，小病到診所或是到地區醫院，大病再到醫院，而且要落實整個轉診的制度，強化分級醫療，所以這個是讓醫療資源能夠用在真正急重症的上面，並不是全部的人一有問題都擠到大醫院裡面去，所以我覺得這個也是解決急診壅塞簡單的解方之一，也是解決健保財政虧損的方式之一，所以有時候我們對這些問題，我們可能要正視問題並想方法去解決。","歐洲自我照護產業，我發現2023年5月他們發布了一個調查報告，指出歐洲每年有12億例的小病痛，這些小病痛他們透過非處方藥的自我照護，不用到醫院，是到藥局去自我藥療，可以省下360億歐元醫藥上面的支出；美國也調查民眾的自我照護，可以為美國醫療省下1,670億美元的費用。健保署也有統計，國人只要減少1次就醫的情況，我們1年估計可以為健保省下340億元，所以表示自我照護、自我藥療這個觀念，其實對於節省珍貴健保資源是有非常顯著效益的。我想請教衛福部部長，你可以將自我照護明確的落實嗎？你是否同意呢？"],["邱部長泰源：謝謝委員的指教，自我照護跟分級醫療是我們這幾十年來政府一直在推動的。在一、二十年前侯勝茂當署長的時候，我是編「健康達人125」教導全國民眾怎麼樣自我照護的主編，當然過去多年來，我在醫療網裡面推動分級醫療，所以我非常敬佩委員提出的這兩個觀念，這個一定要去落實。","在民眾的照護方面，當然最好是能防病於未然，因此在我們「健康台灣」的工作上面，其實特別重視在前端的運動、營養、生活型態改善的宣導跟教育，我相信不管是哪一個醫事人員，尤其是社區的藥局，應該在這個部分可以一起來努力。再加上我們藥師同仁其實都有很好的臨床藥師的訓練，所以基本上對病人也有指示用藥的協助，應該可以共同來照護病人。","目前臺灣也在推動社區整合型的照護體系，裡面最重要的是一個家庭醫師的團隊，所謂家庭醫師不是只有醫師，藥師、物理治療師、職能治療師共同組成一個團隊，讓民眾在社區就有一個很堅強的團隊，有什麼問題就來看他，我相信這個就是分級醫療的第一點，也是我們臺灣很珍貴的家庭醫師整合型照護體系。未來我相信醫師、藥師、各種醫事人員這樣合作起來，一定可以落實分級醫療，也讓我們現在很頭痛的急診或醫院的壅塞可以得到很好的緩解，我們一起來努力，也感謝我們委員的指導。"],["林委員憶君：我覺得政府有很多這方面的政策其實都是很好的，包括轉診制度、分級醫療，還有自我藥療上面，但是一直都沒有落實，就是沒有落實，才會積到變成急診壅塞的問題，所以可能要麻煩部長要多費心一點。"],["邱部長泰源：是。"],["林委員憶君：好，接下來就是全民健康保險法的問題，第五十一條規定「指示藥品」也屬於不列入健保給付範圍的項目之一，是嗎？部長。"],["邱部長泰源：是的。"],["林委員憶君：所以我想請教一下院長和部長，既然你們都認為健保改革，我們同意要先從民眾的自我照護這個觀念開始，是不是應該利用部分比較安全無虞的藥品，把處方藥轉為指示用藥，還有加速指示藥退出健保，這樣我們才能解決健保藥價的黑洞，然後也解決了以藥養醫的弊病。","而且部長，你知道審計部針對現在841項非屬健保規定給付的指示用藥仍未退出健保給付的問題，提出了一個總決算的審核報告，112年度中央政府總決算的審核報告指出：有841項指示用藥列入給付的範圍；檢討進度太慢了，要求衛福部宜督促落實檢討指示用藥給付的允適性，以提高健保資源利用的效率。我們現在簡單的說，也就是指示用藥列入健保給付的範圍，占健保給付藥物比例達到27.3%，意思是指健保給付的藥物中有四分之一的項目是違法給付，更耗費了20億的公帑。所以請問一下院長，衛福部是不是應該要根據審計部審核的報告意見提出檢討改善方案，落實全民健康保險法第五十一條的規定，指示藥品也是屬於不列入健保給付範圍之一的項目？請問何時可以給出改善的方案，何時可以落實？"],["邱部長泰源：謝謝委員的指教，我想不管是健保署或者是食藥署，針對我們的指示用藥都非常用心，也會依照審計部或相關單位的要求來改善，對於處方藥品長期使用經驗上……"],["林委員憶君：安全無虞的藥品。"],["邱部長泰源：處方藥物如果具有安全性，用於緩解輕症且至少有3個醫藥先進國家以指示藥品在管理者，經食藥署評估並邀集醫藥等領域專家共同討論後得轉列為指示藥品……"],["林委員憶君：剛才部長你說有幾個國家？"],["邱部長泰源：其實一直都在努力啦！"],["林委員憶君：3個國家而已嗎？"],["邱部長泰源：至少有3個醫藥先進國家以指示藥品……"],["林委員憶君：好，至少3個。我還有一個問題要問，你先回答這一個。"],["邱部長泰源：好，這個部分我會一直努力，這幾年來，我想委員也知道……"],["林委員憶君：其實指示藥退出健保是因為我們怕健保的財政受到虧損，現在健保署也不好做，我們希望……"],["邱部長泰源：對，另外，當然我們要考慮到人民用藥的方便性……"],["林委員憶君：是。"],["邱部長泰源：所以在醫藥跟人民當中，我們當然以人民為優先……"],["林委員憶君：對，剛才我是一整串的問題……"],["邱部長泰源：我們本來就是為了人民而存在的……"],["林委員憶君：對，一整串的問題是有連貫性的。"],["邱部長泰源：以人民的權益為優先之下，醫藥共同商討，我想都可以解決。"],["林委員憶君：對，就是安全無虞的處方用藥儘量先退成指示用藥，成為指示用藥的話，再來退出健保給付。"],["邱部長泰源：是，這個都有一直在往前走，謝謝委員指教。"],["林委員憶君：好。剛才部長有提到3個國家的問題，這就是下一個問題，為了不讓健保財政一直在虧損中，非必要的醫生處方藥是不是要轉為指示用藥？剛才部長還說是3個國家。像緊急事後避孕藥，現在我們先來講這個，確保女性的生育的自主權，讓女性把握緊急避孕的機會，部長也是醫生，也知道這種藥有黃金的時間，可能12小時、72小時以內一定要服用的。"],["邱部長泰源：是。"],["林委員憶君：有時候到診所、醫院去，或許大家在休診，也都有可能，可能會錯過了這個時間，而且為確保女性生育的自主權，現在是想生的卻不能生，但是針對非自願的、不想生的、要避孕的，衛福部會不會管太多了？","部長，上會期我已經有請教過你了，衛福部要正視女性的自主權和用藥權益，對緊急事後避孕藥要開放變更為指示藥品，確保女性生育的自主權，但是衛福部都沒有給本席一個回應。我現在是說，剛才有談到3個國家，現在全球已經有88個國家將事後避孕藥列為非處方用藥了，而且2023年日本也可以在社區藥局販賣緊急避孕藥，其實這個我們現在還沒有做到對不對？","根據WHO的報告，將事後避孕藥轉成非處方藥是讓女性方便取得這個藥物，不僅可以減少女性因為懷孕而面臨的風險，也可以降低因意外懷孕所帶來社會還有經濟上面的負擔。現在知名的女權團體在2024年10月有對於事後避孕藥是否開放做了一個線上的調查，結果有六成五的民眾支持開放，與2016年調查的七成支持幾乎一致！而且希望可以方便及時取得，在藥局即可購買，還有提高女性自主。","針對這個問題，我想部長應該很重視。我去看過，2016年有針對這個問題討論過，將處方藥改成民眾可以在藥局購買的指示用藥，並獲得衛福部通過，發布緊急事後避孕藥變更為指示藥品的說明。據本席了解，指示藥品成藥組已經開會討論過，將緊急事後避孕藥從醫生處方藥轉列為指示用藥，並在會議中做成會議紀錄，為什麼食藥署到現在還在說醫生團體仍在評估，還沒有共識呢？部長，為什麼衛福部的政策會擱置到現在還沒有共識？這不是在2016年早就有共識了嗎？還是有人不同意？是不是有人刻意去修改整個會議紀錄？衛福部要不要調查一下當時的情況？我是這樣看的，也就是在會議背後有一隻看不到的手，所以我想請部長針對這個問題去了解一下2016年時所發生的事情！你身為醫生，醫者仁心，我拜託你，千萬不要讓女性的生育自主權被剝奪了！政府現在不是在營造友善的生育環境嗎？所以是不是要讓女性能夠安心，且能自由地選擇何時要懷孕？我想這也是政府的重要責任。"],["邱部長泰源：報告委員，謝謝委員的指教。有關事後避孕藥轉列為非處方藥品管理的議題，如同剛剛您所說的，從2016年開始就有討論，我在擔任立委期間也開過不少次的協調會議，正因為醫、藥有不同看法。不管是醫或藥，都是為人民的權益在努力，所以我個人都非常感動。但因為有不同的專業看法，且涉及的層面比較廣泛，故有一些醫事團體、專業團體，尤其是照顧婦女懷孕生產的科別對這部分很有意見……"],["林委員憶君：部長，你剛才講3個國家同意，其實現在已經有88個國家了，臺灣要不要跟國際接軌？我們要走倒退路嗎？"],["邱部長泰源：事後避孕藥還是一種荷爾蒙，還是會影響到人體的……"],["林委員憶君：現在都是醫界在擋，不是嗎？明明在國際上已經有88個國家都這樣做了，對不對？部長，你不能不公啊！現在全部成員都是醫生，這樣是不是太不公了？"],["邱部長泰源：食藥署……"],["林委員憶君：你要為全國民眾想，為全部女性的自主權想，對不對？這是他們生育的自主權，大家都等著你們！"],["邱部長泰源：我們會持續溝通……"],["林委員憶君：你先去看看是不是有人竄改2016年時的會議紀錄？"],["邱部長泰源：我們會去了解。本部食藥署將於114年3月6日召開緊急事後避孕藥丸轉為醫師、藥師……"],["林委員憶君：現在整個會議成員全部都是醫生，請問一下，這樣怎麼會公平呢？"],["邱部長泰源：……之可行性，我們一定會平衡地來討論……"],["卓院長榮泰：報告委員，這讓部長好好去協調。從醫藥分業之後，我們的醫藥關係一直是在比較緩和、和諧的狀況……"],["林委員憶君：是，院長，沒錯，但是安全無虞的藥品我已經在……"],["卓院長榮泰：比較合理地使用……"],["林委員憶君：這是安全無虞的藥品，這東西已經安全無虞，且有88個國家已經這樣做了，只有臺灣沒有這樣做！"],["卓院長榮泰：我要求部長儘快跟醫界、藥界達成共識，讓大家能夠在安全無虞且合理使用的狀況下。但我也要請委員能夠支持，因為委員的專業非常注重健保。今年是健保三十年，我常說健保三十年保障國人健康，現在是我們回頭保障健保的時代。三十年前我就一直主張，小病不用保，大病沒煩惱！"],["林委員憶君：是。"],["卓院長榮泰：小病集中到醫學中心去，用那麼少的代價、自付額就能夠得到醫療，所以應該讓他到診所去，讓他完全負擔……"],["林委員憶君：這就是落實分級醫療……"],["卓院長榮泰：分級醫療，轉診制度。"],["林委員憶君：沒錯！"],["卓院長榮泰：如果我們的觀念能夠轉過來，小病不用保，大病就沒煩惱，讓那個可以傾家蕩產的病，政府來全力照顧他，讓那個會影響到整個公共衛生的病，政府全力來遏止它，政府應該要做這個東西，小病則由大家自己來做……"],["林委員憶君：是，沒錯。"],["卓院長榮泰：另外，我們內、外、婦、兒這四科醫事人員減少的問題，大家的觀念也必須要轉變，我們要落實不同工不同酬的醫療給付，讓醫院醫事人員的工作尊嚴能夠得到保障，如果這個觀念能夠重新的建立，我們可以再創30年、50年更好的健保制度，所以是不是大家有這樣的責任來面對健保的實質改革，而不是在討論錢多錢少、該不該提保費的問題，我們從基本上來討論。"],["林委員憶君：沒錯啊，所以我覺得大家的政策、大家的想法都是正確的，但是完全沒有落實啊！對不對？"],["卓院長榮泰：因為這……"],["林委員憶君：剛才院長講的也對，部長講的也對，我們想的都對嘛，都是往前進嘛，對不對？"],["卓院長榮泰：如果大家有這樣的共識，我們還要持續跟社會對話。我剛剛說內、外、婦、兒這四科的醫事人員很難找，但是如果能夠讓它建立……"],["林委員憶君：所以衛福部要想出方法啊！要怎麼樣來落實啊……"],["卓院長榮泰：但是這個不能，因為這個會增加這方面實質上的支付，所以我們還要平衡，希望做到小病不用保、大病沒煩惱，然後從內、外、婦、兒不同工不同酬的給付開始。我想社會上如果能將這個觀念建立起來，也許剛開始會遭受很多很多的討論，但是我相信提出這樣的討論對社會是正面的。"],["林委員憶君：院長，其實也不是提出這樣的討論，這個事情已經做很久了，我想部長也知道，只是沒有做得很澈底、沒有做得很成功……"],["卓院長榮泰：那我們澈底來實施。"],["林委員憶君：對，所以我覺得我們還是要用心在這一塊啦，好不好？"],["邱部長泰源：好。"],["卓院長榮泰：有些修法的部分可能要有共識才能來進行啦。"],["林委員憶君：這個已經在實施了，只是沒有落實。"],["邱部長泰源：對於自我照護跟分級醫療，我們一定繼續來推，至於醫藥方面，在某些專業的互動，我們也一定持續來溝通，醫藥本是一家，要攜手共同來照顧人民的健康，我們一起來努力。"],["林委員憶君：好，謝謝。"],["邱部長泰源：也謝謝委員的期許跟指教。"],["林委員憶君：好，謝謝部長。","接下來有請交通部長。因為我的發言時間所剩不多，我還是儘快講一下。","院長，你知道0403強震及凱米颱風重創了花蓮的觀光，業者一直覺得去年是從業30年來最慘的一年，地震發生後，花蓮的旅宿跟餐飲業都停業上百家了，在這裡本席還是持續關心花蓮的觀光及交通，因為對花蓮來講，最重要的就是要怎麼樣活下去嘛。去（113）年花蓮遊客是近5年來最低的，比起前一年的112年下降了一半。我想院長也是很認真，當初你都有允諾說每個月要去花蓮勘查整個情況，所以我想院長應該很了解花蓮現在的困境是什麼。","很感謝院長為了振興花蓮的觀光而努力，在去年0403地震後，為了振興花蓮的觀光產業，我們也放寬了公務人員國旅卡休假補助費的措施，請問去年的實施情況如何呢？我想應該是成效不佳吧，因為現在花蓮的店家和民眾還是無感啊！光是以觀光人數來說，從街道上的觀光客就可以看得出來，其實觀光人數是非常非常的少，而且非常非常的慘淡。院長，為什麼只有實施到去年，今年就沒有補助了呢？還是你們在今年有更好的規劃呢？還是有什麼特別加碼的規劃，可以振興我們花蓮的觀光？"],["卓院長榮泰：我先簡單向委員說，不敢說認真兩個字，這是我們團隊應該做的事情。很遺憾的是去年0403之後，7月有好幾次的颱風，導致我們的工程進行到一個程度就必須停下來，甚至往後延，颱風讓很多觀光客又卻步了，這是我們感到非常遺憾的事情。我們總是希望所有的補助措施能夠澈底的落實，有些執行……"],["林委員憶君：請問今年會不會再繼續補助呢？"],["卓院長榮泰：像去年執行不好的部分，我們就把它加碼、放寬，今年交通部也有其他緊急計畫在執行，我請部長來說明。"],["林委員憶君：好。"],["陳部長世凱：報告委員，確實去年花蓮因為地震再加上好幾個颱風，對觀光業的影響非常大，您也非常關心交通建設的問題，目前交通尚稱穩定，最近比較沒有太大的雨，所以在尚稱穩定的狀況下，其實花蓮的觀光在11月份已經漸漸回到112年的水準，也就是說已經有復甦的狀況。去年主要是因為0403的地震，所以做比較大幅度的補助……"],["林委員憶君：沒關係，我想知道有沒有更好的規劃來振興花蓮的觀光，有沒有什麼加碼的政策，還是有做一個更好的規劃？我要先知道這點，因為我後面還有一些問題要問。"],["陳部長世凱：報告委員，去年因為地震的原因，所以用一個救急的方案來補助，有補助的方案。但是我剛剛有提到，現在觀光的狀況已經比較穩定了，所以我們大概不會用……"],["林委員憶君：可是我們的情況還是很慘澹，很多店家都關了，我想院長，你每個月不是有到花蓮去嗎？你可以到那個最主要的街道去看一下吧。"],["陳部長世凱：但是我們11月、12月之後看到的數據比較好……"],["卓院長榮泰：現在除了剛剛委員說的僑委會有這樣的方式之外，去年年底我們副院長還主持了觀光的諮詢會議，也召集了業者，大家也提出了相關的問題，至於僑委會是不是有這樣一個計畫，讓回臺的臺僑、臺商能夠到花蓮去看看漂亮的臺灣……"],["林委員憶君：對，我想僑胞回臺的時候，他們應該會需要，可不可以結合？"],["徐委員長佳青：報告委員，我們去年確實也有加碼在針對僑胞慶典返國的時候，本來我們一般都補助3,000塊，如果特別到花東去旅遊的，我們就補助3,600塊，這樣子做當然多少有增加一些誘因，不過……"],["林委員憶君：那成效怎麼樣呢？"],["徐委員長佳青：不過如同剛剛交通部所報告的，因為去年一直不斷有颱風跟地震的因素影響，所以最終真的去到花東旅遊的人數……"],["林委員憶君：那我想請問一下，今年會不會再有補助？今年還會再有嗎？"],["徐委員長佳青：今年我們會繼續比照。對，就是多增加我們的花東觀光特約商店，以及再增加一樣3,600元的補助，這個我們會來持續。"],["林委員憶君：好，那今年就是還會有，然後做更好的規劃，然後再加碼，好不好？"],["陳部長世凱：另外再跟您補充一下，現在我們有香港飛花蓮的班機，也是一個包機補助28萬，這個部分有在努力。另外院長也有特別交代，我們希望禮拜一到禮拜天，每一天都有臺北飛花蓮的班機，這個部分也已經在進行當中，所以禮拜一到禮拜天，每一天都有班機飛臺北到花蓮。"],["林委員憶君：好。OK，我再問部長一個問題，就是有關於花蓮鐵路高架化的交通問題。臺灣的東部，在花蓮市和吉安鄉這邊，有7個平面的平交道穿越花蓮市和吉安鄉的鬧區，針對這部分，之前引發民怨的情況下，據我了解，這個計畫來來回回的修了好幾次，而且112年4月的時候，當時前交通部長已經同意了，將花蓮站和干城站7個鐵路平交道的高架立體化工程納入花東地區鐵路雙軌電氣化計畫中辦理，並且全額負擔。那時候我看到的是4,562億餘元，編到哪就做到哪，然後114年編了600億。我想請問一下，現在臺鐵花蓮和吉安干城站的高架工程，哪時候可以規劃動工呢？而且據我最近了解，我也覺得很奇怪，就是目前計畫書送到行政院也石沈大海音訊全無，是不是改以鐵路平交道與環境改善設施的周邊土地的計畫審查要點審查，就是中央已經不全額負擔費用了。","我想請教一下院長，中央不全額負擔的原因是什麼？而且目前計畫書是不是已經送到行政院了？如果到行政院的話，可以加速審核嗎？"],["陳部長世凱：報告委員，您剛剛所提的高架化的部分，目前因為它的合理性我們還有一些質疑，因為其他縣市的高架化不是放在雙軌電氣化計畫內……"],["林委員憶君：但是112年4月的時候……"],["陳部長世凱：是。"],["林委員憶君：前交通部長王國材就正面回應了，他說這個他會全部列入，而且答應全額負擔。不要騙我們花蓮人啦！"],["陳部長世凱：但是我們在審議的過程中，確實有不一樣的意見，在審議的過程確實有不一樣的意見。"],["林委員憶君：對啊，但是你們這樣是不是欺騙我們花蓮人？"],["陳部長世凱：這個不是欺騙，跟其他縣市都一樣的標準。"],["林委員憶君：當初已經答應了啊。"],["卓院長榮泰：我們花蓮列為東部的慢活城鄉，我們會整個來規劃，如何讓它展現慢活的生活品質，好不好？"],["林委員憶君：謝謝院長，院長，你要多注重我們花蓮的一些建設啦。"],["卓院長榮泰：好。謝謝。"],["主席：謝謝林憶君委員的質詢，謝謝卓院長的備詢。","接下來我們請莊瑞雄委員質詢。"]],"agenda":{"page_end":100,"meet_id":"院會-11-3-3","speakers":["韓國瑜","黃捷","柯志恩","張啓楷","賴惠員","林德福","林憶君","莊瑞雄","黃仁","何欣純","徐欣瑩"],"page_start":31,"meetingDate":["2025-03-04"],"gazette_id":"1142402","agenda_lcidc_ids":["1142402_00002","1142402_00003"],"meet_name":"立法院第11屆第3會期第3次會議紀錄","content":"施政質詢\n對行政院院長提出施政方針及施政報告繼續質詢─ 繼續質詢─","agenda_id":"1142402_00003"}}}