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\"努\", \"start\": 843.244, \"end\": 843.424, \"score\": 0.994}, {\"word\": \"力\", \"start\": 843.424, \"end\": 843.924, \"score\": 0.895}, {\"word\": \"好\", \"start\": 843.924, \"end\": 845.506, \"score\": 0.883}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"委\", \"start\": 845.506, \"end\": 845.746, \"score\": 0.84}, {\"word\": \"員\"}, {\"word\": \"的\", \"start\": 845.746, \"end\": 845.866, \"score\": 0.871}, {\"word\": \"指\", \"start\": 845.866, \"end\": 846.006, \"score\": 0.941}, {\"word\": \"教\", \"start\": 846.006, \"end\": 846.126, \"score\": 0.921}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"好\", \"start\": 846.126, \"end\": 846.146, \"score\": 0.001}], \"language\": \"zh\"}","srt":"1\n00:00:03,434 --> 00:00:07,239\n謝謝主席已經開始了好謝謝請部長好請我們邱部長\n\n2\n00:00:21,788 --> 00:00:39,797\n在前一陣子可能在二月那時候其實我也接到很多基層醫療就是民眾到醫院然後在急診那邊等非常的久或者是這個在急診然後要進到病房那也等非常久等了很多天\n\n3\n00:00:41,678 --> 00:01:04,543\n這個時候我們就會覺得說其實我們台灣就是一直會覺得說台灣的這個醫療做得很好那為什麼在這一兩年當中大家會覺得好像整個有一些狀況那我們也看到就是說在去年的時候我們去年7月我們也有一個就是護理人力的政策準備中長程的計畫\n\n4\n00:01:05,763 --> 00:01:19,569\n那這個計畫下來之後其實有一些護理人員覺得蠻開心那有的人會有一些抱怨也有一些反彈那我們也看到就是說原本你們今年又編列了這個47億\n\n5\n00:01:21,890 --> 00:01:48,908\n就不分醫院層級然後病房類別擴大給負啦那這個部分我原本一直認為就是說應該是從1月份應該是從1月份就會開始可是好像到現在這些護理人員好像也也還沒有收到這樣的一個給付那我想請教部長這個到底是怎麼回事報告委員我想預算程序如果完成\n\n6\n00:01:50,782 --> 00:01:54,205\n我們就要趕快立即發來現在已經是三月份了因為現在整個預算程序要立好那你們什麼時候提出解凍整個會計程\n\n7\n00:02:11,375 --> 00:02:26,349\n現在呼籲嘛可能要看整個settledown看預算預算有多少當然要解凍的就盡量來解凍請大家幫忙那有些可能被刪的各方面\n\n8\n00:02:27,029 --> 00:02:50,198\n我們做整體一旦確定以後我們追溯到1月馬上來發是所以大家放心啦當然啊當然你從從1月份原本這個從1月份到現在3月了這個會讓很多護理人員會覺得說那我們衛福部就嘴巴說說而已啊實際上也沒有拿到啊\n\n9\n00:02:51,498 --> 00:03:06,473\n我是認為就是說部長針對這一部分如果說需要委員會這邊來協助或者是你們還需要提出這個譬如說可以有一部分可以解凍的話那是不是趕快來進行這樣的一個程序\n\n10\n00:03:08,081 --> 00:03:20,299\n是解凍是一回事感謝委員會幫忙那這是整個會計程序我剛剛有報告過嘛你整個國家總預算的確定以後才會動啊\n\n11\n00:03:22,528 --> 00:03:50,990\n所以我們也希望能夠趕快有確定那昨天也才做一個預算呼籲的處理而已所以部長就是說我們現在為什麼基層醫療院所會有這樣的一個問題其實有很多會覺得說可能護理人力的不足然後有的是關床就是說關床那這個是最大的原因嗎就是說護理人力不足然後關床\n\n12\n00:03:51,610 --> 00:04:15,775\n然後造成可能急診要進到病房就是大塞車這個是最主要的原因嗎當然整個醫療環境都有影響譬如說我們在分級分流有沒有落實那才不會增加急診不必要的壓力人力所以這個的確是未來長期要去要去努力的那個\n\n13\n00:04:20,097 --> 00:04:28,621\n那護理人力的一個職場的環境跟護理人力的不足就是我們大家都知道的事情而且一直在努力\n\n14\n00:04:30,959 --> 00:04:57,365\n需要的人更多但是我們在12項的一個策略努力之下的確在去年的12頁到去年的1頁其實我們也增加了3000多位的婦女同仁雖然最近看起來聽說好像有比較多離子因為最近過年後一般都是離子的一個巔峰等開學以後就是說畢業以後又是一個進來的一個這樣\n\n15\n00:05:00,259 --> 00:05:24,434\n加減起來總是去年也多了3800個但是真的還不夠不但人數我們要加強人數加強我們在互併比的達標會更快我們的工作同仁的壓力也會工作的負荷也會比較輕所以怎麼樣去加強護理人類的留任或者引進是非常重要的課題\n\n16\n00:05:25,216 --> 00:05:47,444\n沒錯那部長我想請教就是說我們一直在提到除了讓所有的這個護理人員可能有這個津貼之外那怎麼樣讓這個分級醫療的這個部分那我想請教部長就目前你認為我們的這個分級醫療做得如何\n\n17\n00:05:49,752 --> 00:06:06,389\n分級醫療其實從民國76年開始我們在做醫療網的時候就是分級醫療那後來當然因為醫院一直蓋所以醫院的立場會覺得分級醫療他們比較不那麼努力在推行是\n\n18\n00:06:06,809 --> 00:06:27,195\n那加上我們的民眾還是比較於傾向使用大醫院好像比較安心部長你們要怎麼去讓民眾更了解就是說要有分級醫療的這樣的一個觀念重病或者是有時候也不能用強迫因為一定要讓民眾說我去看基層醫療點頭比較安心點頭得到很好的照顧\n\n19\n00:06:34,557 --> 00:06:57,525\n我去醫學中心等很久很難掛號等很久看一看就說你這個可能不是我的科要掛另外一科你又要等兩個禮拜這樣真的會比較對病人是情何以堪可是如果你在你的社區就有舌悉的診所或最好是有建立關係的一個家庭醫師製作\n\n20\n00:06:58,925 --> 00:07:17,057\n那你隨時任何問題包括打電話都可以我們現在有社區醫療群社區醫療群就是有一群家庭醫師24小時你有什麼事情只要打個電話一定幫你做處理大家要善用所以你覺得目前分級醫療做得如何\n\n21\n00:07:20,646 --> 00:07:30,602\n一定要大大的加強所以是不滿意從我的角度我是不滿意那如果不滿意的話要怎麼如何加強\n\n22\n00:07:32,621 --> 00:08:00,400\n你一方面宣導嘛另外一方面我也知道就是說我們這個衛福部期望就是醫學中心下轉可能就是說病情穩定的這個慢性病人到基層診所可是我們也看到就是說今年的這個基層的這個總額就是已經確定這個總額這個總預算了嘛那如果說要診所收治更多的這個病人那勢必應該會稀釋掉這個點子\n\n23\n00:08:03,002 --> 00:08:16,656\n好這個點子如果更多病人進來嗎基層診所更多病人進來那可能這個點子就會被稀釋掉那這樣子的話你又要如何去確保就是說這個基層診所是能夠接住病人的所以我\n\n24\n00:08:17,957 --> 00:08:44,387\n覺得就是說部長可能針對這一部分我們又要希望就是說醫學中心這個可能就是做急重難函症的這些病患那希望這個比較輕症可能就到基層醫療院所去那怎麼樣去讓這個分級做得更徹底分級醫療做得更徹底我覺得這個應該也是我們目前要去做的一個課題\n\n25\n00:08:46,069 --> 00:09:01,534\n感謝委員這個非常宏觀的來分析我們整個未來應該要走的走向那我們所有的政策都盡量讓民眾很自然的就變成分級的醫療第一個我們讓民眾有他信心的家庭醫師\n\n26\n00:09:02,714 --> 00:09:24,492\n第二個我們也提高在集中症大醫院裡面集中症的給護我想這個部分在那個實施廠的努力之下也都有很好的成果那今年是一個非常好的機會來實行分級醫療因為今年在政府的幫忙之下以及大家努力之下我們今年的總額是\n\n27\n00:09:26,254 --> 00:09:49,081\n提升很多單單健保的總額就提升500多億當然這裡面也有蠻多部分會在基層所以基層的醫療密集度這個部分的經費會比較多也就是說不怕接病人其實今年是一個很好的機會所以今年如果能夠利用這個錢比較就是說經費比較多的情況之下總共用在健保的700多億包括我們\n\n28\n00:09:50,641 --> 00:10:00,507\n讓基層醫療能夠多做一些預防保健的工作病人下來給他前人的一個照顧然後應該幾戶的譬如說我們的政府也讓成縣\n\n29\n00:10:04,158 --> 00:10:24,298\n可能二十年來沒有增加大家都陪在立場做的這次要加倍幾乎所以你所講的如果說今年預算比往年還多的話我覺得有一些政策我覺得應該要趕快去做而且是要積極的去推動\n\n30\n00:10:24,938 --> 00:10:43,459\n比如說分級醫療的這個部分如果往年做的不是那麼好的話那是不是你覺得說預算有增加那如何鼓勵基層醫療院所或者是這個醫學中心下轉這個可能慢性病的這個患者或是比較輕症的患者下轉我覺得應該也要有一些誘因\n\n31\n00:10:44,881 --> 00:11:10,304\n一方面也要讓所有的這個民眾知道就是我大病可能我這個急症或這個大病可能就到這個醫學中心那其他感冒一般的這個不是那麼嚴重的話可能就到診所或者到地區醫院區醫院就可以了我覺得這個應該也要再再去落實啦要不然我覺得每一年尤其是在過年前後每一次看到可能就\n\n32\n00:11:11,746 --> 00:11:29,247\n就是醫院可能擠爆一方面可能也當時可能這個時候就是流感或者是像今年的話也許是流感或者是諾蘿病毒那也會造成整個這個醫院可能人力不足那怎樣好讓這個大醫院的部分醫學中心這個\n\n33\n00:11:31,169 --> 00:11:48,858\n能夠專心在他們的這個急重難喊症那其他比較輕症或者是比較慢性病的話可能就下轉到其他醫院我覺得這個應該也是我們衛福部如果說今年你覺得預算有比較餘裕的話我覺得應該要有一些誘因然後趕快把這個分級醫療趕快落實\n\n34\n00:11:50,279 --> 00:12:04,367\n好,非常感謝,真的很敬佩我們的委員,對這整個醫療體系的了解跟左右的見解這就是我們今年會努力去做的方向那我們也一定努力讓我們明年不要再發生\n\n35\n00:12:05,387 --> 00:12:25,349\n那個急診太辛苦的一個情況分級醫療今天是一個大好的時機部長最後一個問題就是說之前卓院長有在這個這個巡打的時候有特別提到就是說三班互併比目前還是以獎勵為主那我想請教一下部長你的意見是怎樣\n\n36\n00:12:27,839 --> 00:12:52,551\n我想這個十二項政策是一直聯繫的政策那目前我如果站在醫療的立場那個當然就是希望說我護理人力能夠充足充足我當然就希望讓他達到哪一個醫院長不希望達到護病比但是不能因為人力不足然後又要求到某些制度而讓床沒辦法開\n\n37\n00:12:54,052 --> 00:13:13,211\n我想這個部分的中間永遠一個政策是要他利弊得失共同坐下來談我們衛福部一定跟醫院來針對這個部分當然要跟護理界一直來溝通那我相信至少我們在三班負面筆的努力之下我們在醫學中心已經從36%的\n\n38\n00:13:14,973 --> 00:13:39,347\n三班都達到的已經變成59%區議院從26%已經變成49%在地區議院已經從83%達標三個都達到94%所以我們獎勵其實也是一個讓大家可以做得到的一個方向那將來當更成熟我們人力更多的時候我想就自然水到其層\n\n39\n00:13:40,187 --> 00:14:06,146\n好謝謝我們希望就是說不要再看到就是說這個醫療機構可能整個那個病患可能就全部都塞在急診室我覺得這個是我們不希望看到的啦對我們一定從整個醫療體系的改變區域的防守或者是分級分流這個部分也要來努力好謝謝委員的指教謝謝好\n\n","tsv":"start\tend\ttext\n3434\t7239\t謝謝主席已經開始了好 謝謝 請部長好 請我們邱部長\n21788\t39797\t在前一陣子可能在二月那時候其實我也接到很多基層醫療就是民眾到醫院然後在急診那邊等非常的久或者是這個在急診然後要進到病房那也等非常久等了很多天\n41678\t64543\t這個時候我們就會覺得說其實我們台灣就是一直會覺得說台灣的這個醫療做得很好那為什麼在這一兩年當中大家會覺得好像整個有一些狀況那我們也看到就是說在去年的時候我們去年7月我們也有一個就是護理人力的政策準備中長程的計畫\n65763\t79569\t那這個計畫下來之後其實有一些護理人員覺得蠻開心那有的人會有一些抱怨也有一些反彈那我們也看到就是說原本你們今年又編列了這個47億\n81890\t108908\t就不分醫院層級然後病房類別擴大給負啦那這個部分我原本一直認為就是說應該是從1月份應該是從1月份就會開始可是好像到現在這些護理人員好像也也還沒有收到這樣的一個給付那我想請教部長這個到底是怎麼回事報告委員我想預算程序如果完成\n110782\t114205\t我們就要趕快立即發來現在已經是三月份了因為現在整個預算程序要立好那你們什麼時候提出解凍整個會計程\n131375\t146349\t現在呼籲嘛可能要看整個settle down 看預算 預算有多少當然要解凍的就盡量來解凍 請大家幫忙那有些可能被刪的各方面\n147029\t170198\t我們做整體一旦確定以後我們追溯到1月馬上來發是所以大家放心啦當然啊當然你從從1月份原本這個從1月份到現在3月了這個會讓很多護理人員會覺得說那我們衛福部就嘴巴說說而已啊實際上也沒有拿到啊\n171498\t186473\t我是認為就是說部長針對這一部分如果說需要委員會這邊來協助或者是你們還需要提出這個譬如說可以有一部分可以解凍的話那是不是趕快來進行這樣的一個程序\n188081\t200299\t是 解凍是一回事 感謝委員會幫忙那這是整個會計程序 我剛剛有報告過嘛你整個國家總預算的確定以後才會動啊\n202528\t230990\t所以我們也希望能夠趕快有確定那昨天也才做一個預算呼籲的處理而已所以部長就是說我們現在為什麼基層醫療院所會有這樣的一個問題其實有很多會覺得說可能護理人力的不足然後有的是關床就是說關床那這個是最大的原因嗎就是說護理人力不足然後關床\n231610\t255775\t然後造成可能急診要進到病房就是大塞車這個是最主要的原因嗎當然整個醫療環境都有影響譬如說我們在分級分流有沒有落實那才不會增加急診不必要的壓力人力所以這個的確是未來長期要去要去努力的那個\n260097\t268621\t那護理人力的一個職場的環境跟護理人力的不足就是我們大家都知道的事情而且一直在努力\n270959\t297365\t需要的人更多但是我們在12項的一個策略努力之下的確在去年的12頁到去年的1頁其實我們也增加了3000多位的婦女同仁雖然最近看起來聽說好像有比較多離子因為最近過年後一般都是離子的一個巔峰等開學以後就是說畢業以後又是一個進來的一個這樣\n300259\t324434\t加減起來總是去年也多了3800個但是真的還不夠不但人數我們要加強人數加強我們在互併比的達標會更快我們的工作同仁的壓力也會工作的負荷也會比較輕所以怎麼樣去加強護理人類的留任或者引進是非常重要的課題\n325216\t347444\t沒錯那部長我想請教就是說我們一直在提到除了讓所有的這個護理人員可能有這個津貼之外那怎麼樣讓這個分級醫療的這個部分那我想請教部長就目前你認為我們的這個分級醫療做得如何\n349752\t366389\t分級醫療其實從民國76年開始我們在做醫療網的時候就是分級醫療那後來當然因為醫院一直蓋所以醫院的立場會覺得分級醫療他們比較不那麼努力在推行是\n366809\t387195\t那加上我們的民眾還是比較於傾向使用大醫院好像比較安心部長你們要怎麼去讓民眾更了解就是說要有分級醫療的這樣的一個觀念重病或者是有時候也不能用強迫因為一定要讓民眾說我去看基層醫療點頭比較安心點頭得到很好的照顧\n394557\t417525\t我去醫學中心等很久很難掛號等很久看一看就說你這個可能不是我的科要掛另外一科你又要等兩個禮拜這樣真的會比較對病人是情何以堪可是如果你在你的社區就有舌悉的診所或最好是有建立關係的一個家庭醫師製作\n418925\t437057\t那你隨時任何問題包括打電話都可以我們現在有社區醫療群社區醫療群就是有一群家庭醫師24小時你有什麼事情只要打個電話一定幫你做處理大家要善用所以你覺得目前分級醫療做得如何\n440646\t450602\t一定要大大的加強所以是不滿意從我的角度我是不滿意那如果不滿意的話要怎麼如何加強\n452621\t480400\t你一方面宣導嘛另外一方面我也知道就是說我們這個衛福部期望就是醫學中心下轉可能就是說病情穩定的這個慢性病人到基層診所可是我們也看到就是說今年的這個基層的這個總額就是已經確定這個總額這個總預算了嘛那如果說要診所收治更多的這個病人那勢必應該會稀釋掉這個點子\n483002\t496656\t好這個點子如果更多病人進來嗎基層診所更多病人進來那可能這個點子就會被稀釋掉那這樣子的話你又要如何去確保就是說這個基層診所是能夠接住病人的所以我\n497957\t524387\t覺得就是說部長可能針對這一部分我們又要希望就是說醫學中心這個可能就是做急重難函症的這些病患那希望這個比較輕症可能就到基層醫療院所去那怎麼樣去讓這個分級做得更徹底分級醫療做得更徹底我覺得這個應該也是我們目前要去做的一個課題\n526069\t541534\t感謝委員這個非常宏觀的來分析我們整個未來應該要走的走向那我們所有的政策都盡量讓民眾很自然的就變成分級的醫療第一個我們讓民眾有他信心的家庭醫師\n542714\t564492\t第二個我們也提高在集中症大醫院裡面集中症的給護我想這個部分在那個實施廠的努力之下也都有很好的成果那今年是一個非常好的機會來實行分級醫療因為今年在政府的幫忙之下以及大家努力之下我們今年的總額是\n566254\t589081\t提升很多 單單健保的總額就提升500多億當然這裡面也有蠻多部分會在基層所以基層的醫療密集度這個部分的經費會比較多也就是說不怕接病人其實今年是一個很好的機會所以今年如果能夠利用這個錢比較就是說經費比較多的情況之下總共用在健保的700多億包括我們\n590641\t600507\t讓基層醫療能夠多做一些預防保健的工作病人下來給他前人的一個照顧然後應該幾戶的譬如說我們的政府也讓成縣\n604158\t624298\t可能二十年來沒有增加大家都陪在立場做的這次要加倍幾乎所以你所講的如果說今年預算比往年還多的話我覺得有一些政策我覺得應該要趕快去做而且是要積極的去推動\n624938\t643459\t比如說分級醫療的這個部分如果往年做的不是那麼好的話那是不是你覺得說預算有增加那如何鼓勵基層醫療院所或者是這個醫學中心下轉這個可能慢性病的這個患者或是比較輕症的患者下轉我覺得應該也要有一些誘因\n644881\t670304\t一方面也要讓所有的這個民眾知道就是我大病可能我這個急症或這個大病可能就到這個醫學中心那其他感冒一般的這個不是那麼嚴重的話可能就到診所或者到地區醫院區醫院就可以了我覺得這個應該也要再再去落實啦要不然我覺得每一年尤其是在過年前後每一次看到可能就\n671746\t689247\t就是醫院可能擠爆一方面可能也當時可能這個時候就是流感或者是像今年的話也許是流感或者是諾蘿病毒那也會造成整個這個醫院可能人力不足那怎樣好讓這個大醫院的部分醫學中心這個\n691169\t708858\t能夠專心在他們的這個急重難喊症那其他比較輕症或者是比較慢性病的話可能就下轉到其他醫院我覺得這個應該也是我們衛福部如果說今年你覺得預算有比較餘裕的話我覺得應該要有一些誘因然後趕快把這個分級醫療趕快落實\n710279\t724367\t好,非常感謝,真的很敬佩我們的委員,對這整個醫療體系的了解跟左右的見解這就是我們今年會努力去做的方向那我們也一定努力讓我們明年不要再發生\n725387\t745349\t那個急診太辛苦的一個情況分級醫療今天是一個大好的時機部長最後一個問題就是說之前卓院長有在這個這個巡打的時候有特別提到就是說三班互併比目前還是以獎勵為主那我想請教一下部長你的意見是怎樣\n747839\t772551\t我想這個十二項政策是一直聯繫的政策那目前我如果站在醫療的立場那個當然就是希望說我護理人力能夠充足充足我當然就希望讓他達到哪一個醫院長不希望達到護病比但是不能因為人力不足然後又要求到某些制度而讓床沒辦法開\n774052\t793211\t我想這個部分的中間永遠一個政策是要他利弊得失共同坐下來談我們衛福部一定跟醫院來針對這個部分當然要跟護理界一直來溝通那我相信至少我們在三班負面筆的努力之下我們在醫學中心已經從36%的\n794973\t819347\t三班都達到的已經變成59%區議院從26%已經變成49%在地區議院已經從83%達標 三個都達到94%所以我們獎勵其實也是一個讓大家可以做得到的一個方向那將來當更成熟 我們人力更多的時候我想就自然水到其層\n820187\t846146\t好 謝謝我們希望就是說不要再看到就是說這個醫療機構可能整個那個病患可能就全部都塞在急診室我覺得這個是我們不希望看到的啦對 我們一定從整個醫療體系的改變區域的防守或者是分級分流這個部分也要來努力好 謝謝委員的指教 謝謝好\n","txt":"謝謝主席已經開始了好 謝謝 請部長好 請我們邱部長\n在前一陣子可能在二月那時候其實我也接到很多基層醫療就是民眾到醫院然後在急診那邊等非常的久或者是這個在急診然後要進到病房那也等非常久等了很多天\n這個時候我們就會覺得說其實我們台灣就是一直會覺得說台灣的這個醫療做得很好那為什麼在這一兩年當中大家會覺得好像整個有一些狀況那我們也看到就是說在去年的時候我們去年7月我們也有一個就是護理人力的政策準備中長程的計畫\n那這個計畫下來之後其實有一些護理人員覺得蠻開心那有的人會有一些抱怨也有一些反彈那我們也看到就是說原本你們今年又編列了這個47億\n就不分醫院層級然後病房類別擴大給負啦那這個部分我原本一直認為就是說應該是從1月份應該是從1月份就會開始可是好像到現在這些護理人員好像也也還沒有收到這樣的一個給付那我想請教部長這個到底是怎麼回事報告委員我想預算程序如果完成\n我們就要趕快立即發來現在已經是三月份了因為現在整個預算程序要立好那你們什麼時候提出解凍整個會計程\n現在呼籲嘛可能要看整個settle down 看預算 預算有多少當然要解凍的就盡量來解凍 請大家幫忙那有些可能被刪的各方面\n我們做整體一旦確定以後我們追溯到1月馬上來發是所以大家放心啦當然啊當然你從從1月份原本這個從1月份到現在3月了這個會讓很多護理人員會覺得說那我們衛福部就嘴巴說說而已啊實際上也沒有拿到啊\n我是認為就是說部長針對這一部分如果說需要委員會這邊來協助或者是你們還需要提出這個譬如說可以有一部分可以解凍的話那是不是趕快來進行這樣的一個程序\n是 解凍是一回事 感謝委員會幫忙那這是整個會計程序 我剛剛有報告過嘛你整個國家總預算的確定以後才會動啊\n所以我們也希望能夠趕快有確定那昨天也才做一個預算呼籲的處理而已所以部長就是說我們現在為什麼基層醫療院所會有這樣的一個問題其實有很多會覺得說可能護理人力的不足然後有的是關床就是說關床那這個是最大的原因嗎就是說護理人力不足然後關床\n然後造成可能急診要進到病房就是大塞車這個是最主要的原因嗎當然整個醫療環境都有影響譬如說我們在分級分流有沒有落實那才不會增加急診不必要的壓力人力所以這個的確是未來長期要去要去努力的那個\n那護理人力的一個職場的環境跟護理人力的不足就是我們大家都知道的事情而且一直在努力\n需要的人更多但是我們在12項的一個策略努力之下的確在去年的12頁到去年的1頁其實我們也增加了3000多位的婦女同仁雖然最近看起來聽說好像有比較多離子因為最近過年後一般都是離子的一個巔峰等開學以後就是說畢業以後又是一個進來的一個這樣\n加減起來總是去年也多了3800個但是真的還不夠不但人數我們要加強人數加強我們在互併比的達標會更快我們的工作同仁的壓力也會工作的負荷也會比較輕所以怎麼樣去加強護理人類的留任或者引進是非常重要的課題\n沒錯那部長我想請教就是說我們一直在提到除了讓所有的這個護理人員可能有這個津貼之外那怎麼樣讓這個分級醫療的這個部分那我想請教部長就目前你認為我們的這個分級醫療做得如何\n分級醫療其實從民國76年開始我們在做醫療網的時候就是分級醫療那後來當然因為醫院一直蓋所以醫院的立場會覺得分級醫療他們比較不那麼努力在推行是\n那加上我們的民眾還是比較於傾向使用大醫院好像比較安心部長你們要怎麼去讓民眾更了解就是說要有分級醫療的這樣的一個觀念重病或者是有時候也不能用強迫因為一定要讓民眾說我去看基層醫療點頭比較安心點頭得到很好的照顧\n我去醫學中心等很久很難掛號等很久看一看就說你這個可能不是我的科要掛另外一科你又要等兩個禮拜這樣真的會比較對病人是情何以堪可是如果你在你的社區就有舌悉的診所或最好是有建立關係的一個家庭醫師製作\n那你隨時任何問題包括打電話都可以我們現在有社區醫療群社區醫療群就是有一群家庭醫師24小時你有什麼事情只要打個電話一定幫你做處理大家要善用所以你覺得目前分級醫療做得如何\n一定要大大的加強所以是不滿意從我的角度我是不滿意那如果不滿意的話要怎麼如何加強\n你一方面宣導嘛另外一方面我也知道就是說我們這個衛福部期望就是醫學中心下轉可能就是說病情穩定的這個慢性病人到基層診所可是我們也看到就是說今年的這個基層的這個總額就是已經確定這個總額這個總預算了嘛那如果說要診所收治更多的這個病人那勢必應該會稀釋掉這個點子\n好這個點子如果更多病人進來嗎基層診所更多病人進來那可能這個點子就會被稀釋掉那這樣子的話你又要如何去確保就是說這個基層診所是能夠接住病人的所以我\n覺得就是說部長可能針對這一部分我們又要希望就是說醫學中心這個可能就是做急重難函症的這些病患那希望這個比較輕症可能就到基層醫療院所去那怎麼樣去讓這個分級做得更徹底分級醫療做得更徹底我覺得這個應該也是我們目前要去做的一個課題\n感謝委員這個非常宏觀的來分析我們整個未來應該要走的走向那我們所有的政策都盡量讓民眾很自然的就變成分級的醫療第一個我們讓民眾有他信心的家庭醫師\n第二個我們也提高在集中症大醫院裡面集中症的給護我想這個部分在那個實施廠的努力之下也都有很好的成果那今年是一個非常好的機會來實行分級醫療因為今年在政府的幫忙之下以及大家努力之下我們今年的總額是\n提升很多 單單健保的總額就提升500多億當然這裡面也有蠻多部分會在基層所以基層的醫療密集度這個部分的經費會比較多也就是說不怕接病人其實今年是一個很好的機會所以今年如果能夠利用這個錢比較就是說經費比較多的情況之下總共用在健保的700多億包括我們\n讓基層醫療能夠多做一些預防保健的工作病人下來給他前人的一個照顧然後應該幾戶的譬如說我們的政府也讓成縣\n可能二十年來沒有增加大家都陪在立場做的這次要加倍幾乎所以你所講的如果說今年預算比往年還多的話我覺得有一些政策我覺得應該要趕快去做而且是要積極的去推動\n比如說分級醫療的這個部分如果往年做的不是那麼好的話那是不是你覺得說預算有增加那如何鼓勵基層醫療院所或者是這個醫學中心下轉這個可能慢性病的這個患者或是比較輕症的患者下轉我覺得應該也要有一些誘因\n一方面也要讓所有的這個民眾知道就是我大病可能我這個急症或這個大病可能就到這個醫學中心那其他感冒一般的這個不是那麼嚴重的話可能就到診所或者到地區醫院區醫院就可以了我覺得這個應該也要再再去落實啦要不然我覺得每一年尤其是在過年前後每一次看到可能就\n就是醫院可能擠爆一方面可能也當時可能這個時候就是流感或者是像今年的話也許是流感或者是諾蘿病毒那也會造成整個這個醫院可能人力不足那怎樣好讓這個大醫院的部分醫學中心這個\n能夠專心在他們的這個急重難喊症那其他比較輕症或者是比較慢性病的話可能就下轉到其他醫院我覺得這個應該也是我們衛福部如果說今年你覺得預算有比較餘裕的話我覺得應該要有一些誘因然後趕快把這個分級醫療趕快落實\n好,非常感謝,真的很敬佩我們的委員,對這整個醫療體系的了解跟左右的見解這就是我們今年會努力去做的方向那我們也一定努力讓我們明年不要再發生\n那個急診太辛苦的一個情況分級醫療今天是一個大好的時機部長最後一個問題就是說之前卓院長有在這個這個巡打的時候有特別提到就是說三班互併比目前還是以獎勵為主那我想請教一下部長你的意見是怎樣\n我想這個十二項政策是一直聯繫的政策那目前我如果站在醫療的立場那個當然就是希望說我護理人力能夠充足充足我當然就希望讓他達到哪一個醫院長不希望達到護病比但是不能因為人力不足然後又要求到某些制度而讓床沒辦法開\n我想這個部分的中間永遠一個政策是要他利弊得失共同坐下來談我們衛福部一定跟醫院來針對這個部分當然要跟護理界一直來溝通那我相信至少我們在三班負面筆的努力之下我們在醫學中心已經從36%的\n三班都達到的已經變成59%區議院從26%已經變成49%在地區議院已經從83%達標 三個都達到94%所以我們獎勵其實也是一個讓大家可以做得到的一個方向那將來當更成熟 我們人力更多的時候我想就自然水到其層\n好 謝謝我們希望就是說不要再看到就是說這個醫療機構可能整個那個病患可能就全部都塞在急診室我覺得這個是我們不希望看到的啦對 我們一定從整個醫療體系的改變區域的防守或者是分級分流這個部分也要來努力好 謝謝委員的指教 謝謝好\n","vtt":"WEBVTT\n\n00:03.434 --> 00:07.239\n謝謝主席已經開始了好謝謝請部長好請我們邱部長\n\n00:21.788 --> 00:39.797\n在前一陣子可能在二月那時候其實我也接到很多基層醫療就是民眾到醫院然後在急診那邊等非常的久或者是這個在急診然後要進到病房那也等非常久等了很多天\n\n00:41.678 --> 01:04.543\n這個時候我們就會覺得說其實我們台灣就是一直會覺得說台灣的這個醫療做得很好那為什麼在這一兩年當中大家會覺得好像整個有一些狀況那我們也看到就是說在去年的時候我們去年7月我們也有一個就是護理人力的政策準備中長程的計畫\n\n01:05.763 --> 01:19.569\n那這個計畫下來之後其實有一些護理人員覺得蠻開心那有的人會有一些抱怨也有一些反彈那我們也看到就是說原本你們今年又編列了這個47億\n\n01:21.890 --> 01:48.908\n就不分醫院層級然後病房類別擴大給負啦那這個部分我原本一直認為就是說應該是從1月份應該是從1月份就會開始可是好像到現在這些護理人員好像也也還沒有收到這樣的一個給付那我想請教部長這個到底是怎麼回事報告委員我想預算程序如果完成\n\n01:50.782 --> 01:54.205\n我們就要趕快立即發來現在已經是三月份了因為現在整個預算程序要立好那你們什麼時候提出解凍整個會計程\n\n02:11.375 --> 02:26.349\n現在呼籲嘛可能要看整個settledown看預算預算有多少當然要解凍的就盡量來解凍請大家幫忙那有些可能被刪的各方面\n\n02:27.029 --> 02:50.198\n我們做整體一旦確定以後我們追溯到1月馬上來發是所以大家放心啦當然啊當然你從從1月份原本這個從1月份到現在3月了這個會讓很多護理人員會覺得說那我們衛福部就嘴巴說說而已啊實際上也沒有拿到啊\n\n02:51.498 --> 03:06.473\n我是認為就是說部長針對這一部分如果說需要委員會這邊來協助或者是你們還需要提出這個譬如說可以有一部分可以解凍的話那是不是趕快來進行這樣的一個程序\n\n03:08.081 --> 03:20.299\n是解凍是一回事感謝委員會幫忙那這是整個會計程序我剛剛有報告過嘛你整個國家總預算的確定以後才會動啊\n\n03:22.528 --> 03:50.990\n所以我們也希望能夠趕快有確定那昨天也才做一個預算呼籲的處理而已所以部長就是說我們現在為什麼基層醫療院所會有這樣的一個問題其實有很多會覺得說可能護理人力的不足然後有的是關床就是說關床那這個是最大的原因嗎就是說護理人力不足然後關床\n\n03:51.610 --> 04:15.775\n然後造成可能急診要進到病房就是大塞車這個是最主要的原因嗎當然整個醫療環境都有影響譬如說我們在分級分流有沒有落實那才不會增加急診不必要的壓力人力所以這個的確是未來長期要去要去努力的那個\n\n04:20.097 --> 04:28.621\n那護理人力的一個職場的環境跟護理人力的不足就是我們大家都知道的事情而且一直在努力\n\n04:30.959 --> 04:57.365\n需要的人更多但是我們在12項的一個策略努力之下的確在去年的12頁到去年的1頁其實我們也增加了3000多位的婦女同仁雖然最近看起來聽說好像有比較多離子因為最近過年後一般都是離子的一個巔峰等開學以後就是說畢業以後又是一個進來的一個這樣\n\n05:00.259 --> 05:24.434\n加減起來總是去年也多了3800個但是真的還不夠不但人數我們要加強人數加強我們在互併比的達標會更快我們的工作同仁的壓力也會工作的負荷也會比較輕所以怎麼樣去加強護理人類的留任或者引進是非常重要的課題\n\n05:25.216 --> 05:47.444\n沒錯那部長我想請教就是說我們一直在提到除了讓所有的這個護理人員可能有這個津貼之外那怎麼樣讓這個分級醫療的這個部分那我想請教部長就目前你認為我們的這個分級醫療做得如何\n\n05:49.752 --> 06:06.389\n分級醫療其實從民國76年開始我們在做醫療網的時候就是分級醫療那後來當然因為醫院一直蓋所以醫院的立場會覺得分級醫療他們比較不那麼努力在推行是\n\n06:06.809 --> 06:27.195\n那加上我們的民眾還是比較於傾向使用大醫院好像比較安心部長你們要怎麼去讓民眾更了解就是說要有分級醫療的這樣的一個觀念重病或者是有時候也不能用強迫因為一定要讓民眾說我去看基層醫療點頭比較安心點頭得到很好的照顧\n\n06:34.557 --> 06:57.525\n我去醫學中心等很久很難掛號等很久看一看就說你這個可能不是我的科要掛另外一科你又要等兩個禮拜這樣真的會比較對病人是情何以堪可是如果你在你的社區就有舌悉的診所或最好是有建立關係的一個家庭醫師製作\n\n06:58.925 --> 07:17.057\n那你隨時任何問題包括打電話都可以我們現在有社區醫療群社區醫療群就是有一群家庭醫師24小時你有什麼事情只要打個電話一定幫你做處理大家要善用所以你覺得目前分級醫療做得如何\n\n07:20.646 --> 07:30.602\n一定要大大的加強所以是不滿意從我的角度我是不滿意那如果不滿意的話要怎麼如何加強\n\n07:32.621 --> 08:00.400\n你一方面宣導嘛另外一方面我也知道就是說我們這個衛福部期望就是醫學中心下轉可能就是說病情穩定的這個慢性病人到基層診所可是我們也看到就是說今年的這個基層的這個總額就是已經確定這個總額這個總預算了嘛那如果說要診所收治更多的這個病人那勢必應該會稀釋掉這個點子\n\n08:03.002 --> 08:16.656\n好這個點子如果更多病人進來嗎基層診所更多病人進來那可能這個點子就會被稀釋掉那這樣子的話你又要如何去確保就是說這個基層診所是能夠接住病人的所以我\n\n08:17.957 --> 08:44.387\n覺得就是說部長可能針對這一部分我們又要希望就是說醫學中心這個可能就是做急重難函症的這些病患那希望這個比較輕症可能就到基層醫療院所去那怎麼樣去讓這個分級做得更徹底分級醫療做得更徹底我覺得這個應該也是我們目前要去做的一個課題\n\n08:46.069 --> 09:01.534\n感謝委員這個非常宏觀的來分析我們整個未來應該要走的走向那我們所有的政策都盡量讓民眾很自然的就變成分級的醫療第一個我們讓民眾有他信心的家庭醫師\n\n09:02.714 --> 09:24.492\n第二個我們也提高在集中症大醫院裡面集中症的給護我想這個部分在那個實施廠的努力之下也都有很好的成果那今年是一個非常好的機會來實行分級醫療因為今年在政府的幫忙之下以及大家努力之下我們今年的總額是\n\n09:26.254 --> 09:49.081\n提升很多單單健保的總額就提升500多億當然這裡面也有蠻多部分會在基層所以基層的醫療密集度這個部分的經費會比較多也就是說不怕接病人其實今年是一個很好的機會所以今年如果能夠利用這個錢比較就是說經費比較多的情況之下總共用在健保的700多億包括我們\n\n09:50.641 --> 10:00.507\n讓基層醫療能夠多做一些預防保健的工作病人下來給他前人的一個照顧然後應該幾戶的譬如說我們的政府也讓成縣\n\n10:04.158 --> 10:24.298\n可能二十年來沒有增加大家都陪在立場做的這次要加倍幾乎所以你所講的如果說今年預算比往年還多的話我覺得有一些政策我覺得應該要趕快去做而且是要積極的去推動\n\n10:24.938 --> 10:43.459\n比如說分級醫療的這個部分如果往年做的不是那麼好的話那是不是你覺得說預算有增加那如何鼓勵基層醫療院所或者是這個醫學中心下轉這個可能慢性病的這個患者或是比較輕症的患者下轉我覺得應該也要有一些誘因\n\n10:44.881 --> 11:10.304\n一方面也要讓所有的這個民眾知道就是我大病可能我這個急症或這個大病可能就到這個醫學中心那其他感冒一般的這個不是那麼嚴重的話可能就到診所或者到地區醫院區醫院就可以了我覺得這個應該也要再再去落實啦要不然我覺得每一年尤其是在過年前後每一次看到可能就\n\n11:11.746 --> 11:29.247\n就是醫院可能擠爆一方面可能也當時可能這個時候就是流感或者是像今年的話也許是流感或者是諾蘿病毒那也會造成整個這個醫院可能人力不足那怎樣好讓這個大醫院的部分醫學中心這個\n\n11:31.169 --> 11:48.858\n能夠專心在他們的這個急重難喊症那其他比較輕症或者是比較慢性病的話可能就下轉到其他醫院我覺得這個應該也是我們衛福部如果說今年你覺得預算有比較餘裕的話我覺得應該要有一些誘因然後趕快把這個分級醫療趕快落實\n\n11:50.279 --> 12:04.367\n好,非常感謝,真的很敬佩我們的委員,對這整個醫療體系的了解跟左右的見解這就是我們今年會努力去做的方向那我們也一定努力讓我們明年不要再發生\n\n12:05.387 --> 12:25.349\n那個急診太辛苦的一個情況分級醫療今天是一個大好的時機部長最後一個問題就是說之前卓院長有在這個這個巡打的時候有特別提到就是說三班互併比目前還是以獎勵為主那我想請教一下部長你的意見是怎樣\n\n12:27.839 --> 12:52.551\n我想這個十二項政策是一直聯繫的政策那目前我如果站在醫療的立場那個當然就是希望說我護理人力能夠充足充足我當然就希望讓他達到哪一個醫院長不希望達到護病比但是不能因為人力不足然後又要求到某些制度而讓床沒辦法開\n\n12:54.052 --> 13:13.211\n我想這個部分的中間永遠一個政策是要他利弊得失共同坐下來談我們衛福部一定跟醫院來針對這個部分當然要跟護理界一直來溝通那我相信至少我們在三班負面筆的努力之下我們在醫學中心已經從36%的\n\n13:14.973 --> 13:39.347\n三班都達到的已經變成59%區議院從26%已經變成49%在地區議院已經從83%達標三個都達到94%所以我們獎勵其實也是一個讓大家可以做得到的一個方向那將來當更成熟我們人力更多的時候我想就自然水到其層\n\n13:40.187 --> 14:06.146\n好謝謝我們希望就是說不要再看到就是說這個醫療機構可能整個那個病患可能就全部都塞在急診室我覺得這個是我們不希望看到的啦對我們一定從整個醫療體系的改變區域的防守或者是分級分流這個部分也要來努力好謝謝委員的指教謝謝好\n\n","segments":[{"start":3.434,"end":7.239,"text":"謝謝主席已經開始了好 謝謝 請部長好 請我們邱部長"},{"start":21.788,"end":39.797,"text":"在前一陣子可能在二月那時候其實我也接到很多基層醫療就是民眾到醫院然後在急診那邊等非常的久或者是這個在急診然後要進到病房那也等非常久等了很多天"},{"start":41.678,"end":64.543,"text":"這個時候我們就會覺得說其實我們台灣就是一直會覺得說台灣的這個醫療做得很好那為什麼在這一兩年當中大家會覺得好像整個有一些狀況那我們也看到就是說在去年的時候我們去年7月我們也有一個就是護理人力的政策準備中長程的計畫"},{"start":65.763,"end":79.569,"text":"那這個計畫下來之後其實有一些護理人員覺得蠻開心那有的人會有一些抱怨也有一些反彈那我們也看到就是說原本你們今年又編列了這個47億"},{"start":81.89,"end":108.908,"text":"就不分醫院層級然後病房類別擴大給負啦那這個部分我原本一直認為就是說應該是從1月份應該是從1月份就會開始可是好像到現在這些護理人員好像也也還沒有收到這樣的一個給付那我想請教部長這個到底是怎麼回事報告委員我想預算程序如果完成"},{"start":110.782,"end":114.205,"text":"我們就要趕快立即發來現在已經是三月份了因為現在整個預算程序要立好那你們什麼時候提出解凍整個會計程"},{"start":131.375,"end":146.349,"text":"現在呼籲嘛可能要看整個settle down 看預算 預算有多少當然要解凍的就盡量來解凍 請大家幫忙那有些可能被刪的各方面"},{"start":147.029,"end":170.198,"text":"我們做整體一旦確定以後我們追溯到1月馬上來發是所以大家放心啦當然啊當然你從從1月份原本這個從1月份到現在3月了這個會讓很多護理人員會覺得說那我們衛福部就嘴巴說說而已啊實際上也沒有拿到啊"},{"start":171.498,"end":186.473,"text":"我是認為就是說部長針對這一部分如果說需要委員會這邊來協助或者是你們還需要提出這個譬如說可以有一部分可以解凍的話那是不是趕快來進行這樣的一個程序"},{"start":188.081,"end":200.299,"text":"是 解凍是一回事 感謝委員會幫忙那這是整個會計程序 我剛剛有報告過嘛你整個國家總預算的確定以後才會動啊"},{"start":202.528,"end":230.99,"text":"所以我們也希望能夠趕快有確定那昨天也才做一個預算呼籲的處理而已所以部長就是說我們現在為什麼基層醫療院所會有這樣的一個問題其實有很多會覺得說可能護理人力的不足然後有的是關床就是說關床那這個是最大的原因嗎就是說護理人力不足然後關床"},{"start":231.61,"end":255.775,"text":"然後造成可能急診要進到病房就是大塞車這個是最主要的原因嗎當然整個醫療環境都有影響譬如說我們在分級分流有沒有落實那才不會增加急診不必要的壓力人力所以這個的確是未來長期要去要去努力的那個"},{"start":260.097,"end":268.621,"text":"那護理人力的一個職場的環境跟護理人力的不足就是我們大家都知道的事情而且一直在努力"},{"start":270.959,"end":297.365,"text":"需要的人更多但是我們在12項的一個策略努力之下的確在去年的12頁到去年的1頁其實我們也增加了3000多位的婦女同仁雖然最近看起來聽說好像有比較多離子因為最近過年後一般都是離子的一個巔峰等開學以後就是說畢業以後又是一個進來的一個這樣"},{"start":300.259,"end":324.434,"text":"加減起來總是去年也多了3800個但是真的還不夠不但人數我們要加強人數加強我們在互併比的達標會更快我們的工作同仁的壓力也會工作的負荷也會比較輕所以怎麼樣去加強護理人類的留任或者引進是非常重要的課題"},{"start":325.216,"end":347.444,"text":"沒錯那部長我想請教就是說我們一直在提到除了讓所有的這個護理人員可能有這個津貼之外那怎麼樣讓這個分級醫療的這個部分那我想請教部長就目前你認為我們的這個分級醫療做得如何"},{"start":349.752,"end":366.389,"text":"分級醫療其實從民國76年開始我們在做醫療網的時候就是分級醫療那後來當然因為醫院一直蓋所以醫院的立場會覺得分級醫療他們比較不那麼努力在推行是"},{"start":366.809,"end":387.195,"text":"那加上我們的民眾還是比較於傾向使用大醫院好像比較安心部長你們要怎麼去讓民眾更了解就是說要有分級醫療的這樣的一個觀念重病或者是有時候也不能用強迫因為一定要讓民眾說我去看基層醫療點頭比較安心點頭得到很好的照顧"},{"start":394.557,"end":417.525,"text":"我去醫學中心等很久很難掛號等很久看一看就說你這個可能不是我的科要掛另外一科你又要等兩個禮拜這樣真的會比較對病人是情何以堪可是如果你在你的社區就有舌悉的診所或最好是有建立關係的一個家庭醫師製作"},{"start":418.925,"end":437.057,"text":"那你隨時任何問題包括打電話都可以我們現在有社區醫療群社區醫療群就是有一群家庭醫師24小時你有什麼事情只要打個電話一定幫你做處理大家要善用所以你覺得目前分級醫療做得如何"},{"start":440.646,"end":450.602,"text":"一定要大大的加強所以是不滿意從我的角度我是不滿意那如果不滿意的話要怎麼如何加強"},{"start":452.621,"end":480.4,"text":"你一方面宣導嘛另外一方面我也知道就是說我們這個衛福部期望就是醫學中心下轉可能就是說病情穩定的這個慢性病人到基層診所可是我們也看到就是說今年的這個基層的這個總額就是已經確定這個總額這個總預算了嘛那如果說要診所收治更多的這個病人那勢必應該會稀釋掉這個點子"},{"start":483.002,"end":496.656,"text":"好這個點子如果更多病人進來嗎基層診所更多病人進來那可能這個點子就會被稀釋掉那這樣子的話你又要如何去確保就是說這個基層診所是能夠接住病人的所以我"},{"start":497.957,"end":524.387,"text":"覺得就是說部長可能針對這一部分我們又要希望就是說醫學中心這個可能就是做急重難函症的這些病患那希望這個比較輕症可能就到基層醫療院所去那怎麼樣去讓這個分級做得更徹底分級醫療做得更徹底我覺得這個應該也是我們目前要去做的一個課題"},{"start":526.069,"end":541.534,"text":"感謝委員這個非常宏觀的來分析我們整個未來應該要走的走向那我們所有的政策都盡量讓民眾很自然的就變成分級的醫療第一個我們讓民眾有他信心的家庭醫師"},{"start":542.714,"end":564.492,"text":"第二個我們也提高在集中症大醫院裡面集中症的給護我想這個部分在那個實施廠的努力之下也都有很好的成果那今年是一個非常好的機會來實行分級醫療因為今年在政府的幫忙之下以及大家努力之下我們今年的總額是"},{"start":566.254,"end":589.081,"text":"提升很多 單單健保的總額就提升500多億當然這裡面也有蠻多部分會在基層所以基層的醫療密集度這個部分的經費會比較多也就是說不怕接病人其實今年是一個很好的機會所以今年如果能夠利用這個錢比較就是說經費比較多的情況之下總共用在健保的700多億包括我們"},{"start":590.641,"end":600.507,"text":"讓基層醫療能夠多做一些預防保健的工作病人下來給他前人的一個照顧然後應該幾戶的譬如說我們的政府也讓成縣"},{"start":604.158,"end":624.298,"text":"可能二十年來沒有增加大家都陪在立場做的這次要加倍幾乎所以你所講的如果說今年預算比往年還多的話我覺得有一些政策我覺得應該要趕快去做而且是要積極的去推動"},{"start":624.938,"end":643.459,"text":"比如說分級醫療的這個部分如果往年做的不是那麼好的話那是不是你覺得說預算有增加那如何鼓勵基層醫療院所或者是這個醫學中心下轉這個可能慢性病的這個患者或是比較輕症的患者下轉我覺得應該也要有一些誘因"},{"start":644.881,"end":670.304,"text":"一方面也要讓所有的這個民眾知道就是我大病可能我這個急症或這個大病可能就到這個醫學中心那其他感冒一般的這個不是那麼嚴重的話可能就到診所或者到地區醫院區醫院就可以了我覺得這個應該也要再再去落實啦要不然我覺得每一年尤其是在過年前後每一次看到可能就"},{"start":671.746,"end":689.247,"text":"就是醫院可能擠爆一方面可能也當時可能這個時候就是流感或者是像今年的話也許是流感或者是諾蘿病毒那也會造成整個這個醫院可能人力不足那怎樣好讓這個大醫院的部分醫學中心這個"},{"start":691.169,"end":708.858,"text":"能夠專心在他們的這個急重難喊症那其他比較輕症或者是比較慢性病的話可能就下轉到其他醫院我覺得這個應該也是我們衛福部如果說今年你覺得預算有比較餘裕的話我覺得應該要有一些誘因然後趕快把這個分級醫療趕快落實"},{"start":710.279,"end":724.367,"text":"好,非常感謝,真的很敬佩我們的委員,對這整個醫療體系的了解跟左右的見解這就是我們今年會努力去做的方向那我們也一定努力讓我們明年不要再發生"},{"start":725.387,"end":745.349,"text":"那個急診太辛苦的一個情況分級醫療今天是一個大好的時機部長最後一個問題就是說之前卓院長有在這個這個巡打的時候有特別提到就是說三班互併比目前還是以獎勵為主那我想請教一下部長你的意見是怎樣"},{"start":747.839,"end":772.551,"text":"我想這個十二項政策是一直聯繫的政策那目前我如果站在醫療的立場那個當然就是希望說我護理人力能夠充足充足我當然就希望讓他達到哪一個醫院長不希望達到護病比但是不能因為人力不足然後又要求到某些制度而讓床沒辦法開"},{"start":774.052,"end":793.211,"text":"我想這個部分的中間永遠一個政策是要他利弊得失共同坐下來談我們衛福部一定跟醫院來針對這個部分當然要跟護理界一直來溝通那我相信至少我們在三班負面筆的努力之下我們在醫學中心已經從36%的"},{"start":794.973,"end":819.347,"text":"三班都達到的已經變成59%區議院從26%已經變成49%在地區議院已經從83%達標 三個都達到94%所以我們獎勵其實也是一個讓大家可以做得到的一個方向那將來當更成熟 我們人力更多的時候我想就自然水到其層"},{"start":820.187,"end":846.146,"text":"好 謝謝我們希望就是說不要再看到就是說這個醫療機構可能整個那個病患可能就全部都塞在急診室我覺得這個是我們不希望看到的啦對 我們一定從整個醫療體系的改變區域的防守或者是分級分流這個部分也要來努力好 謝謝委員的指教 謝謝好"}]}}},"gazette":{"lineno":669,"blocks":[["黃委員秀芳：（11時9分）謝謝主席，請部長。"],["主席：請邱部長。"],["邱部長泰源：委員好。"],["黃委員秀芳：部長好。前一陣子可能在2月那時候，我接到很多基層民眾反映，到醫院急診等非常久，或者在急診要進到病房也等非常久，等了很多天。其實臺灣的醫療一直做得很好，這個時候我們就會覺得為什麼在這一、兩年當中好像有一些狀況。","我們看到去年7月有推出護理人力政策整備中長程計畫，這個計畫下來之後，有一些護理人員覺得蠻開心，有人會有一些抱怨，也有一些反彈。我們也看到原本你們今年編列了47億元，不分醫院層級、病房類別擴大給付。關於這個部分，我原本一直認為應該是從1月份就會開始，可是到現在護理人員好像還沒有收到這個給付。我想請教部長，這到底是怎麼回事？"],["邱部長泰源：報告委員，我想預算程序如果完成，我們就會趕快立即發出，也會追溯到1月。"],["黃委員秀芳：現在已經是3月份了，已經3月中了。"],["邱部長泰源：因為現在整個預算程序在……"],["黃委員秀芳：好，那你們什麼時候提出解凍？"],["邱部長泰源：整個會計程序，現在在覆議中，可能要看整個settle down之後預算有多少，當然要解凍的就盡量解凍，請大家幫忙。有些可能被刪，我們做整理。一旦確定以後，我們追溯到1月，馬上來發，請大家放心。"],["黃委員秀芳：當然啊，從原本1月份要發，到現在3月了，這會讓很多護理人員覺得衛福部就嘴巴說說而已，實際上也沒有拿到啊。我是認為，針對這一部分，部長如果需要委員會這邊來協助，或者是你們還需要提出有一部分可以解凍的話，是不是趕快來進行這樣的程序？"],["邱部長泰源：是，解凍是一回事，感謝委員會幫忙。這是整個會計程序，我剛剛有報告過，整個國家總預算確定以後才可以動，所以我們也希望能夠趕快確定，昨天也才作預算覆議的處理而已。"],["黃委員秀芳：是、是。所以部長，現在為什麼基層醫療院所會有這樣的問題，其實很可能是護理人力的不足，有的是關床，這是最大的原因嗎？就是護理人力不足然後關床，造成急診要進到病房大塞車，這是最主要的原因嗎？"],["邱部長泰源：當然整個醫療環境都有影響，比如說我們在分級分流有沒有落實，才不會增加急診不必要的壓力、人力，這的確是未來長期要去努力的。護理人力的職場環境跟護理人力不足是我們大家都知道的事情，而且一直在努力。"],["黃委員秀芳：是。"],["邱部長泰源：其實需要的人更多，但是我們在12項策略努力之下，的確在去年1月到12月也增加了三千多位的護理同仁。雖然最近聽說好像有比較多人離職，因為過年後一般都是離職的巔峰，等開學以後，學生畢業後又會錄取進來，這樣加減起來，去年總數多了三千八百多人，但是真的還不夠。不但人數要加強，在人數加強後，護病比的達標會更快，我們工作同仁的壓力、工作負荷也會比較輕。所以怎麼樣加強護理人力的留任或引進，是非常重要的課題。"],["黃委員秀芳：沒錯！部長，我們一直提到除了讓所有護理人員有津貼之外，我想請教部長，目前你認為我們的分級醫療做得如何？"],["邱部長泰源：其實從民國76年開始，我們在做醫療網的時候就是分級醫療，後來當然因為醫院一直蓋，以醫院的立場，會覺得他們比較不是那麼努力在推行分級醫療；加上民眾還是比較傾向使用大醫院，好像比較安心。"],["黃委員秀芳：好，部長你們要怎麼讓民眾更了解，要有分級醫療的觀念？"],["邱部長泰源：這個有時候也不能用強迫的。"],["黃委員秀芳：當然不是強迫的。"],["邱部長泰源：一定要讓民眾覺得我去看基層醫療院所，反而可以比較安心，得到很好的照顧，而不是去醫學中心等很久，很難掛號，醫生看一看，結果說你這個可能不是我的科，要掛另外一科，你又要等二個禮拜，這樣對病人來說真的情何以堪。"],["黃委員秀芳：是。"],["邱部長泰源：可是如果你在你的社區就有熟悉的診所，最好是有建立關係的家庭醫師制度，你隨時有任何問題，包括打電話都可以。我們現在有社區醫療群，就是有一群家庭醫師24小時待命，如果你有什麼事情，只要打個電話，一定幫你處理，大家要善用啊！"],["黃委員秀芳：是，好。所以你覺得目前分級醫療做得如何？我是想要知道你認為目前……"],["邱部長泰源：一定要大大的加強、大大的加強！"],["黃委員秀芳：要大大的加強，所以是不滿意？"],["邱部長泰源：從我的角度，我是不滿意。"],["黃委員秀芳：如果不滿意的話，要怎麼加強？你一方面宣導嘛，另外一方面，我也知道衛福部期望醫學中心下轉可能病情穩定的慢性病人到基層診所，可是我們也看到今年的基層總額預算已經確定，如果要診所收治更多病人，勢必會稀釋點值。如果更多病人進基層診所，可能這個點值就會被稀釋掉，這樣子的話，你要如何確保基層診所能夠接住病人？所以我覺得部長可能針對這一部分，希望醫學中心收治急重難罕症的病患，比較輕症的病患可能就到基層醫療院所，怎麼樣讓分級醫療做得更徹底，我覺得這應該也是我們目前要去做的一個課題。"],["邱部長泰源：感謝委員非常宏觀的分析我們未來應該要走的走向，我們所有的政策都盡量讓民眾很自然的接受分級醫療。第一個，我們讓民眾有他信任的家庭醫師；第二個，我們也提高大醫院急重症的給付，我想這個部分在石署長的努力之下，也都有很好的成果。","今年是一個非常好的機會來實行分級醫療，因為今年在政府的幫忙以及大家的努力之下，我們今年的總額提升很多，單單健保的總額就提升五百多億元，當然這裡面有蠻多部分會在基層，所以基層醫療密集度部分的經費會比較多，也就是說不怕接病人。其實今年是一個很好的機會，所以如果能夠利用今年經費比較多的情況之下，總共用在健保的有七百多億元，包括我們讓基層醫療能夠多做一些預防保健的工作；病人下來，給他全能的照顧，然後應該給付的，比如成健，可能二十年來沒有增加經費，大家都賠錢去作，政府這次可以用double的給付，今年是很好的機會。"],["黃委員秀芳：好，部長，照你所講的，如果今年的預算比往年還多，我覺得有一些政策應該要趕快去做，而且要積極地推動。"],["邱部長泰源：是的。"],["黃委員秀芳：譬如說分級醫療，如果往年做得不是那麼好，你說今年預算有增加，如何鼓勵基層醫療院所或醫學中心下轉慢性病患者，或是比較輕症的患者下轉，我覺得應該也要有一些誘因啊。"],["邱部長泰源：有、有、有。"],["黃委員秀芳：一方面也要讓所有民眾知道，大病或急重症才到醫學中心，其他感冒或一般不是那麼嚴重的疾病，可能就到診所或地區醫院、區域醫院就可以了，我覺得這個應該也要再去落實啦！要不然每一年，尤其每次過年前後看到醫院擠爆，一方面也可能當時有流感，或者像今年也許是流感或諾羅病毒，也會造成醫院人力不足。怎樣讓大醫院、部分醫學中心能夠專心在急重難罕症，其他比較輕症或慢性病可能就下轉到其他醫院。如果衛福部今年預算比較有餘裕，我覺得應該要有一些誘因，趕快落實分級醫療。"],["邱部長泰源：好，非常感謝，真的很敬佩我們的委員，對整個醫療體系的了解，提供非常卓越的見解，這就是我們今年會努力做的方向，我們也一定努力讓明年不要再發生急診太辛苦的情況。"],["黃委員秀芳：是。"],["邱部長泰源：分級醫療，今年是一個大好的時機。"],["黃委員秀芳：好。部長，最後一個問題，之前卓院長在詢答的時候特別提到三班護病比目前還是以獎勵為主，我想請教部長的意見是怎樣？"],["邱部長泰源：我想這個12項政策是連續的政策，目前如果站在醫療的立場，當然希望護理人力能夠充足，哪一個醫院院長不希望達到護病比，但是不能因為人力不足，又要求某些制度，而讓床沒辦法開。我想一個政策的利弊得失，大家共同坐下來談，針對這個部分，我們衛福部一定跟醫院，當然也要跟護理界一直溝通。我相信至少在大家努力之下，三班護病比在醫學中心已經從36%，三班都達到的變成59%，區域醫院從26%變成49%，地區醫院三班比已經從83%達標到94%。所以我們提供獎勵，其實也是讓大家可以做得到的一個方向。將來當然更成熟、人力更多的時候，我想自然就水到渠成。"],["黃委員秀芳：好，謝謝。我們希望不要在醫療機構再看到病患全部都塞在急診室，這是我們不希望看到的。"],["邱部長泰源：對！我們從整個醫療體系的改變、區域的防守，或者是分級、分流的部分，也要來努力。"],["黃委員秀芳：是，好，謝謝。"],["邱部長泰源：謝謝委員的指教，謝謝。"],["主席：謝謝黃秀芳委員。","目前我們收到臨時提案共2案，待會王正旭委員質詢之後，我們來進行處理。接下來請蘇清泉委員發言。"]],"agenda":{"page_end":314,"meet_id":"委員會-11-3-26-2","speakers":["蘇清泉","陳昭姿","林月琴","陳菁徽","王育敏","邱鎮軍","廖偉翔","涂權吉","黃秀芳","王正旭","林淑芬","羅智強","黃國昌","楊瓊瓔","陳瑩","洪孟楷","張啓楷","劉建國","陳培瑜","楊曜","王義川"],"page_start":227,"meetingDate":["2025-03-13"],"gazette_id":"1142701","agenda_lcidc_ids":["1142701_00006"],"meet_name":"立法院第11屆第3會期社會福利及衛生環境委員會第2次全體委員會議紀錄","content":"邀請衛生福利部部長就「有關全國急重症醫療量能」進行專題報告，並備質詢","agenda_id":"1142701_00005"}}}