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\"end\": 1010.917, \"score\": 0.893}, {\"word\": \"席\", \"start\": 1010.917, \"end\": 1010.937, \"score\": 0.653}], \"language\": \"zh\"}","srt":"1\n00:00:04,365 --> 00:00:05,171\n謝謝主席,麻煩邱部長\n\n2\n00:00:10,703 --> 00:00:39,741\n吳院長今天是五一勞動節所以我還是想跟部長您討論一下醫護這個勞動權益的問題龍頭醫院台大醫院你我都服務過的醫院吳院長他還蠻喜歡公開評論時事所以我想以他帶領龍頭醫院加上他這個特質我認為他應該要對自己要求這個自我要求是要更高的你同意吧龍頭醫院嘛然後他也會關心其他的事情\n\n3\n00:00:40,501 --> 00:00:57,017\n但是台大工業企業工會剛會這個禮拜四月二十八號揭露台大院的荒唐行徑他在這個五月一號的這個假班別的一個議院調查表他只給護理人員兩個選項喔柏俊這都很清楚你有看過嗎\n\n4\n00:01:00,599 --> 00:01:15,888\n你現在看兩個選項而已,同意到院工作後調一,國定假日,第二個同意到院工作後領加班費,否定這是依法要休假一整天,當天不上班的選項沒了,不見了,它只有兩個選項,我先跟你說,因為這個是\n\n5\n00:01:19,750 --> 00:01:34,911\n一個非常清楚的事實台大醫院看似在徵詢醫院事實上是已經徵詢就是同仁的意願但事實上已經設計好了不管你勾哪一項你那天就是得來一定要出勤部長你覺得這樣做可以嗎\n\n6\n00:01:35,874 --> 00:01:54,200\n謝謝委員,非常關心我們這種勞動的權益,我想也不只台大,全國所有的醫療業,台大是龍頭,我們先聽著台大這點台大有解說,這是針對來五一那天上班的人,給他們簽你是要選擇\n\n7\n00:01:57,282 --> 00:02:10,861\n我跟您講台大企業工會工會他們做的調查77點多就超過四分之三的人說他們根本沒有備訓諮詢就直接排定了我給你做參考\n\n8\n00:02:12,883 --> 00:02:34,654\n這個是臺大醫院說法,但事實上可能就不是如此博定還是請你要注意一下,雖然好像說臺大醫院是屬於教育部管,不過我想衛福部也是您到督導的對象博定他這個預例醫療決定推動到現在,您知道簽署率有多高嗎?簽署率有多少嗎?大概千分之1.31\n\n9\n00:02:36,711 --> 00:02:47,899\n簽分之1.31柏定拜託高板櫃再不到百分之一又簽分之幾統計學就是沒有嘛等於沒有人簽嘛我大概可以這麼講柏定你有簽嗎我有簽安寧環和醫療但病毒法沒有我覺得我們的意願都很清楚已經可以表達了在安寧環和醫療法因為法推出以後就是鼓勵\n\n10\n00:03:05,331 --> 00:03:24,863\n鼓勵後我們還是會看一下數字這也不是對錯的問題每一個人都是這間排審的三個版本它當然主要在經費之應場域放寬還有代理人的一個限制調整也許大家不太一樣不過我覺得方向是整個是正確的那就是要尊重這個意願人他自主權但是我也要提醒這個衛福部\n\n11\n00:03:25,964 --> 00:03:33,314\n就是說你們對於這個所有醫護跟相關學會的意見要稍微去多多徵詢你知道以前的爭議點在哪裡嗎你知道以前的爭議點對爭議點在什麼地方爭議點是在哪裡\n\n12\n00:03:46,605 --> 00:03:53,027\n因為他的爭議點很多,病人自治權法案那個時候當時應該是蘇昭偉那個時代在推,但是我在學界應該也對這個法有相關的隱瞞因為爭議點是醫師說進戶中一陣子轉嫁給醫師,就是醫師背負太多的責任\n\n13\n00:04:09,633 --> 00:04:37,231\n爭議點那這個東西就是找醫護人員找他們來一起討論嘛怎麼樣讓他們就覺得是相對是讓他們願意做這樣的事情配合這樣的政策但是又不是說你責任最後都丟給我其實爭議點就是這個啦民眾黨我們期待的是有這個病毒法還要一個尊嚴善終法才能夠完善這個善終權那因為病毒法保障的是無效醫療嘛可以拒絕無效醫療那自然善終一個選擇\n\n14\n00:04:38,132 --> 00:05:00,418\n但是尊嚴善終是進一步讓極度痛苦的人透過嚴謹的程序然後他可以這個做自主來選擇他比較有尊嚴有體面的方式來結束生命兩者是一個互補就是可以完善一個生命自主跟尊嚴死亡那這是一個現代的價值這個衛福部現在好像都不想面對這個問題\n\n15\n00:05:03,906 --> 00:05:26,119\n我們不管是衛福部的各個單位跟學界跟相關的委員會始終在面對這個問題不是沒有面對這個問題博不丁我是要跟你提起遲早要面對因為齁所有的民調大概有七八成的民眾台灣民眾是支持這個法案的但這個法案怎麼寫我知道要很小心很謹慎但是我跟博不丁這樣說啦博不丁賴總統4月27日出席健康台灣全國論壇提了很多見解\n\n16\n00:05:31,122 --> 00:05:51,810\n當天也在場,所以我想你應該都很清楚那我賴總統有表達,政府提出這個癌藥基金100億元那他先編列50億元但並不是100億元用完就結束,不夠了就補上去,隔年再補這樣讓這個水庫可以保持一定水平那我想提醒部長\n\n17\n00:05:53,371 --> 00:06:11,278\n百億癌藥基金是個中繼站的概念我對你講中繼站過去的意思就是病人要團體期待然後去參觀其他國家的做法就是有一些加速審查的藥品他可能還沒有完全確定但是有些病人他有需求所以他讓這個中繼站\n\n18\n00:06:12,859 --> 00:06:39,259\n能夠暫時性的支付這類的藥品目前健保署還沒有改口雖然我們有很多已經確定療效的安全性的都沒有附滿附足但是這一塊本來是要做這個部分它是一個中繼站的概念你看賴總統也是用水庫的概念水庫本來水就是進進出出的那就是要加速通過藥來用那既然是中繼站的話真正的問題是新藥經過開放性使用用這筆錢\n\n19\n00:06:41,040 --> 00:07:00,787\n那之後要評估嘛因為你暫時性使用那目前大概都兩年嘛署長沒有改變大概兩年後評估嘛那兩年後評估有三個結果柏中你要聽得很清楚你日理千機賴總統日理萬機你日理千機百機你也是要清楚這件事那時署長要非常清楚因為他在執行這件事情\n\n20\n00:07:01,747 --> 00:07:19,142\n你現在兩年後,結果會有三個評估以後,一個淘汰出局就這個有在加速生產那個經不起考驗淘汰第二個我們覺得時間不夠要繼續觀察第三個他同意了,我們覺得他的療程安全都確定了所以我們要把它回歸到正常的使用\n\n21\n00:07:21,103 --> 00:07:43,591\n這有三條路可以走不然我是要說的癌藥不斷的在研發需求也會增加百億如何分配我到現在看不到用完怎麼辦因為賴總統我覺得他不能理解很深入的是ok的因為日理萬機賴總統意思好像好像預期會有勝他先用多少不夠我再補他預期會有勝那部長你也會認為有勝嗎\n\n22\n00:07:48,092 --> 00:08:13,638\n我有我的資深專業的那個經驗30年前告訴你保留癌症病人絕對會面臨另外一個噩夢因為錢是不夠用的不夠用大概要讓這個滿足這一塊幾百億都不夠那最後會怎麼樣呢維持現況現況是什麼就是不人道的方式你限制癌症病人使用的對象變得很小很窄然後限制他使用次數跟時間\n\n23\n00:08:15,398 --> 00:08:35,711\n那這個這麼多先生這是第一個到最後回到現在的噩夢這個事情我可以確定是這樣第二個當剛剛我跟你說明過當挑選後經過評估因為要評估暫時中繼站那你要進進出出到哪個地方去根據美國的經驗繼續使用就確定療效大概有六成他沒有經驗所以我們先用美國的經驗有兩成大概淘汰還有兩成他大概說我們要更長時間的觀察那有這兩個事情在前提那我請問部長\n\n24\n00:08:44,717 --> 00:08:50,782\n這個衛福部有規劃那個中長期的裁員嗎還是說你想說先擋個兩年拖個兩年再說呢好\n\n25\n00:08:52,933 --> 00:09:07,460\n包委員真的非常敬佩您指教這麼多專業的一個做法我相信對未來在處理心療癌症這個預算能夠有很大的幫助但是我必須要講賴總統絕對存著就是希望希望說真的病人需要癌藥的時候我們就是想盡辦法\n\n26\n00:09:17,845 --> 00:09:29,413\n給他充分足夠及時那這個部分後面他立定了一個很這麼關懷我們前骨癌症的病人的方向以後原則我沒有問題那我們怎麼來把它做法嘛就是我們必須要來把它落實但是他有總統也特別強調說要多少就補多少\n\n27\n00:09:47,725 --> 00:10:13,547\n就是要把我們的癌症的病人幫他照顧好降低死亡率那署長我剛剛講的那些問題你有瞭解嗎你也知道問題在哪裡嘛對不對加速的通過那你現在怎麼辦你準備好了沒有大概已經這個很快你準備了這個要解決的問題就是這個癌症新藥基金這個等於是讓我們在財務預估上可以算準確\n\n28\n00:10:15,008 --> 00:10:37,469\n我們現在有的時候還不知道到底使用會有多少所以未來還是會回到健保基金一樣的它回到健保所以在這健保裡面去編列這個新藥預算的時候讓它可以等你有一個庫讓你先了解那我告訴你說美國大概六成人會回來你六成人回來錢都準備好了那你這樣病人怎麼辦我治療有效結果你不讓我繼續用惡夢出現\n\n29\n00:10:40,452 --> 00:10:43,794\n無縫的接軌啦你今天也談不出這個100億怎麼分啦怎麼allocation怎麼分配啦這個還有很大的問題還是不夠因為賴總統他以為夠他還說不夠我就補回去不夠就補回去不夠的啦賴總統也覺得不夠啦不夠的話問題就來那你就開始要壓縮使用嘛壓縮就開始分配嘛\n\n30\n00:11:01,303 --> 00:11:16,521\n分配就開始你誰先用這個就涉及每一個人的觀點主審的最大這個就是我跟你講很多人他不是真的要去圖利誰可是他有他自己的想法這個是很難處理的所以我也一直很關心這件事情然後現在我就回到說現在你的這個分區共管你知道這個有後遺症嗎不管署長或部長\n\n31\n00:11:21,607 --> 00:11:40,107\n不同區域之一人之人本來就不均勻啦你分區共管那會不會惡化那個城鄉的差距呢而且如果地方管理適當齁那健保這個費用運用適當民眾群會不會受損那衛福部跟健保署是否已經有事辦範圍啊標準配套監督機制你就等於說幫他去管啊\n\n32\n00:11:41,488 --> 00:11:51,513\n那每個醫院就管你在這個情況下如果你在等於在自生自滅喔你不把總額這個大帽子拿掉你等於讓各地區各醫院自己去自生自滅喔\n\n33\n00:11:53,206 --> 00:12:06,877\n現在已經發生了你看好我看下一張好了就是我告訴你這個現象你們大家知道你看現在醫院怎麼存活南部的醫學中心就在醫生的處方的螢光幕上跟你說跟你說我建議你開這個藥因為這個要打圈圈兩個圈圈為什麼呢因為利潤最高\n\n34\n00:12:11,661 --> 00:12:14,982\n你難免逼著人家去做這件事嘛而且就是說還寫說敬請開立藥品時同時考慮醫療經濟學的成本效益其實藥品價格不代表醫療成本效益經濟學的但是它就是一個簡化的方式那他們的醫師自己說這些提示雖然沒有強制但是在這個院務會這個每一季的討論的時候你就科別業績沒搞\n\n35\n00:12:38,050 --> 00:12:52,642\n你這個要被檢討績效不好啊這個情況下醫師就被迫去勾那個藥啊已經出現了啦部長署長我想你們都知道吧醫院會建議你醫生怎麼藥病人聽聽看我的意思是醫院建議他用哪一個藥那我的感覺呢我的權益呢病醫生的專業權自主權怎麼辦後遺症都出現所以我才說\n\n36\n00:13:01,829 --> 00:13:07,170\n你要分區各管但是你有沒有監測的配套的機制去看看這個品質嘛對不對就像署長昨天那個林靜儀的那件事情對不對他的他提出來的那個國際要價不是那個藥品的國際要價他把它污品掉了今天的專科醫師都跑出來講了所以他裡面那個不同的那個所謂的那個封口劑喔裡面有不同還有人添加凝血因子還有人添加防沾黏的功能根本都不一樣\n\n37\n00:13:31,414 --> 00:13:42,039\n你把它全部從分類分組一個叫grouping他們最害怕這個字你沒有廠牌之分把它放在同一組用裡面最低的價錢林靜儀次長唸出來的這邊都有公開的資料他唸的不是那個藥品的國際藥價但是你們在分組的時候可能出問題現在醫師大反彈因為那個病只有一次救命的機會對不對大動脈剝離主動脈剝離只有一次救命機會他當時沒有辦法就沒有辦法\n\n38\n00:13:58,687 --> 00:14:11,981\n如果你把它縫好了水還是漏出來雪還是漏出來就要靠這個凝膠去把它黏住就像淋到水管的私力控一樣嘛對不對那它可能是本質不一樣我是看專科醫師在談這件事情那你要把它放在同一組以後請林次長不懂不要亂講話現在醫師大反彈了\n\n39\n00:14:20,510 --> 00:14:28,615\n我簡單回應一下,第一個就是各區的公關,我相信你來行的,你是不是所有相關的委員會你都當過,其實在南區做得不錯但是這個現象都出現啊\n\n40\n00:14:38,961 --> 00:14:57,235\n所以美國的模式,我們總是要突破嘛所以是可以用在各區也是共管,其實這樣各區也是自己共管只是方式不太一樣現在出現後遺症我們告訴你嘛我們一定是預防後遺症那像剛剛提出這個部分我們健保署去了解逼迫醫院去這樣做啊\n\n41\n00:15:04,201 --> 00:15:16,947\n其實如果一個以,因為我也是醫師,我也非常反對影響到醫師的住宿專業錢跟一樣嘛,我們不管是醫藥都是專業的嘛,我們真的很不希望被影響但是怎麼樣慢慢的讓整個醫療的行為能夠\n\n42\n00:15:22,950 --> 00:15:47,247\n能夠恢復健康經濟,然後對人民好我們價值理念都一樣,我現在在說就食物啦另外署長你在醫材,那個當然我在藥品太久了醫材的部分,你要grouping的時候,你要把它分類成同一組,當作你們是同一夥的同樣的東西,我只花一樣的錢去買的時候,還是要小心啊因為醫生說不同成分,裡面我一聽有磷血因子,加磷血因子當然貴啊\n\n43\n00:15:49,755 --> 00:16:09,720\n當然我不知道,那林次長他給的那個國際要價不是他的國際要價然後大家就會以為說,就這麼貴你怎麼還要炒,炒的是醫生啊謝謝委員,我跟委員一樣都不是對所有的藥物都那麼清楚所以還是需要專家的意見為主啦所以我們會再回去,我們都有機制\n\n44\n00:16:12,140 --> 00:16:40,721\n我們這個過去全部都是自費啦過去都是自費現在才納入健保給付那至於一開始五月要納入健保給付他還有時間來申付他要提高價格把成本給我們看我們還是要為健保的財務把關啦所以我們要跟國際要價相比需要看他的成本合給一個合理的價格但是沒有他就隱藏他的自己的國際要價嘛你們這個共理會的表就隱藏他是空白啦只有他空白其他都有啊\n\n45\n00:16:41,682 --> 00:16:50,937\n所以就是這個要出問題啦這個藥也不是最主流的藥所以其他主流的藥沒有問題所以供藥上沒有問題我以表達謝謝主席\n\n","tsv":"start\tend\ttext\n4365\t5171\t謝謝主席,麻煩邱部長\n10703\t39741\t吳院長今天是五一勞動節所以我還是想跟部長您討論一下醫護這個勞動權益的問題龍頭醫院台大醫院你我都服務過的醫院吳院長他還蠻喜歡公開評論時事所以我想以他帶領龍頭醫院加上他這個特質我認為他應該要對自己要求這個自我要求是要更高的你同意吧龍頭醫院嘛然後他也會關心其他的事情\n40501\t57017\t但是台大工業企業工會剛會這個禮拜四月二十八號揭露台大院的荒唐行徑他在這個五月一號的這個假班別的一個議院調查表他只給護理人員兩個選項喔柏俊這都很清楚你有看過嗎\n60599\t75888\t你現在看兩個選項而已,同意到院工作後調一,國定假日,第二個同意到院工作後領加班費,否定這是依法要休假一整天,當天不上班的選項沒了,不見了,它只有兩個選項,我先跟你說,因為這個是\n79750\t94911\t一個非常清楚的事實台大醫院看似在徵詢醫院事實上是已經徵詢就是同仁的意願但事實上已經設計好了不管你勾哪一項你那天就是得來一定要出勤部長你覺得這樣做可以嗎\n95874\t114200\t謝謝委員,非常關心我們這種勞動的權益,我想也不只台大,全國所有的醫療業,台大是龍頭,我們先聽著台大這點台大有解說,這是針對來五一那天上班的人,給他們簽你是要選擇\n117282\t130861\t我跟您講台大企業工會 工會 他們做的調查77點多就超過四分之三的人說他們根本沒有備訓諮詢就直接排定了我給你做參考\n132883\t154654\t這個是臺大醫院說法,但事實上可能就不是如此博定還是請你要注意一下,雖然好像說臺大醫院是屬於教育部管,不過我想衛福部也是您到督導的對象博定他這個預例醫療決定推動到現在,您知道簽署率有多高嗎?簽署率有多少嗎?大概千分之1.31\n156711\t167899\t簽分之1.31 柏定拜託 高板櫃再不到百分之一 又簽分之幾統計學就是沒有嘛 等於沒有人簽嘛我大概可以這麼講 柏定你有簽嗎我有簽安寧環和醫療但病毒法沒有我覺得我們的意願都很清楚 已經可以表達了在安寧環和醫療法因為法推出以後就是鼓勵\n185331\t204863\t鼓勵後我們還是會看一下數字這也不是對錯的問題每一個人都是這間排審的三個版本它當然主要在經費之應場域放寬還有代理人的一個限制調整也許大家不太一樣不過我覺得方向是整個是正確的那就是要尊重這個意願人他自主權但是我也要提醒這個衛福部\n205964\t213314\t就是說你們對於這個所有醫護跟相關學會的意見要稍微去多多徵詢你知道以前的爭議點在哪裡嗎你知道以前的爭議點對 爭議點在什麼地方爭議點是在哪裡\n226605\t233027\t因為他的爭議點很多,病人自治權法案那個時候當時應該是蘇昭偉那個時代在推,但是我在學界應該也對這個法有相關的隱瞞因為爭議點是醫師說進戶中一陣子轉嫁給醫師,就是醫師背負太多的責任\n249633\t277231\t爭議點 那這個東西就是找醫護人員找他們來一起討論嘛怎麼樣讓他們就覺得是相對是讓他們願意做這樣的事情配合這樣的政策但是又不是說你責任最後都丟給我其實爭議點就是這個啦民眾黨我們期待的是有這個病毒法還要一個尊嚴善終法才能夠完善這個善終權那因為病毒法保障的是無效醫療嘛可以拒絕無效醫療 那自然善終一個選擇\n278132\t300418\t但是尊嚴善終是進一步讓極度痛苦的人透過嚴謹的程序然後他可以這個做自主來選擇他比較有尊嚴有體面的方式來結束生命兩者是一個互補就是可以完善一個生命自主跟尊嚴死亡那這是一個現代的價值這個衛福部現在好像都不想面對這個問題\n303906\t326119\t我們不管是衛福部的各個單位跟學界跟相關的委員會始終在面對這個問題不是沒有面對這個問題博不丁我是要跟你提起遲早要面對因為齁所有的民調大概有七八成的民眾台灣民眾是支持這個法案的但這個法案怎麼寫我知道要很小心很謹慎但是我跟博不丁這樣說啦博不丁賴總統4月27日出席健康台灣全國論壇提了很多見解\n331122\t351810\t當天也在場,所以我想你應該都很清楚那我賴總統有表達,政府提出這個癌藥基金100億元那他先編列50億元但並不是100億元用完就結束,不夠了就補上去,隔年再補這樣讓這個水庫可以保持一定水平那我想提醒部長\n353371\t371278\t百億癌藥基金是個中繼站的概念我對你講中繼站過去的意思就是病人要團體期待然後去參觀其他國家的做法就是有一些加速審查的藥品他可能還沒有完全確定但是有些病人他有需求所以他讓這個中繼站\n372859\t399259\t能夠暫時性的支付這類的藥品目前健保署還沒有改口雖然我們有很多已經確定療效的安全性的都沒有附滿附足但是這一塊本來是要做這個部分它是一個中繼站的概念你看賴總統也是用水庫的概念水庫本來水就是進進出出的那就是要加速通過藥來用那既然是中繼站的話真正的問題是新藥經過開放性使用用這筆錢\n401040\t420787\t那之後要評估嘛 因為你暫時性使用那目前大概都兩年嘛 署長沒有改變 大概兩年後評估嘛那兩年後評估有三個結果 柏中你要聽得很清楚你日理千機 賴總統日理萬機 你日理千機百機 你也是要清楚這件事那時署長要非常清楚 因為他在執行這件事情\n421747\t439142\t你現在兩年後,結果會有三個評估以後,一個淘汰出局就這個有在加速生產那個經不起考驗淘汰第二個我們覺得時間不夠要繼續觀察第三個他同意了,我們覺得他的療程安全都確定了所以我們要把它回歸到正常的使用\n441103\t463591\t這有三條路可以走不然我是要說的癌藥不斷的在研發需求也會增加百億如何分配我到現在看不到用完怎麼辦因為賴總統我覺得他不能理解很深入的是ok的因為日理萬機賴總統意思好像好像預期會有勝他先用多少不夠我再補他預期會有勝那部長你也會認為有勝嗎\n468092\t493638\t我有我的資深專業的那個經驗30年前告訴你 保留癌症病人絕對會面臨另外一個噩夢因為錢是不夠用的不夠用大概要讓這個滿足這一塊 幾百億都不夠那最後會怎麼樣呢 維持現況現況是什麼 就是不人道的方式你限制癌症病人使用的對象變得很小很窄然後限制他使用次數跟時間\n495398\t515711\t那這個這麼多先生這是第一個到最後回到現在的噩夢這個事情我可以確定是這樣第二個當剛剛我跟你說明過當挑選後經過評估因為要評估暫時中繼站那你要進進出出到哪個地方去根據美國的經驗繼續使用就確定療效大概有六成他沒有經驗所以我們先用美國的經驗有兩成大概淘汰還有兩成他大概說我們要更長時間的觀察那有這兩個事情在前提那我請問部長\n524717\t530782\t這個衛福部有規劃那個中長期的裁員嗎還是說你想說先擋個兩年拖個兩年再說呢好\n532933\t547460\t包委員真的非常敬佩您指教這麼多專業的一個做法我相信對未來在處理心療癌症這個預算能夠有很大的幫助但是我必須要講賴總統絕對存著就是希望希望說真的病人需要癌藥的時候我們就是想盡辦法\n557845\t569413\t給他充分 足夠及時那這個部分後面他立定了一個很這麼關懷我們前骨癌症的病人的方向以後原則我沒有問題那我們怎麼來把它做法嘛就是我們必須要來把它落實但是他有總統也特別強調說要多少就補多少\n587725\t613547\t就是要把我們的癌症的病人幫他照顧好 降低死亡率那署長我剛剛講的那些問題 你有瞭解嗎你也知道問題在哪裡嘛 對不對 加速的通過那你現在怎麼辦 你準備好了沒有 大概已經這個很快 你準備了這個要解決的問題 就是這個癌症新藥基金這個等於是讓我們在財務預估上可以算準確\n615008\t637469\t我們現在有的時候還不知道到底使用會有多少所以未來還是會回到健保基金一樣的它回到健保所以在這健保裡面去編列這個新藥預算的時候讓它可以等你有一個庫讓你先了解那我告訴你說美國大概六成人會回來你六成人回來錢都準備好了那你這樣病人怎麼辦我治療有效結果你不讓我繼續用惡夢出現\n640452\t643794\t無縫的接軌啦你今天也談不出這個100億怎麼分啦怎麼 allocation 怎麼分配啦這個還有很大的問題還是不夠因為賴總統他以為夠他還說不夠我就補回去不夠就補回去不夠的啦賴總統也覺得不夠啦不夠的話問題就來那你就開始要壓縮使用嘛壓縮就開始分配嘛\n661303\t676521\t分配就開始你誰先用這個就涉及每一個人的觀點主審的最大這個就是我跟你講很多人他不是真的要去圖利誰可是他有他自己的想法這個是很難處理的所以我也一直很關心這件事情然後現在我就回到說現在你的這個分區共管你知道這個有後遺症嗎不管署長或部長\n681607\t700107\t不同區域之一人之人本來就不均勻啦你分區共管那會不會惡化那個城鄉的差距呢而且如果地方管理適當齁那健保這個費用運用適當民眾群會不會受損那衛福部跟健保署是否已經有事辦範圍啊標準配套監督機制你就等於說幫他去管啊\n701488\t711513\t那每個醫院就管 你在這個情況下如果你在等於在自生自滅喔你不把總額這個大帽子拿掉你等於讓各地區各醫院自己去自生自滅喔\n713206\t726877\t現在已經發生了你看好我看下一張好了就是我告訴你這個現象你們大家知道你看現在醫院怎麼存活南部的醫學中心就在醫生的處方的螢光幕上跟你說跟你說我建議你開這個藥因為這個要打圈圈兩個圈圈為什麼呢因為利潤最高\n731661\t734982\t你難免逼著人家去做這件事嘛而且就是說還寫說敬請開立藥品時同時考慮醫療經濟學的成本效益其實藥品價格不代表醫療成本效益經濟學的但是它就是一個簡化的方式那他們的醫師自己說這些提示雖然沒有強制但是在這個院務會這個每一季的討論的時候你就科別業績沒搞\n758050\t772642\t你這個要被檢討 績效不好啊這個情況下醫師就被迫去勾那個藥啊已經出現了啦 部長署長 我想你們都知道吧醫院會建議你醫生怎麼藥 病人聽聽看我的意思是醫院建議他用哪一個藥那我的感覺呢 我的權益呢病醫生的專業權 自主權怎麼辦後遺症都出現 所以我才說\n781829\t787170\t你要分區各管但是你有沒有監測的配套的機制去看看這個品質嘛對不對就像署長昨天那個林靜儀的那件事情對不對他的他提出來的那個國際要價不是那個藥品的國際要價他把它污品掉了今天的專科醫師都跑出來講了所以他裡面那個不同的那個所謂的那個封口劑喔裡面有不同還有人添加凝血因子還有人添加防沾黏的功能根本都不一樣\n811414\t822039\t你把它全部從分類分組一個叫grouping他們最害怕這個字你沒有廠牌之分把它放在同一組用裡面最低的價錢林靜儀次長唸出來的這邊都有公開的資料他唸的不是那個藥品的國際藥價但是你們在分組的時候可能出問題現在醫師大反彈因為那個病只有一次救命的機會對不對大動脈剝離主動脈剝離只有一次救命機會他當時沒有辦法就沒有辦法\n838687\t851981\t如果你把它縫好了 水還是漏出來 雪還是漏出來就要靠這個凝膠去把它黏住就像淋到水管的私力控一樣嘛 對不對那它可能是本質不一樣 我是看專科醫師在談這件事情那你要把它放在同一組以後請林次長不懂 不要亂講話 現在醫師大反彈了\n860510\t868615\t我簡單回應一下,第一個就是各區的公關,我相信你來行的,你是不是所有相關的委員會你都當過,其實在南區做得不錯但是這個現象都出現啊\n878961\t897235\t所以美國的模式,我們總是要突破嘛所以是可以用在各區也是共管,其實這樣各區也是自己共管只是方式不太一樣現在出現後遺症我們告訴你嘛我們一定是預防後遺症那像剛剛提出這個部分我們健保署去了解逼迫醫院去這樣做啊\n904201\t916947\t其實如果一個以,因為我也是醫師,我也非常反對影響到醫師的住宿專業錢跟一樣嘛,我們不管是醫藥都是專業的嘛,我們真的很不希望被影響但是怎麼樣慢慢的讓整個醫療的行為能夠\n922950\t947247\t能夠恢復健康經濟,然後對人民好我們價值理念都一樣,我現在在說就食物啦另外署長你在醫材,那個當然我在藥品太久了醫材的部分,你要grouping的時候,你要把它分類成同一組,當作你們是同一夥的同樣的東西,我只花一樣的錢去買的時候,還是要小心啊因為醫生說不同成分,裡面我一聽有磷血因子,加磷血因子當然貴啊\n949755\t969720\t當然我不知道,那林次長他給的那個國際要價不是他的國際要價然後大家就會以為說,就這麼貴你怎麼還要炒,炒的是醫生啊謝謝委員,我跟委員一樣都不是對所有的藥物都那麼清楚所以還是需要專家的意見為主啦所以我們會再回去,我們都有機制\n972140\t1000721\t我們這個過去全部都是自費啦過去都是自費現在才納入健保給付那至於一開始五月要納入健保給付他還有時間來申付他要提高價格把成本給我們看我們還是要為健保的財務把關啦所以我們要跟國際要價相比需要看他的成本合給一個合理的價格但是沒有他就隱藏他的自己的國際要價嘛你們這個共理會的表就隱藏他是空白啦只有他空白其他都有啊\n1001682\t1010937\t所以就是這個要出問題啦這個藥也不是最主流的藥所以其他主流的藥沒有問題所以供藥上沒有問題我以表達謝謝主席\n","txt":"謝謝主席,麻煩邱部長\n吳院長今天是五一勞動節所以我還是想跟部長您討論一下醫護這個勞動權益的問題龍頭醫院台大醫院你我都服務過的醫院吳院長他還蠻喜歡公開評論時事所以我想以他帶領龍頭醫院加上他這個特質我認為他應該要對自己要求這個自我要求是要更高的你同意吧龍頭醫院嘛然後他也會關心其他的事情\n但是台大工業企業工會剛會這個禮拜四月二十八號揭露台大院的荒唐行徑他在這個五月一號的這個假班別的一個議院調查表他只給護理人員兩個選項喔柏俊這都很清楚你有看過嗎\n你現在看兩個選項而已,同意到院工作後調一,國定假日,第二個同意到院工作後領加班費,否定這是依法要休假一整天,當天不上班的選項沒了,不見了,它只有兩個選項,我先跟你說,因為這個是\n一個非常清楚的事實台大醫院看似在徵詢醫院事實上是已經徵詢就是同仁的意願但事實上已經設計好了不管你勾哪一項你那天就是得來一定要出勤部長你覺得這樣做可以嗎\n謝謝委員,非常關心我們這種勞動的權益,我想也不只台大,全國所有的醫療業,台大是龍頭,我們先聽著台大這點台大有解說,這是針對來五一那天上班的人,給他們簽你是要選擇\n我跟您講台大企業工會 工會 他們做的調查77點多就超過四分之三的人說他們根本沒有備訓諮詢就直接排定了我給你做參考\n這個是臺大醫院說法,但事實上可能就不是如此博定還是請你要注意一下,雖然好像說臺大醫院是屬於教育部管,不過我想衛福部也是您到督導的對象博定他這個預例醫療決定推動到現在,您知道簽署率有多高嗎?簽署率有多少嗎?大概千分之1.31\n簽分之1.31 柏定拜託 高板櫃再不到百分之一 又簽分之幾統計學就是沒有嘛 等於沒有人簽嘛我大概可以這麼講 柏定你有簽嗎我有簽安寧環和醫療但病毒法沒有我覺得我們的意願都很清楚 已經可以表達了在安寧環和醫療法因為法推出以後就是鼓勵\n鼓勵後我們還是會看一下數字這也不是對錯的問題每一個人都是這間排審的三個版本它當然主要在經費之應場域放寬還有代理人的一個限制調整也許大家不太一樣不過我覺得方向是整個是正確的那就是要尊重這個意願人他自主權但是我也要提醒這個衛福部\n就是說你們對於這個所有醫護跟相關學會的意見要稍微去多多徵詢你知道以前的爭議點在哪裡嗎你知道以前的爭議點對 爭議點在什麼地方爭議點是在哪裡\n因為他的爭議點很多,病人自治權法案那個時候當時應該是蘇昭偉那個時代在推,但是我在學界應該也對這個法有相關的隱瞞因為爭議點是醫師說進戶中一陣子轉嫁給醫師,就是醫師背負太多的責任\n爭議點 那這個東西就是找醫護人員找他們來一起討論嘛怎麼樣讓他們就覺得是相對是讓他們願意做這樣的事情配合這樣的政策但是又不是說你責任最後都丟給我其實爭議點就是這個啦民眾黨我們期待的是有這個病毒法還要一個尊嚴善終法才能夠完善這個善終權那因為病毒法保障的是無效醫療嘛可以拒絕無效醫療 那自然善終一個選擇\n但是尊嚴善終是進一步讓極度痛苦的人透過嚴謹的程序然後他可以這個做自主來選擇他比較有尊嚴有體面的方式來結束生命兩者是一個互補就是可以完善一個生命自主跟尊嚴死亡那這是一個現代的價值這個衛福部現在好像都不想面對這個問題\n我們不管是衛福部的各個單位跟學界跟相關的委員會始終在面對這個問題不是沒有面對這個問題博不丁我是要跟你提起遲早要面對因為齁所有的民調大概有七八成的民眾台灣民眾是支持這個法案的但這個法案怎麼寫我知道要很小心很謹慎但是我跟博不丁這樣說啦博不丁賴總統4月27日出席健康台灣全國論壇提了很多見解\n當天也在場,所以我想你應該都很清楚那我賴總統有表達,政府提出這個癌藥基金100億元那他先編列50億元但並不是100億元用完就結束,不夠了就補上去,隔年再補這樣讓這個水庫可以保持一定水平那我想提醒部長\n百億癌藥基金是個中繼站的概念我對你講中繼站過去的意思就是病人要團體期待然後去參觀其他國家的做法就是有一些加速審查的藥品他可能還沒有完全確定但是有些病人他有需求所以他讓這個中繼站\n能夠暫時性的支付這類的藥品目前健保署還沒有改口雖然我們有很多已經確定療效的安全性的都沒有附滿附足但是這一塊本來是要做這個部分它是一個中繼站的概念你看賴總統也是用水庫的概念水庫本來水就是進進出出的那就是要加速通過藥來用那既然是中繼站的話真正的問題是新藥經過開放性使用用這筆錢\n那之後要評估嘛 因為你暫時性使用那目前大概都兩年嘛 署長沒有改變 大概兩年後評估嘛那兩年後評估有三個結果 柏中你要聽得很清楚你日理千機 賴總統日理萬機 你日理千機百機 你也是要清楚這件事那時署長要非常清楚 因為他在執行這件事情\n你現在兩年後,結果會有三個評估以後,一個淘汰出局就這個有在加速生產那個經不起考驗淘汰第二個我們覺得時間不夠要繼續觀察第三個他同意了,我們覺得他的療程安全都確定了所以我們要把它回歸到正常的使用\n這有三條路可以走不然我是要說的癌藥不斷的在研發需求也會增加百億如何分配我到現在看不到用完怎麼辦因為賴總統我覺得他不能理解很深入的是ok的因為日理萬機賴總統意思好像好像預期會有勝他先用多少不夠我再補他預期會有勝那部長你也會認為有勝嗎\n我有我的資深專業的那個經驗30年前告訴你 保留癌症病人絕對會面臨另外一個噩夢因為錢是不夠用的不夠用大概要讓這個滿足這一塊 幾百億都不夠那最後會怎麼樣呢 維持現況現況是什麼 就是不人道的方式你限制癌症病人使用的對象變得很小很窄然後限制他使用次數跟時間\n那這個這麼多先生這是第一個到最後回到現在的噩夢這個事情我可以確定是這樣第二個當剛剛我跟你說明過當挑選後經過評估因為要評估暫時中繼站那你要進進出出到哪個地方去根據美國的經驗繼續使用就確定療效大概有六成他沒有經驗所以我們先用美國的經驗有兩成大概淘汰還有兩成他大概說我們要更長時間的觀察那有這兩個事情在前提那我請問部長\n這個衛福部有規劃那個中長期的裁員嗎還是說你想說先擋個兩年拖個兩年再說呢好\n包委員真的非常敬佩您指教這麼多專業的一個做法我相信對未來在處理心療癌症這個預算能夠有很大的幫助但是我必須要講賴總統絕對存著就是希望希望說真的病人需要癌藥的時候我們就是想盡辦法\n給他充分 足夠及時那這個部分後面他立定了一個很這麼關懷我們前骨癌症的病人的方向以後原則我沒有問題那我們怎麼來把它做法嘛就是我們必須要來把它落實但是他有總統也特別強調說要多少就補多少\n就是要把我們的癌症的病人幫他照顧好 降低死亡率那署長我剛剛講的那些問題 你有瞭解嗎你也知道問題在哪裡嘛 對不對 加速的通過那你現在怎麼辦 你準備好了沒有 大概已經這個很快 你準備了這個要解決的問題 就是這個癌症新藥基金這個等於是讓我們在財務預估上可以算準確\n我們現在有的時候還不知道到底使用會有多少所以未來還是會回到健保基金一樣的它回到健保所以在這健保裡面去編列這個新藥預算的時候讓它可以等你有一個庫讓你先了解那我告訴你說美國大概六成人會回來你六成人回來錢都準備好了那你這樣病人怎麼辦我治療有效結果你不讓我繼續用惡夢出現\n無縫的接軌啦你今天也談不出這個100億怎麼分啦怎麼 allocation 怎麼分配啦這個還有很大的問題還是不夠因為賴總統他以為夠他還說不夠我就補回去不夠就補回去不夠的啦賴總統也覺得不夠啦不夠的話問題就來那你就開始要壓縮使用嘛壓縮就開始分配嘛\n分配就開始你誰先用這個就涉及每一個人的觀點主審的最大這個就是我跟你講很多人他不是真的要去圖利誰可是他有他自己的想法這個是很難處理的所以我也一直很關心這件事情然後現在我就回到說現在你的這個分區共管你知道這個有後遺症嗎不管署長或部長\n不同區域之一人之人本來就不均勻啦你分區共管那會不會惡化那個城鄉的差距呢而且如果地方管理適當齁那健保這個費用運用適當民眾群會不會受損那衛福部跟健保署是否已經有事辦範圍啊標準配套監督機制你就等於說幫他去管啊\n那每個醫院就管 你在這個情況下如果你在等於在自生自滅喔你不把總額這個大帽子拿掉你等於讓各地區各醫院自己去自生自滅喔\n現在已經發生了你看好我看下一張好了就是我告訴你這個現象你們大家知道你看現在醫院怎麼存活南部的醫學中心就在醫生的處方的螢光幕上跟你說跟你說我建議你開這個藥因為這個要打圈圈兩個圈圈為什麼呢因為利潤最高\n你難免逼著人家去做這件事嘛而且就是說還寫說敬請開立藥品時同時考慮醫療經濟學的成本效益其實藥品價格不代表醫療成本效益經濟學的但是它就是一個簡化的方式那他們的醫師自己說這些提示雖然沒有強制但是在這個院務會這個每一季的討論的時候你就科別業績沒搞\n你這個要被檢討 績效不好啊這個情況下醫師就被迫去勾那個藥啊已經出現了啦 部長署長 我想你們都知道吧醫院會建議你醫生怎麼藥 病人聽聽看我的意思是醫院建議他用哪一個藥那我的感覺呢 我的權益呢病醫生的專業權 自主權怎麼辦後遺症都出現 所以我才說\n你要分區各管但是你有沒有監測的配套的機制去看看這個品質嘛對不對就像署長昨天那個林靜儀的那件事情對不對他的他提出來的那個國際要價不是那個藥品的國際要價他把它污品掉了今天的專科醫師都跑出來講了所以他裡面那個不同的那個所謂的那個封口劑喔裡面有不同還有人添加凝血因子還有人添加防沾黏的功能根本都不一樣\n你把它全部從分類分組一個叫grouping他們最害怕這個字你沒有廠牌之分把它放在同一組用裡面最低的價錢林靜儀次長唸出來的這邊都有公開的資料他唸的不是那個藥品的國際藥價但是你們在分組的時候可能出問題現在醫師大反彈因為那個病只有一次救命的機會對不對大動脈剝離主動脈剝離只有一次救命機會他當時沒有辦法就沒有辦法\n如果你把它縫好了 水還是漏出來 雪還是漏出來就要靠這個凝膠去把它黏住就像淋到水管的私力控一樣嘛 對不對那它可能是本質不一樣 我是看專科醫師在談這件事情那你要把它放在同一組以後請林次長不懂 不要亂講話 現在醫師大反彈了\n我簡單回應一下,第一個就是各區的公關,我相信你來行的,你是不是所有相關的委員會你都當過,其實在南區做得不錯但是這個現象都出現啊\n所以美國的模式,我們總是要突破嘛所以是可以用在各區也是共管,其實這樣各區也是自己共管只是方式不太一樣現在出現後遺症我們告訴你嘛我們一定是預防後遺症那像剛剛提出這個部分我們健保署去了解逼迫醫院去這樣做啊\n其實如果一個以,因為我也是醫師,我也非常反對影響到醫師的住宿專業錢跟一樣嘛,我們不管是醫藥都是專業的嘛,我們真的很不希望被影響但是怎麼樣慢慢的讓整個醫療的行為能夠\n能夠恢復健康經濟,然後對人民好我們價值理念都一樣,我現在在說就食物啦另外署長你在醫材,那個當然我在藥品太久了醫材的部分,你要grouping的時候,你要把它分類成同一組,當作你們是同一夥的同樣的東西,我只花一樣的錢去買的時候,還是要小心啊因為醫生說不同成分,裡面我一聽有磷血因子,加磷血因子當然貴啊\n當然我不知道,那林次長他給的那個國際要價不是他的國際要價然後大家就會以為說,就這麼貴你怎麼還要炒,炒的是醫生啊謝謝委員,我跟委員一樣都不是對所有的藥物都那麼清楚所以還是需要專家的意見為主啦所以我們會再回去,我們都有機制\n我們這個過去全部都是自費啦過去都是自費現在才納入健保給付那至於一開始五月要納入健保給付他還有時間來申付他要提高價格把成本給我們看我們還是要為健保的財務把關啦所以我們要跟國際要價相比需要看他的成本合給一個合理的價格但是沒有他就隱藏他的自己的國際要價嘛你們這個共理會的表就隱藏他是空白啦只有他空白其他都有啊\n所以就是這個要出問題啦這個藥也不是最主流的藥所以其他主流的藥沒有問題所以供藥上沒有問題我以表達謝謝主席\n","vtt":"WEBVTT\n\n00:04.365 --> 00:05.171\n謝謝主席,麻煩邱部長\n\n00:10.703 --> 00:39.741\n吳院長今天是五一勞動節所以我還是想跟部長您討論一下醫護這個勞動權益的問題龍頭醫院台大醫院你我都服務過的醫院吳院長他還蠻喜歡公開評論時事所以我想以他帶領龍頭醫院加上他這個特質我認為他應該要對自己要求這個自我要求是要更高的你同意吧龍頭醫院嘛然後他也會關心其他的事情\n\n00:40.501 --> 00:57.017\n但是台大工業企業工會剛會這個禮拜四月二十八號揭露台大院的荒唐行徑他在這個五月一號的這個假班別的一個議院調查表他只給護理人員兩個選項喔柏俊這都很清楚你有看過嗎\n\n01:00.599 --> 01:15.888\n你現在看兩個選項而已,同意到院工作後調一,國定假日,第二個同意到院工作後領加班費,否定這是依法要休假一整天,當天不上班的選項沒了,不見了,它只有兩個選項,我先跟你說,因為這個是\n\n01:19.750 --> 01:34.911\n一個非常清楚的事實台大醫院看似在徵詢醫院事實上是已經徵詢就是同仁的意願但事實上已經設計好了不管你勾哪一項你那天就是得來一定要出勤部長你覺得這樣做可以嗎\n\n01:35.874 --> 01:54.200\n謝謝委員,非常關心我們這種勞動的權益,我想也不只台大,全國所有的醫療業,台大是龍頭,我們先聽著台大這點台大有解說,這是針對來五一那天上班的人,給他們簽你是要選擇\n\n01:57.282 --> 02:10.861\n我跟您講台大企業工會工會他們做的調查77點多就超過四分之三的人說他們根本沒有備訓諮詢就直接排定了我給你做參考\n\n02:12.883 --> 02:34.654\n這個是臺大醫院說法,但事實上可能就不是如此博定還是請你要注意一下,雖然好像說臺大醫院是屬於教育部管,不過我想衛福部也是您到督導的對象博定他這個預例醫療決定推動到現在,您知道簽署率有多高嗎?簽署率有多少嗎?大概千分之1.31\n\n02:36.711 --> 02:47.899\n簽分之1.31柏定拜託高板櫃再不到百分之一又簽分之幾統計學就是沒有嘛等於沒有人簽嘛我大概可以這麼講柏定你有簽嗎我有簽安寧環和醫療但病毒法沒有我覺得我們的意願都很清楚已經可以表達了在安寧環和醫療法因為法推出以後就是鼓勵\n\n03:05.331 --> 03:24.863\n鼓勵後我們還是會看一下數字這也不是對錯的問題每一個人都是這間排審的三個版本它當然主要在經費之應場域放寬還有代理人的一個限制調整也許大家不太一樣不過我覺得方向是整個是正確的那就是要尊重這個意願人他自主權但是我也要提醒這個衛福部\n\n03:25.964 --> 03:33.314\n就是說你們對於這個所有醫護跟相關學會的意見要稍微去多多徵詢你知道以前的爭議點在哪裡嗎你知道以前的爭議點對爭議點在什麼地方爭議點是在哪裡\n\n03:46.605 --> 03:53.027\n因為他的爭議點很多,病人自治權法案那個時候當時應該是蘇昭偉那個時代在推,但是我在學界應該也對這個法有相關的隱瞞因為爭議點是醫師說進戶中一陣子轉嫁給醫師,就是醫師背負太多的責任\n\n04:09.633 --> 04:37.231\n爭議點那這個東西就是找醫護人員找他們來一起討論嘛怎麼樣讓他們就覺得是相對是讓他們願意做這樣的事情配合這樣的政策但是又不是說你責任最後都丟給我其實爭議點就是這個啦民眾黨我們期待的是有這個病毒法還要一個尊嚴善終法才能夠完善這個善終權那因為病毒法保障的是無效醫療嘛可以拒絕無效醫療那自然善終一個選擇\n\n04:38.132 --> 05:00.418\n但是尊嚴善終是進一步讓極度痛苦的人透過嚴謹的程序然後他可以這個做自主來選擇他比較有尊嚴有體面的方式來結束生命兩者是一個互補就是可以完善一個生命自主跟尊嚴死亡那這是一個現代的價值這個衛福部現在好像都不想面對這個問題\n\n05:03.906 --> 05:26.119\n我們不管是衛福部的各個單位跟學界跟相關的委員會始終在面對這個問題不是沒有面對這個問題博不丁我是要跟你提起遲早要面對因為齁所有的民調大概有七八成的民眾台灣民眾是支持這個法案的但這個法案怎麼寫我知道要很小心很謹慎但是我跟博不丁這樣說啦博不丁賴總統4月27日出席健康台灣全國論壇提了很多見解\n\n05:31.122 --> 05:51.810\n當天也在場,所以我想你應該都很清楚那我賴總統有表達,政府提出這個癌藥基金100億元那他先編列50億元但並不是100億元用完就結束,不夠了就補上去,隔年再補這樣讓這個水庫可以保持一定水平那我想提醒部長\n\n05:53.371 --> 06:11.278\n百億癌藥基金是個中繼站的概念我對你講中繼站過去的意思就是病人要團體期待然後去參觀其他國家的做法就是有一些加速審查的藥品他可能還沒有完全確定但是有些病人他有需求所以他讓這個中繼站\n\n06:12.859 --> 06:39.259\n能夠暫時性的支付這類的藥品目前健保署還沒有改口雖然我們有很多已經確定療效的安全性的都沒有附滿附足但是這一塊本來是要做這個部分它是一個中繼站的概念你看賴總統也是用水庫的概念水庫本來水就是進進出出的那就是要加速通過藥來用那既然是中繼站的話真正的問題是新藥經過開放性使用用這筆錢\n\n06:41.040 --> 07:00.787\n那之後要評估嘛因為你暫時性使用那目前大概都兩年嘛署長沒有改變大概兩年後評估嘛那兩年後評估有三個結果柏中你要聽得很清楚你日理千機賴總統日理萬機你日理千機百機你也是要清楚這件事那時署長要非常清楚因為他在執行這件事情\n\n07:01.747 --> 07:19.142\n你現在兩年後,結果會有三個評估以後,一個淘汰出局就這個有在加速生產那個經不起考驗淘汰第二個我們覺得時間不夠要繼續觀察第三個他同意了,我們覺得他的療程安全都確定了所以我們要把它回歸到正常的使用\n\n07:21.103 --> 07:43.591\n這有三條路可以走不然我是要說的癌藥不斷的在研發需求也會增加百億如何分配我到現在看不到用完怎麼辦因為賴總統我覺得他不能理解很深入的是ok的因為日理萬機賴總統意思好像好像預期會有勝他先用多少不夠我再補他預期會有勝那部長你也會認為有勝嗎\n\n07:48.092 --> 08:13.638\n我有我的資深專業的那個經驗30年前告訴你保留癌症病人絕對會面臨另外一個噩夢因為錢是不夠用的不夠用大概要讓這個滿足這一塊幾百億都不夠那最後會怎麼樣呢維持現況現況是什麼就是不人道的方式你限制癌症病人使用的對象變得很小很窄然後限制他使用次數跟時間\n\n08:15.398 --> 08:35.711\n那這個這麼多先生這是第一個到最後回到現在的噩夢這個事情我可以確定是這樣第二個當剛剛我跟你說明過當挑選後經過評估因為要評估暫時中繼站那你要進進出出到哪個地方去根據美國的經驗繼續使用就確定療效大概有六成他沒有經驗所以我們先用美國的經驗有兩成大概淘汰還有兩成他大概說我們要更長時間的觀察那有這兩個事情在前提那我請問部長\n\n08:44.717 --> 08:50.782\n這個衛福部有規劃那個中長期的裁員嗎還是說你想說先擋個兩年拖個兩年再說呢好\n\n08:52.933 --> 09:07.460\n包委員真的非常敬佩您指教這麼多專業的一個做法我相信對未來在處理心療癌症這個預算能夠有很大的幫助但是我必須要講賴總統絕對存著就是希望希望說真的病人需要癌藥的時候我們就是想盡辦法\n\n09:17.845 --> 09:29.413\n給他充分足夠及時那這個部分後面他立定了一個很這麼關懷我們前骨癌症的病人的方向以後原則我沒有問題那我們怎麼來把它做法嘛就是我們必須要來把它落實但是他有總統也特別強調說要多少就補多少\n\n09:47.725 --> 10:13.547\n就是要把我們的癌症的病人幫他照顧好降低死亡率那署長我剛剛講的那些問題你有瞭解嗎你也知道問題在哪裡嘛對不對加速的通過那你現在怎麼辦你準備好了沒有大概已經這個很快你準備了這個要解決的問題就是這個癌症新藥基金這個等於是讓我們在財務預估上可以算準確\n\n10:15.008 --> 10:37.469\n我們現在有的時候還不知道到底使用會有多少所以未來還是會回到健保基金一樣的它回到健保所以在這健保裡面去編列這個新藥預算的時候讓它可以等你有一個庫讓你先了解那我告訴你說美國大概六成人會回來你六成人回來錢都準備好了那你這樣病人怎麼辦我治療有效結果你不讓我繼續用惡夢出現\n\n10:40.452 --> 10:43.794\n無縫的接軌啦你今天也談不出這個100億怎麼分啦怎麼allocation怎麼分配啦這個還有很大的問題還是不夠因為賴總統他以為夠他還說不夠我就補回去不夠就補回去不夠的啦賴總統也覺得不夠啦不夠的話問題就來那你就開始要壓縮使用嘛壓縮就開始分配嘛\n\n11:01.303 --> 11:16.521\n分配就開始你誰先用這個就涉及每一個人的觀點主審的最大這個就是我跟你講很多人他不是真的要去圖利誰可是他有他自己的想法這個是很難處理的所以我也一直很關心這件事情然後現在我就回到說現在你的這個分區共管你知道這個有後遺症嗎不管署長或部長\n\n11:21.607 --> 11:40.107\n不同區域之一人之人本來就不均勻啦你分區共管那會不會惡化那個城鄉的差距呢而且如果地方管理適當齁那健保這個費用運用適當民眾群會不會受損那衛福部跟健保署是否已經有事辦範圍啊標準配套監督機制你就等於說幫他去管啊\n\n11:41.488 --> 11:51.513\n那每個醫院就管你在這個情況下如果你在等於在自生自滅喔你不把總額這個大帽子拿掉你等於讓各地區各醫院自己去自生自滅喔\n\n11:53.206 --> 12:06.877\n現在已經發生了你看好我看下一張好了就是我告訴你這個現象你們大家知道你看現在醫院怎麼存活南部的醫學中心就在醫生的處方的螢光幕上跟你說跟你說我建議你開這個藥因為這個要打圈圈兩個圈圈為什麼呢因為利潤最高\n\n12:11.661 --> 12:14.982\n你難免逼著人家去做這件事嘛而且就是說還寫說敬請開立藥品時同時考慮醫療經濟學的成本效益其實藥品價格不代表醫療成本效益經濟學的但是它就是一個簡化的方式那他們的醫師自己說這些提示雖然沒有強制但是在這個院務會這個每一季的討論的時候你就科別業績沒搞\n\n12:38.050 --> 12:52.642\n你這個要被檢討績效不好啊這個情況下醫師就被迫去勾那個藥啊已經出現了啦部長署長我想你們都知道吧醫院會建議你醫生怎麼藥病人聽聽看我的意思是醫院建議他用哪一個藥那我的感覺呢我的權益呢病醫生的專業權自主權怎麼辦後遺症都出現所以我才說\n\n13:01.829 --> 13:07.170\n你要分區各管但是你有沒有監測的配套的機制去看看這個品質嘛對不對就像署長昨天那個林靜儀的那件事情對不對他的他提出來的那個國際要價不是那個藥品的國際要價他把它污品掉了今天的專科醫師都跑出來講了所以他裡面那個不同的那個所謂的那個封口劑喔裡面有不同還有人添加凝血因子還有人添加防沾黏的功能根本都不一樣\n\n13:31.414 --> 13:42.039\n你把它全部從分類分組一個叫grouping他們最害怕這個字你沒有廠牌之分把它放在同一組用裡面最低的價錢林靜儀次長唸出來的這邊都有公開的資料他唸的不是那個藥品的國際藥價但是你們在分組的時候可能出問題現在醫師大反彈因為那個病只有一次救命的機會對不對大動脈剝離主動脈剝離只有一次救命機會他當時沒有辦法就沒有辦法\n\n13:58.687 --> 14:11.981\n如果你把它縫好了水還是漏出來雪還是漏出來就要靠這個凝膠去把它黏住就像淋到水管的私力控一樣嘛對不對那它可能是本質不一樣我是看專科醫師在談這件事情那你要把它放在同一組以後請林次長不懂不要亂講話現在醫師大反彈了\n\n14:20.510 --> 14:28.615\n我簡單回應一下,第一個就是各區的公關,我相信你來行的,你是不是所有相關的委員會你都當過,其實在南區做得不錯但是這個現象都出現啊\n\n14:38.961 --> 14:57.235\n所以美國的模式,我們總是要突破嘛所以是可以用在各區也是共管,其實這樣各區也是自己共管只是方式不太一樣現在出現後遺症我們告訴你嘛我們一定是預防後遺症那像剛剛提出這個部分我們健保署去了解逼迫醫院去這樣做啊\n\n15:04.201 --> 15:16.947\n其實如果一個以,因為我也是醫師,我也非常反對影響到醫師的住宿專業錢跟一樣嘛,我們不管是醫藥都是專業的嘛,我們真的很不希望被影響但是怎麼樣慢慢的讓整個醫療的行為能夠\n\n15:22.950 --> 15:47.247\n能夠恢復健康經濟,然後對人民好我們價值理念都一樣,我現在在說就食物啦另外署長你在醫材,那個當然我在藥品太久了醫材的部分,你要grouping的時候,你要把它分類成同一組,當作你們是同一夥的同樣的東西,我只花一樣的錢去買的時候,還是要小心啊因為醫生說不同成分,裡面我一聽有磷血因子,加磷血因子當然貴啊\n\n15:49.755 --> 16:09.720\n當然我不知道,那林次長他給的那個國際要價不是他的國際要價然後大家就會以為說,就這麼貴你怎麼還要炒,炒的是醫生啊謝謝委員,我跟委員一樣都不是對所有的藥物都那麼清楚所以還是需要專家的意見為主啦所以我們會再回去,我們都有機制\n\n16:12.140 --> 16:40.721\n我們這個過去全部都是自費啦過去都是自費現在才納入健保給付那至於一開始五月要納入健保給付他還有時間來申付他要提高價格把成本給我們看我們還是要為健保的財務把關啦所以我們要跟國際要價相比需要看他的成本合給一個合理的價格但是沒有他就隱藏他的自己的國際要價嘛你們這個共理會的表就隱藏他是空白啦只有他空白其他都有啊\n\n16:41.682 --> 16:50.937\n所以就是這個要出問題啦這個藥也不是最主流的藥所以其他主流的藥沒有問題所以供藥上沒有問題我以表達謝謝主席\n\n","segments":[{"start":4.365,"end":5.171,"text":"謝謝主席,麻煩邱部長"},{"start":10.703,"end":39.741,"text":"吳院長今天是五一勞動節所以我還是想跟部長您討論一下醫護這個勞動權益的問題龍頭醫院台大醫院你我都服務過的醫院吳院長他還蠻喜歡公開評論時事所以我想以他帶領龍頭醫院加上他這個特質我認為他應該要對自己要求這個自我要求是要更高的你同意吧龍頭醫院嘛然後他也會關心其他的事情"},{"start":40.501,"end":57.017,"text":"但是台大工業企業工會剛會這個禮拜四月二十八號揭露台大院的荒唐行徑他在這個五月一號的這個假班別的一個議院調查表他只給護理人員兩個選項喔柏俊這都很清楚你有看過嗎"},{"start":60.599,"end":75.888,"text":"你現在看兩個選項而已,同意到院工作後調一,國定假日,第二個同意到院工作後領加班費,否定這是依法要休假一整天,當天不上班的選項沒了,不見了,它只有兩個選項,我先跟你說,因為這個是"},{"start":79.75,"end":94.911,"text":"一個非常清楚的事實台大醫院看似在徵詢醫院事實上是已經徵詢就是同仁的意願但事實上已經設計好了不管你勾哪一項你那天就是得來一定要出勤部長你覺得這樣做可以嗎"},{"start":95.874,"end":114.2,"text":"謝謝委員,非常關心我們這種勞動的權益,我想也不只台大,全國所有的醫療業,台大是龍頭,我們先聽著台大這點台大有解說,這是針對來五一那天上班的人,給他們簽你是要選擇"},{"start":117.282,"end":130.861,"text":"我跟您講台大企業工會 工會 他們做的調查77點多就超過四分之三的人說他們根本沒有備訓諮詢就直接排定了我給你做參考"},{"start":132.883,"end":154.654,"text":"這個是臺大醫院說法,但事實上可能就不是如此博定還是請你要注意一下,雖然好像說臺大醫院是屬於教育部管,不過我想衛福部也是您到督導的對象博定他這個預例醫療決定推動到現在,您知道簽署率有多高嗎?簽署率有多少嗎?大概千分之1.31"},{"start":156.711,"end":167.899,"text":"簽分之1.31 柏定拜託 高板櫃再不到百分之一 又簽分之幾統計學就是沒有嘛 等於沒有人簽嘛我大概可以這麼講 柏定你有簽嗎我有簽安寧環和醫療但病毒法沒有我覺得我們的意願都很清楚 已經可以表達了在安寧環和醫療法因為法推出以後就是鼓勵"},{"start":185.331,"end":204.863,"text":"鼓勵後我們還是會看一下數字這也不是對錯的問題每一個人都是這間排審的三個版本它當然主要在經費之應場域放寬還有代理人的一個限制調整也許大家不太一樣不過我覺得方向是整個是正確的那就是要尊重這個意願人他自主權但是我也要提醒這個衛福部"},{"start":205.964,"end":213.314,"text":"就是說你們對於這個所有醫護跟相關學會的意見要稍微去多多徵詢你知道以前的爭議點在哪裡嗎你知道以前的爭議點對 爭議點在什麼地方爭議點是在哪裡"},{"start":226.605,"end":233.027,"text":"因為他的爭議點很多,病人自治權法案那個時候當時應該是蘇昭偉那個時代在推,但是我在學界應該也對這個法有相關的隱瞞因為爭議點是醫師說進戶中一陣子轉嫁給醫師,就是醫師背負太多的責任"},{"start":249.633,"end":277.231,"text":"爭議點 那這個東西就是找醫護人員找他們來一起討論嘛怎麼樣讓他們就覺得是相對是讓他們願意做這樣的事情配合這樣的政策但是又不是說你責任最後都丟給我其實爭議點就是這個啦民眾黨我們期待的是有這個病毒法還要一個尊嚴善終法才能夠完善這個善終權那因為病毒法保障的是無效醫療嘛可以拒絕無效醫療 那自然善終一個選擇"},{"start":278.132,"end":300.418,"text":"但是尊嚴善終是進一步讓極度痛苦的人透過嚴謹的程序然後他可以這個做自主來選擇他比較有尊嚴有體面的方式來結束生命兩者是一個互補就是可以完善一個生命自主跟尊嚴死亡那這是一個現代的價值這個衛福部現在好像都不想面對這個問題"},{"start":303.906,"end":326.119,"text":"我們不管是衛福部的各個單位跟學界跟相關的委員會始終在面對這個問題不是沒有面對這個問題博不丁我是要跟你提起遲早要面對因為齁所有的民調大概有七八成的民眾台灣民眾是支持這個法案的但這個法案怎麼寫我知道要很小心很謹慎但是我跟博不丁這樣說啦博不丁賴總統4月27日出席健康台灣全國論壇提了很多見解"},{"start":331.122,"end":351.81,"text":"當天也在場,所以我想你應該都很清楚那我賴總統有表達,政府提出這個癌藥基金100億元那他先編列50億元但並不是100億元用完就結束,不夠了就補上去,隔年再補這樣讓這個水庫可以保持一定水平那我想提醒部長"},{"start":353.371,"end":371.278,"text":"百億癌藥基金是個中繼站的概念我對你講中繼站過去的意思就是病人要團體期待然後去參觀其他國家的做法就是有一些加速審查的藥品他可能還沒有完全確定但是有些病人他有需求所以他讓這個中繼站"},{"start":372.859,"end":399.259,"text":"能夠暫時性的支付這類的藥品目前健保署還沒有改口雖然我們有很多已經確定療效的安全性的都沒有附滿附足但是這一塊本來是要做這個部分它是一個中繼站的概念你看賴總統也是用水庫的概念水庫本來水就是進進出出的那就是要加速通過藥來用那既然是中繼站的話真正的問題是新藥經過開放性使用用這筆錢"},{"start":401.04,"end":420.787,"text":"那之後要評估嘛 因為你暫時性使用那目前大概都兩年嘛 署長沒有改變 大概兩年後評估嘛那兩年後評估有三個結果 柏中你要聽得很清楚你日理千機 賴總統日理萬機 你日理千機百機 你也是要清楚這件事那時署長要非常清楚 因為他在執行這件事情"},{"start":421.747,"end":439.142,"text":"你現在兩年後,結果會有三個評估以後,一個淘汰出局就這個有在加速生產那個經不起考驗淘汰第二個我們覺得時間不夠要繼續觀察第三個他同意了,我們覺得他的療程安全都確定了所以我們要把它回歸到正常的使用"},{"start":441.103,"end":463.591,"text":"這有三條路可以走不然我是要說的癌藥不斷的在研發需求也會增加百億如何分配我到現在看不到用完怎麼辦因為賴總統我覺得他不能理解很深入的是ok的因為日理萬機賴總統意思好像好像預期會有勝他先用多少不夠我再補他預期會有勝那部長你也會認為有勝嗎"},{"start":468.092,"end":493.638,"text":"我有我的資深專業的那個經驗30年前告訴你 保留癌症病人絕對會面臨另外一個噩夢因為錢是不夠用的不夠用大概要讓這個滿足這一塊 幾百億都不夠那最後會怎麼樣呢 維持現況現況是什麼 就是不人道的方式你限制癌症病人使用的對象變得很小很窄然後限制他使用次數跟時間"},{"start":495.398,"end":515.711,"text":"那這個這麼多先生這是第一個到最後回到現在的噩夢這個事情我可以確定是這樣第二個當剛剛我跟你說明過當挑選後經過評估因為要評估暫時中繼站那你要進進出出到哪個地方去根據美國的經驗繼續使用就確定療效大概有六成他沒有經驗所以我們先用美國的經驗有兩成大概淘汰還有兩成他大概說我們要更長時間的觀察那有這兩個事情在前提那我請問部長"},{"start":524.717,"end":530.782,"text":"這個衛福部有規劃那個中長期的裁員嗎還是說你想說先擋個兩年拖個兩年再說呢好"},{"start":532.933,"end":547.46,"text":"包委員真的非常敬佩您指教這麼多專業的一個做法我相信對未來在處理心療癌症這個預算能夠有很大的幫助但是我必須要講賴總統絕對存著就是希望希望說真的病人需要癌藥的時候我們就是想盡辦法"},{"start":557.845,"end":569.413,"text":"給他充分 足夠及時那這個部分後面他立定了一個很這麼關懷我們前骨癌症的病人的方向以後原則我沒有問題那我們怎麼來把它做法嘛就是我們必須要來把它落實但是他有總統也特別強調說要多少就補多少"},{"start":587.725,"end":613.547,"text":"就是要把我們的癌症的病人幫他照顧好 降低死亡率那署長我剛剛講的那些問題 你有瞭解嗎你也知道問題在哪裡嘛 對不對 加速的通過那你現在怎麼辦 你準備好了沒有 大概已經這個很快 你準備了這個要解決的問題 就是這個癌症新藥基金這個等於是讓我們在財務預估上可以算準確"},{"start":615.008,"end":637.469,"text":"我們現在有的時候還不知道到底使用會有多少所以未來還是會回到健保基金一樣的它回到健保所以在這健保裡面去編列這個新藥預算的時候讓它可以等你有一個庫讓你先了解那我告訴你說美國大概六成人會回來你六成人回來錢都準備好了那你這樣病人怎麼辦我治療有效結果你不讓我繼續用惡夢出現"},{"start":640.452,"end":643.794,"text":"無縫的接軌啦你今天也談不出這個100億怎麼分啦怎麼 allocation 怎麼分配啦這個還有很大的問題還是不夠因為賴總統他以為夠他還說不夠我就補回去不夠就補回去不夠的啦賴總統也覺得不夠啦不夠的話問題就來那你就開始要壓縮使用嘛壓縮就開始分配嘛"},{"start":661.303,"end":676.521,"text":"分配就開始你誰先用這個就涉及每一個人的觀點主審的最大這個就是我跟你講很多人他不是真的要去圖利誰可是他有他自己的想法這個是很難處理的所以我也一直很關心這件事情然後現在我就回到說現在你的這個分區共管你知道這個有後遺症嗎不管署長或部長"},{"start":681.607,"end":700.107,"text":"不同區域之一人之人本來就不均勻啦你分區共管那會不會惡化那個城鄉的差距呢而且如果地方管理適當齁那健保這個費用運用適當民眾群會不會受損那衛福部跟健保署是否已經有事辦範圍啊標準配套監督機制你就等於說幫他去管啊"},{"start":701.488,"end":711.513,"text":"那每個醫院就管 你在這個情況下如果你在等於在自生自滅喔你不把總額這個大帽子拿掉你等於讓各地區各醫院自己去自生自滅喔"},{"start":713.206,"end":726.877,"text":"現在已經發生了你看好我看下一張好了就是我告訴你這個現象你們大家知道你看現在醫院怎麼存活南部的醫學中心就在醫生的處方的螢光幕上跟你說跟你說我建議你開這個藥因為這個要打圈圈兩個圈圈為什麼呢因為利潤最高"},{"start":731.661,"end":734.982,"text":"你難免逼著人家去做這件事嘛而且就是說還寫說敬請開立藥品時同時考慮醫療經濟學的成本效益其實藥品價格不代表醫療成本效益經濟學的但是它就是一個簡化的方式那他們的醫師自己說這些提示雖然沒有強制但是在這個院務會這個每一季的討論的時候你就科別業績沒搞"},{"start":758.05,"end":772.642,"text":"你這個要被檢討 績效不好啊這個情況下醫師就被迫去勾那個藥啊已經出現了啦 部長署長 我想你們都知道吧醫院會建議你醫生怎麼藥 病人聽聽看我的意思是醫院建議他用哪一個藥那我的感覺呢 我的權益呢病醫生的專業權 自主權怎麼辦後遺症都出現 所以我才說"},{"start":781.829,"end":787.17,"text":"你要分區各管但是你有沒有監測的配套的機制去看看這個品質嘛對不對就像署長昨天那個林靜儀的那件事情對不對他的他提出來的那個國際要價不是那個藥品的國際要價他把它污品掉了今天的專科醫師都跑出來講了所以他裡面那個不同的那個所謂的那個封口劑喔裡面有不同還有人添加凝血因子還有人添加防沾黏的功能根本都不一樣"},{"start":811.414,"end":822.039,"text":"你把它全部從分類分組一個叫grouping他們最害怕這個字你沒有廠牌之分把它放在同一組用裡面最低的價錢林靜儀次長唸出來的這邊都有公開的資料他唸的不是那個藥品的國際藥價但是你們在分組的時候可能出問題現在醫師大反彈因為那個病只有一次救命的機會對不對大動脈剝離主動脈剝離只有一次救命機會他當時沒有辦法就沒有辦法"},{"start":838.687,"end":851.981,"text":"如果你把它縫好了 水還是漏出來 雪還是漏出來就要靠這個凝膠去把它黏住就像淋到水管的私力控一樣嘛 對不對那它可能是本質不一樣 我是看專科醫師在談這件事情那你要把它放在同一組以後請林次長不懂 不要亂講話 現在醫師大反彈了"},{"start":860.51,"end":868.615,"text":"我簡單回應一下,第一個就是各區的公關,我相信你來行的,你是不是所有相關的委員會你都當過,其實在南區做得不錯但是這個現象都出現啊"},{"start":878.961,"end":897.235,"text":"所以美國的模式,我們總是要突破嘛所以是可以用在各區也是共管,其實這樣各區也是自己共管只是方式不太一樣現在出現後遺症我們告訴你嘛我們一定是預防後遺症那像剛剛提出這個部分我們健保署去了解逼迫醫院去這樣做啊"},{"start":904.201,"end":916.947,"text":"其實如果一個以,因為我也是醫師,我也非常反對影響到醫師的住宿專業錢跟一樣嘛,我們不管是醫藥都是專業的嘛,我們真的很不希望被影響但是怎麼樣慢慢的讓整個醫療的行為能夠"},{"start":922.95,"end":947.247,"text":"能夠恢復健康經濟,然後對人民好我們價值理念都一樣,我現在在說就食物啦另外署長你在醫材,那個當然我在藥品太久了醫材的部分,你要grouping的時候,你要把它分類成同一組,當作你們是同一夥的同樣的東西,我只花一樣的錢去買的時候,還是要小心啊因為醫生說不同成分,裡面我一聽有磷血因子,加磷血因子當然貴啊"},{"start":949.755,"end":969.72,"text":"當然我不知道,那林次長他給的那個國際要價不是他的國際要價然後大家就會以為說,就這麼貴你怎麼還要炒,炒的是醫生啊謝謝委員,我跟委員一樣都不是對所有的藥物都那麼清楚所以還是需要專家的意見為主啦所以我們會再回去,我們都有機制"},{"start":972.14,"end":1000.721,"text":"我們這個過去全部都是自費啦過去都是自費現在才納入健保給付那至於一開始五月要納入健保給付他還有時間來申付他要提高價格把成本給我們看我們還是要為健保的財務把關啦所以我們要跟國際要價相比需要看他的成本合給一個合理的價格但是沒有他就隱藏他的自己的國際要價嘛你們這個共理會的表就隱藏他是空白啦只有他空白其他都有啊"},{"start":1001.682,"end":1010.937,"text":"所以就是這個要出問題啦這個藥也不是最主流的藥所以其他主流的藥沒有問題所以供藥上沒有問題我以表達謝謝主席"}]}}},"gazette":{"lineno":76,"blocks":[["陳委員昭姿：（9時12分）謝謝主席。麻煩邱部長。"],["主席：請部長。"],["邱部長泰源：委員早。"],["陳委員昭姿：部長早。今天是五一勞動節，所以我還是想一開始就先跟部長討論一下醫護勞動權益的問題。部長，龍頭醫院──臺大醫院是你我都服務過的醫院，吳院長還蠻喜歡公開評論時事，以他帶領龍頭醫院，加上他的這個特質，我認為他對自我的要求應該是要更高的，你同意吧？"],["邱部長泰源：是的，同意。"],["陳委員昭姿：是龍頭醫院，然後他也會關心其他的事情。但是臺大醫院企業工會這個禮拜一（4月28號）揭露臺大醫院的荒唐行徑，它在5月1號的班別意願調查表只給護理人員兩個選項，部長，這都很清楚，你有看過嗎？"],["邱部長泰源：我知道這件事。"],["陳委員昭姿：好，你現在看，只有兩個選項而已，分別是：同意到院工作後調移國定假日；第二個，同意到院工作後領加班費。部長，這是依法要休假一整天，但當天不上班的選項不見了，它只有兩個選項。我先跟你說，因為這是一個非常清楚的事實，臺大醫院看似在徵詢同仁意願，但事實上已經設計好了，不管你勾哪一項，你那天就是得來，一定要出勤。部長，你覺得這樣做可以嗎？"],["邱部長泰源：謝謝委員非常關心醫護勞動的權益，我想也不只臺大，全國所有的醫療院所都要做……"],["陳委員昭姿：臺大是龍頭，我們先盯著臺大。"],["邱部長泰源：這點臺大有解釋，這是針對五一那天上班的人，給他們簽是要選擇……"],["陳委員昭姿：部長，我知道你的說法，我跟你說，臺大醫院企業工會做的調查，有百分之七十七點多，就是超過四分之三的人說他們根本沒有被諮詢，就直接排定了，我給你參考。"],["邱部長泰源：好，沒關係，這個我們會……"],["陳委員昭姿：這個是臺大醫院的說法，但事實上可能不是如此，部長，還是請你要注意一下，雖然臺大醫院好像是屬於教育部管，不過我想也是衛福部要督導的對象。"],["邱部長泰源：我們會注意。"],["陳委員昭姿：部長，預立醫療決定推動到現在，您知道簽署率有多高、簽署率有多少嗎？"],["邱部長泰源：大概千分之一點三一。"],["陳委員昭姿：千分之一點三一！部長拜託，九萬多人，不到百分之一，還說千分之幾，在統計學上就等於沒有人簽嘛！我大概可以這麼講了。部長，你自己有簽嗎？"],["邱部長泰源：那個時候我有簽安寧緩和醫療……"],["陳委員昭姿：但病主法沒有。"],["邱部長泰源：我覺得我們的意願都已經很清楚可以表達了，在安寧緩和醫療法裡面。"],["陳委員昭姿：法推出以後就是鼓勵，鼓勵後我們還是會看一下數字，這也不是對錯的問題，而是每個人的想法。今天排審的3個版本主要的重點在經費支應、場域放寬，還有代理人的限制調整。也許大家不太一樣，不過我覺得整個方向是正確的，就是要尊重意願人的自主權。但是我也要提醒衛福部，對於所有醫護跟相關學會的意見你們要多多去徵詢。部長，你知道以前的爭議點在哪裡嗎？"],["邱部長泰源：你說病人自主權法案嗎？"],["陳委員昭姿：對，它的爭議點在什麼地方？最大的爭議點是在哪裡？"],["邱部長泰源：它的爭議點很多，病人自主權法案當時應該是蘇召委那個時代在推……"],["陳委員昭姿：我了解，等一下我還要再跟你談另外一個法案。"],["邱部長泰源：但是我在學界應該也對這個法有相關的……"],["陳委員昭姿：它的爭議點是醫師說政府將責任轉嫁給醫師，就是醫師背負太多的責任。這個東西就是找醫護人員來一起討論嘛！怎麼樣讓他們覺得相對願意做這樣的事情，配合這樣的政策，但是又不是最後把責任都丟給他們，其實爭議點就是這個啦！","部長，民眾黨期待的是有這個病主法，還要有一個尊嚴善終法，才能夠完善善終權，因為病主法保障的是可以拒絕無效醫療，是自然善終的一個選擇；但是尊嚴善終法是進一步讓極度痛苦的人透過嚴謹的程序，他可以自主選擇比較有尊嚴、體面的方式來結束生命，兩者互補，可以完善生命自主跟尊嚴死亡，這是一個現代的價值。部長，衛福部現在好像都不想面對尊嚴善終法這個問題。"],["邱部長泰源：報告委員，我們不管是衛福部的各個單位，跟學界、跟相關委員會，始終在面對這個問題，不是沒有面對這個問題。"],["陳委員昭姿：部長，我是要提醒你，遲早要面對，因為所有的民調，大概有七、八成的臺灣民眾是支持這個法案的，但這個法案怎麼寫？我知道要很小心、很謹慎，但是我要這樣跟部長說。","部長，賴總統4月27日出席「健康台灣全國論壇」，提了很多見解，您當天也在場，所以你應該都很清楚，賴總統有表示，政府提出癌藥基金100億元，他先編列50億元，但並不是100億元用完就結束，不夠了就補上去，隔年再補，讓這個水庫可以保持一定水位。我想提醒部長，百億癌藥基金是個中繼站的概念，部長知道中繼站過去的意思是，病人要團體期待，然後去參考其他國家的作法，就是有一些加速審查的藥品，可能還沒有完全確定，但是有些病人有需求，所以他讓這個中繼站能夠暫時性的支付這類藥品。目前健保署還沒有改口，雖然我們有很多已經確定療效的、安全性的，都沒有付滿付足，但是這一塊本來是要做這個部分，它是一個中繼站的概念。你看賴總統也是用水庫的概念，水庫的水本來就是進進出出，就是要加速通過藥來用。既然是中繼站的概念，真正的問題是，新藥經過開放性使用，用這筆錢，之後要評估，因為這是暫時性使用，目前大概都兩年，署長，沒有改變吧？大概是兩年後評估，兩年後評估有三個結果。部長，你要聽清楚，賴總統日理萬機，你日理千機、百機，你也是要清楚這件事，石署長更要非常清楚，因為他在執行這件事情。現在兩年後評估結果會有三個，第一個是淘汰出局，這個藥禁不起考驗，被淘汰。第二個，我們覺得時間不夠，要繼續觀察。第三個，他同意了，我們覺得它的療效、安全性都確定了，所以要把它回歸到正常使用。有這三條路可以走。","部長，我要說的是，癌藥不斷地在研發，需求也會增加，百億如何分配？我到現在還看不到。用完怎麼辦？賴總統不能理解得很深入，我覺得是OK的，因為他日理萬機，但賴總統的意思好像是預期會有剩，它先用多少，不夠再補，他預期會有剩。部長，你也認為會有剩嗎？你先不要說，我用我30年的資深專業經驗告訴你，癌症病人絕對會面臨另外一個噩夢，因為錢是不夠用的，要滿足這一塊，幾百億都不夠！最後會怎麼樣呢？就是維持現況，現況是什麼？就是繼續不人道的方式，你限制癌症病人使用的對象變得很小、很窄，然後限制他使用的次數跟時間，這麼多限制，這是第一個，到最後回到現在的噩夢，這個事情我可以確定是這樣。第二個，剛剛我跟你說明過，當挑選後經過評估，因為是中繼站，你要進進出出到哪個地方去？根據美國的經驗，繼續使用，就是確定療效的大概有六成，臺灣沒有經驗，所以我們先用美國的經驗，然後大概有兩成淘汰，還有兩成還要更長時間的觀察。有這兩個事情作為前提，請問部長，衛福部有規劃中長期的財源嗎？還是你想說先擋個兩年、拖個兩年再說呢？"],["邱部長泰源：報告委員，真的非常敬佩您指教這麼多專業的作法，我相信對於未來在處理癌症新藥的預算能夠有很大的幫助。"],["陳委員昭姿：就讓部長了解，我想石署長應該……"],["邱部長泰源：但是我必須要講，賴總統絕對存著希望……"],["陳委員昭姿：沒問題，賴總統……"],["邱部長泰源：希望病人需要癌藥的時候，我們就是想盡辦法給他充分、足夠、即時……"],["陳委員昭姿：但是你這是去年編的！"],["邱部長泰源：這個部分，後面他立定了一個這麼關懷全國癌症病人的方向以後……"],["陳委員昭姿：部長，你現在說的是原則，原則部分我沒有問題，我在講實務。"],["邱部長泰源：我們怎麼來把它作法，就是我們必須要把它落實……"],["陳委員昭姿：我開了兩次公聽會，都看不到實務要怎麼做。"],["邱部長泰源：總統也特別強調說，要多少就補多少……"],["陳委員昭姿：部長，不好意思，現在在講操作了，我進入實質操作。"],["邱部長泰源：我知道，操作部分我們可以再來說，我只是先跟委員報告，賴總統的心就是要把癌症病人照顧好，降低死亡率……"],["陳委員昭姿：我相信賴總統，他是我的好朋友，他當然要幫助癌症死亡率降低，數字我都會背了。","署長，我剛剛講的這些問題，你有了解嗎？你也知道問題在哪裡嗎？加速的通過，你現在怎麼辦？你準備好了沒有？很快，那你準備好了嗎？"],["邱部長泰源：請署長補充一下。"],["石署長崇良：要解決的問題就是，癌症新藥基金等於是讓我們在財務預估上可以更準確，我們現在有的時候還不知道到底使用了多少，如果未來還是會回到健保基金，一樣的，它會回到健保，所以在健保裡面去編列新藥預算的時候，讓它可以估得更準確。"],["陳委員昭姿：等於有一個庫讓你先了解。"],["石署長崇良：對。"],["陳委員昭姿：我可以告訴你，美國大概有六成會回來，六成回來後，錢都準備好了喔！那你讓病人怎麼辦？我治療有效，結果你不讓我繼續用，噩夢出現！"],["石署長崇良：對啊，所以他就會很無縫的接軌。"],["陳委員昭姿：我想你今天也談不出這100億要怎麼分配、怎麼allocation，這個還有很大的問題，還是不夠，因為賴總統不知道，他以為夠，他還說不夠再補回去。不夠的啦！"],["邱部長泰源：賴總統也知道需要再一直補充。"],["陳委員昭姿：不夠的話，問題就來了，你就開始要壓縮使用，壓縮就開始分配，分配就開始要決定誰先用，這個就涉及每一個人的觀點，主審的最大，這個就是我跟你講的，很多人不是真的要去圖利誰，可是他有他自己的想法，這個是很難處理的，所以我也一直很關心這件事情。","我先回到現在你的分區共管，你知道這個有後遺症嗎？署長、部長，不同區域醫療資源本來就不均勻，你分區共管會不會惡化城鄉差距呢？而且如果地方管理失當，會不會出現健保費用運用失當、民眾權益會不會受損？衛福部跟健保署是否已經有試辦範圍、標準、配套監督機制？你就等於是放給他們自己去管，讓每個醫院自己去管，在這個情況下，等於是自生自滅喔！你不把總額這個大帽子拿掉，你等於是讓各地區、各醫院自生自滅喔！現在已經發生啦！","這個現象大家都知道，你看現在醫院怎麼存活？南部的醫學中心就在醫生處方的螢光幕上跟你說，我建議你開這個藥，因為這個藥打「◎」，為什麼呢？因為利潤最高。你難免逼著人家去做這件事，而且還寫說「敬請開立藥品時，同時考慮醫療經濟學之成本效益」。其實藥品價格不代表醫療經濟學的成本效益，但是它就是一個簡化的方式，他們醫師自己都說了，這些提示雖然沒有強制性，但是每一季討論的時候，你的科別業績不夠、績效不好就會被檢討，在這個情況下，醫師就會被迫去勾選那個藥。這個現象已經出現了，部長、署長，我想你們都知道吧？醫院會建議醫生用什麼藥，病人聽聽看，我的醫生說是醫院建議他用哪一個藥，那我的感覺呢？我的權益呢？醫生的專業權、自主權怎麼辦？後遺症都出現了！所以我才說你要分區共管，但是你有沒有監測的配套機制去看看這個品質？","署長，就像昨天林靜儀那件事情，他提出的國際藥價不是那個藥品的國際藥價，他把它grouping掉耶！今天專科醫師都跑出來講了，說它裡面是不同的封合劑，有人添加凝血因子，有人添加防沾黏的功能，根本都不一樣，你把它全部從一個分類分組，一個叫grouping，他們最害怕這個字，你沒有廠牌之分，把它放在同一組，用裡面最低的價錢。林靜儀次長唸出來的，這邊都有，因為是公開的資料，他唸的不是那個藥品的國際藥價，但是你們在分組的時候可能出問題，現在醫師大反彈，因為那個病只有一次救命的機會，主動脈剝離只有一次救命的機會，他當時沒有辦法就是沒有辦法了，如果你把它縫好後，水還是漏出來、血還是漏出來，就要靠這個凝膠去把它黏住，就像你家水管的矽利康一樣，對不對？它可能是本質不一樣，我是看專科醫師在談這件事情，你要把它放在同一組，以後請林次長不懂不要亂講話，現在醫師大反彈啦！"],["邱部長泰源：委員，我簡單回應一下，第一個，有關各區共管，我想你也是內行的，所有相關的委員會你都當過，其實在南區也做得不錯，大家看起來都是……"],["陳委員昭姿：但是這個現象都出現啦！"],["邱部長泰源：這個部分等一下。所以不錯的模式，我們總是要突破，所以是不是可以用在各區也是共管，其實這樣各區也是自己在共管，只是方式不太一樣……"],["陳委員昭姿：你這個管的意思我懂，但是現在出現後遺症了，我們告訴你，有後遺症嘛！"],["邱部長泰源：我們一定是預防後遺症。"],["陳委員昭姿：他會挑選利潤高的，因為你付的不足嘛！"],["邱部長泰源：像剛剛提出的這個部分，我會請健保署去了解。"],["陳委員昭姿：逼迫醫院去這樣做啊！"],["邱部長泰源：因為我也是醫師出身，我也非常反對影響到醫師的自主專業權，這個一樣，不管醫藥都是專業的，我們真的很不希望被影響……"],["陳委員昭姿：可是就影響啦！我已經告訴你被影響了。"],["邱部長泰源：但是怎麼樣慢慢地讓整個醫療行為能夠合乎健康經濟，然後對人民好……"],["陳委員昭姿：部長，我想我們的價值理念都一樣，我現在在說的是很實務。另外，署長，你在醫材……當然我在藥品太久了，關於醫材的部分，你要grouping的時候，你要把它分類成同一組，當作他們是同一夥的、同樣的東西，我只花一樣的錢去買的時候，還是要小心啊！因為醫生說不同成分，我一聽有凝血因子，加凝血因子當然貴啊！林次長給的那個國際藥價不是他的國際藥價，然後大家就會以為就已經這麼貴了，你們怎麼還在吵，對不對？吵的是醫生啊！"],["石署長崇良：謝謝委員，我看委員一樣都不是對所有的藥物都那麼清楚，所以還是需要專家的意見為主，因此我們會再回去……"],["陳委員昭姿：沒有，現在是……"],["石署長崇良：我們都有機制，這個過去全部都是自費……"],["陳委員昭姿：把人家當……"],["石署長崇良：過去都是自費，現在才納入健保給付，至於一開始……5月1號開始納入健保給付，他還有時間來申復，他要提高價格，把成本給我們看……"],["陳委員昭姿：申復是一件事，當你看到價格……"],["石署長崇良：我們還是要為健保的財務把關，所以我們要跟國際藥價相比，需要看他的成本再核給一個合理的價格。"],["陳委員昭姿：但是沒有，他就隱藏自己的國際藥價，你們共擬會的表就隱藏，他是空白的啊！只有他是空白，其他都有啊！所以就是這個藥出問題啦！你就講清楚……"],["石署長崇良：這個藥也不是最主流的藥，所以其他主流的藥沒有問題……"],["陳委員昭姿：好，謝謝。"],["石署長崇良：所以供藥上沒有問題。"],["陳委員昭姿：好，謝謝，我已經表達，謝謝主席。"],["主席：好，謝謝。"],["邱部長泰源：謝謝委員。"],["主席：這樣有充分表達啦！"],["陳委員昭姿：謝謝。"],["主席：接下來請林月琴委員詢答。"]],"agenda":{"page_end":422,"meet_id":"委員會-11-3-26-9","speakers":["劉建國","陳昭姿","林月琴","蘇清泉","邱鎮軍","王育敏","楊瓊瓔","莊瑞雄","廖偉翔","林淑芬","黃秀芳","王正旭","陳培瑜","楊曜","陳瑩","涂權吉","陳菁徽"],"page_start":359,"meetingDate":["2025-05-01"],"gazette_id":"1144501","agenda_lcidc_ids":["1144501_00008"],"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9次全體委員會議紀錄","content":"審查：一、委員王育敏等18人擬具「病人自主權利法部分條文修正草案」案；二、委員劉建國等\n16人擬具「病人自主權利法部分條文修正草案」案；三、委員邱志偉等19人擬具「病人自主權利\n法第八條、第九條及第十五條條文修正草案」案【僅詢答】","agenda_id":"1144501_00007"}}}