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00:00:56,038\n然後提供很完整的一方面去尊重醫療自主一方面去保障這個善終權益所以這個法我覺得整個亞洲地區來講台灣我們走在前面這個的確是我們應該要好好的來推動的那這六年來其實事情下來呢有出現一些的狀況跟問題就是說當時這個利益非常良善的法案但是上路之後\n\n3\n00:00:56,798 --> 00:00:59,579\n至少這個整個執行的醫療簽署率其實並不高如果累計的話現在大概跟我們成人的比例站起來大概只有0.5%所以也代表說我們六年了應該回過頭來檢討我們有哪些地方可以好好的來\n\n4\n00:01:12,765 --> 00:01:41,490\n改變那我想當時推動這部法案非常用力的楊玉欣委員那他雖然現在離開立法院但是他很關注這個法後續的實施所以基本上我想我跟劉建國委員我們其實都跟他有保持這個互動所以討論之後我們提出了這樣的一個修法的版本那很重要的幾個點第一個當然就是在這個醫療費用的部分這個是現在很多人\n\n5\n00:01:42,208 --> 00:02:03,505\n可能覺得在醫療費用他其實是自己要負擔2000到3500那這個也會阻礙一些人就是說可能礙於費用他沒有辦法來做這個預理醫療的簽署所以費用的部分政府是使得來支應這個是這一次修法的重點那當然\n\n6\n00:02:04,287 --> 00:02:16,814\n會希望說是不是健保這邊可以來給予支應所以這個部分這個是很大的一個重點另外一個就是現在可以進行這個育麗醫療照護諮商的單位除了原來在醫療機構裡面的區域醫院跟診所之外那是不是應該可以去開放一樣是很專業的團體\n\n7\n00:02:27,213 --> 00:02:55,598\n包括這個有一些護理機構長照機構心理治療所心理諮商所還有社工事務所也都可以來參與因為主要是現在的這個等待的時間是比較長的就是醫院裡面能提供的量能其實也是比較低的所以這個部分也希望可以來開放那另外就是要實施病毒法怎麼樣真正去落實這個原來病人的意願\n\n8\n00:02:56,377 --> 00:03:04,963\n那關係人也不可以再去妨礙醫師執行這個是在第4條裡面有提出來修訂那另外病毒法裡面第14條裡面\n\n9\n00:03:07,476 --> 00:03:26,916\n特別去修訂就是不要讓這個執行的醫療機構或醫師再去擔負這個刑事行政的責任原本來就有規定那現在再增加一個是民事的責任所以我想這一次委員提出這樣的一個修法就是希望說讓我們這麼亞洲第一的我們的病毒法\n\n10\n00:03:27,423 --> 00:03:37,798\n就是可以真正的落實然後去符合到他原來的這個我們希望病人自主而且呢可以善終這樣的一個目標\n\n11\n00:03:39,898 --> 00:03:56,857\n那所以這個謝謝莊委給我提案說明的時間那接下來我們就請那個部長是不是我們針對這個議題我們好好的來討論一下第一個就是我想請教部長事實上你剛剛的發言我發現你也是非常支持這一個善終\n\n12\n00:03:58,683 --> 00:04:17,214\n醫療這樣的一個方向喔那但是病毒法實施到現在你可以看到他的這個施行率的確是不高喔那所以這個就衛福部部長的角度的話第一個我要問你說你滿意現在的這一個育立醫療的人數嗎就是你是不是覺得他應該還有成長的空間\n\n13\n00:04:20,995 --> 00:04:33,384\n我們當然希望它人數一個成長因為其實各個醫院已經都準備團隊在那邊準備服務了啦所以其實量能是有但是就是民眾有沒有意願\n\n14\n00:04:35,085 --> 00:04:59,417\n那這個真的剛剛也有委員提到怎麼樣做生命的教育加強生命的教育讓大家能夠來注重這個他自然就覺得這個去簽有意義那這個也是七棟的聯誼可能也不止完全是經會的問題當然經會也是的確是一個原因但是如果生命教育夠讓大家知道這是重要的\n\n15\n00:05:00,157 --> 00:05:18,543\n我相信這有更大的啟動力我覺得都要啦就是說讓民眾可以有這個比較好的認知願意接受另外一方面就是去排除他的那個障礙跟門檻那我想今天為什麼很具體的在這個法案裡面就是希望可以\n\n16\n00:05:19,043 --> 00:05:21,565\n把這個經費放進來因為我想這個很多團體在第一線推他們的確發現民眾覺得說我很願意簽但是你還要我自己這套腰包再多花3500塊我要花時間然後我要花錢才能完成這個程序我覺得他的確是增加了他的困難度了\n\n17\n00:05:37,139 --> 00:05:54,083\n所以這個部分呢這次才會有修法希望說在預算的部分是不是政府的力量可以就像宣導你今天去宣導也是政府的力量協助來宣導那今天要民眾再次多出這個錢我覺得政府相對也是有這個責任如果我們要去推動的話應該可以就是\n\n18\n00:05:57,263 --> 00:06:13,382\n多增加這個補助的項目那當然你們原本有對外說2026年要全民免費你知不知道這件事媒體上面有報導原本衛福部是有打算2026年是要全民免費的\n\n19\n00:06:14,463 --> 00:06:37,241\n那當時你們這樣的一個目標跟方向其實對於整體的推動是很好的一個方向但是後來為什麼又縮回來了你們現在限縮到五月開始你們只有65歲以上的重大傷病跟65歲以上的多重慢性病就是原本你們其實是有一個很大的目標跟理想就是說就推動全民免費為什麼後來這個政策又縮回來\n\n20\n00:06:44,231 --> 00:07:03,948\n我想可能觀念上也不是錢免免費,而是說其實如果能夠早一點立下一些衣族其實未來在做默契的時候,選擇好的對象真的可以節省醫療費用這節省的醫療費用可能遠大於你這個諮商的費用\n\n21\n00:07:05,349 --> 00:07:31,297\n所以這種健康投資是值得來評估但是在可能我想國家的財源一定或者健保的財源有限那什麼才是排比較重要的大家可以來討論大家可以討論譬如說剛剛說剛剛時事處長有提什麼藥品都想進來想提高價錢我們的健保就是這樣子今年已經是最大的大家的努力是像多了700多億\n\n22\n00:07:35,498 --> 00:08:00,423\n可能還是要很多很多的要努力的空間所以進來他對財務的衝擊是怎麼樣這個的確是我們用開放的胸心用關懷的心那這一部分我可以拜託部長你們回去再研議一下你們現在是開放到65歲但是事實上這個重大傷病就是說你為什麼要用一個年紀來限制這個重大傷病\n\n23\n00:08:01,423 --> 00:08:30,452\n可不可以就是以重大傷病或多重慢性病為前提你們去估算一下這樣的人口大概有多少如果你沒有辦法一步到位就是你任何年齡來你完全都免費但是至少我覺得當人開始生病的時候這個問題跟他就是越接近也越需要那你們可不可以再去估另外一部分的經費就是說只要他領有重大傷病卡或是多重慢性病他就可以因為他已經在這個健保體系\n\n24\n00:08:31,192 --> 00:08:52,572\n如果他有意願你們就可以補助這部分會多花你們多少錢因為事實上你們現在所設定的一年健保支出3.6億不是一個非常大筆的數額那你如果再擴大一點的話你的總經費會增加多少我是覺得這部分的經費坦白講不是在你所有的健保預算裡面他真的不是最大筆\n\n25\n00:08:56,834 --> 00:09:21,723\n我看署長其實也很用力在推動這一點我要肯定那你自己有沒有估算過這個都經過精算其實65歲我們先講重大傷病重大傷病大概是100萬人那麼這個65歲以上大概是50萬那麼底下這個65歲以上多重慢性病這邊大概在100多130萬左右所以兩個合起來是180萬\n\n26\n00:09:23,203 --> 00:09:43,410\n所以光是180萬的人全部做一個人3000塊的話是54億啦那所以我們只是想說因為也不會一下子全部的180萬一年通通做完不可能所以我們才說那這樣我們健保應該還可以支撐這樣的費用那當然如果做的多了我們再爭取預算那也不要\n\n27\n00:09:44,410 --> 00:09:52,899\n這個影響到整個健保的財務所以我們大概是這樣的方式先擴大到這個65歲以上的重大傷病跟多重慢性病這個涵蓋的範圍是180萬人\n\n28\n00:09:57,089 --> 00:10:22,594\n因為其實這我們跟健保署有討論過就現況而言的宣導策略然後簽署的高峰會在60歲以上然後所以才會是說錢用在刀口上然後至於是說一些宣導策略如果有做一些改善的話其實擴大的這部分我們兩邊會密切的合作還有長照是這邊會一起以上你剛說的是60對不對你現在設定65有沒有可能放寬到60\n\n29\n00:10:24,433 --> 00:10:38,849\n我們先執行一步我想我們後面還會進入到主條我拜託衛福部一件事就是你去精算一下你的版本你現在6560跟50你就提供這三種版本到底在你的健保經費裡面\n\n30\n00:10:40,010 --> 00:11:00,778\n可能要多少因為我也可以理解很多東西可能很難一步到位但是如果在你們現行要擴大的可以再更擴大的話我覺得這個因為你們剛剛已經講了事實上這件事情一方面是保障病人本身一方面對你整個健保剛剛部長也有講如果越多人去預例這樣子的一個\n\n31\n00:11:02,560 --> 00:11:27,377\n的這個去預列這個醫療的這個確認的話那事實上未來再節省你的健保支出那個其實是會有一個反饋機制你知道嗎你簽越多事實上你未來要支付的可能就是越少因為你一些無效醫療他會提前去終止所以你應該用一個比較大的水庫的概念來看待這件事而不是只有看說我現在要多支出3.6億10億你應該去精算每一個有簽署的你將來節省的醫療的\n\n32\n00:11:33,040 --> 00:11:47,848\n無效的醫療支出可能會有多少你這樣算下來之後你就知道說它反而這邊越增加不是越增加你的健保支出而可能是越節省未來整個醫療的無效支出我覺得你們要有這樣的概念來看待這件事情\n\n33\n00:11:48,416 --> 00:12:16,003\n所以我想這是很重要也是一直我們在研議的方向但是我剛剛有報告過其實簽了ADE以後到最後的話大概有七成是吻合的那是早期喔後來慢慢的吻合率比較低為什麼後來做ACP的過程比較變成比較不像引擎所以品質也很重要因為品質之後你才能夠復活到最後真的是在做的時候\n\n34\n00:12:16,724 --> 00:12:33,318\n跟當時簽AD是吻合的不然的話幹嘛當時簽AD變成生命教育而已啊所以我們不但要有生命教育還要有真的能夠協助在他真正到末期的時候有一個很好的合乎他的治療方向這個我同意啊所以這個也是財務方面的部分我們來好啊我希望你們提出一個財務評估的報告那另外一個\n\n35\n00:12:40,984 --> 00:13:08,523\n這個就是說要不要開放其他機構可以進來做這個諮商你們反對你們在報告裡面就是反對那我也看到醫師公會幾大團體他們其實也是反對但是這件事情我是覺得有討論的空間就是說如果他們做到等同的水準我們應該不是從各團體它的出發點而是從一個病人他可以得到服務如果他可以得到同品質的諮商的\n\n36\n00:13:09,203 --> 00:13:26,637\n這樣的一個品質那是不是可以去要求就是說你可以要求那些其他想參與的這些專業團體你要達到我這樣的要求就是你這個諮商過程你要達到我的標準而不是一開始就去否決掉說不行啊你們通通不能進來我覺得這件事情剛剛部長你在講說是開放的態度嘛在這件事情的討論我是蠻希望你也是秉持一個比較開放的態度\n\n37\n00:13:33,702 --> 00:13:53,710\n態度而不是一開始就直接否決了應該是可以有討論的空間這個可不可以再演繹因為討論法條還有時間你們回去再想想看好不好那個意思是要不要回應一下簡單回應一下就是說現在講的執行場域其實我們覺得病人在哪裡這件事情會是比較重要\n\n38\n00:13:54,170 --> 00:14:20,829\n所以我们才会觉得是说以现阶段直接的是说要修法改扩大场域这件事情不如是说我们回过头来在我们目前设定的target这边在执行的过程当中有没有什么可以去做调整的我们目前的方向上面会是这样为什么因为在做资商的过程当中我必须对医疗接触措施对这个疾病的预后要有很清楚的描述那个资商的跨体才会好\n\n39\n00:14:21,509 --> 00:14:46,183\n那現階段的大家的各自的專業其實是因為太鑽了所以對HORZONTO這一塊怎麼樣去講的醫療接觸措施對羈絆與喉其實我們會覺得是說這個地方還需要一些共識這樣子的話才會有好的品質所以部長其實有特別講的是說現階段其實需要凝聚更多的共識以上好那如果是這樣子的話我覺得你們該去研議因為像護理機構跟長照機構其實會有蠻多是\n\n40\n00:14:49,305 --> 00:15:05,189\n他可能要育立一組這樣的一個病人而且他本身其實也有醫事人員所以像這一個或許就是你們第一步可以優先去考量的就是說跟醫療更接近的更相近的他不見得都是在醫院這些人都是在護理之家他可能就在長照機構裡面那你這個就不開放嗎你還要他回到那個診所嗎或者是回到醫院才可以去做這樣的一個\n\n41\n00:15:15,913 --> 00:15:27,866\n智商嗎我覺得剛剛市長講一句話很好病人在哪裡你就應該是以這個為前提吧對不對所以這一塊我覺得是有討論空間部長你怎麼表示一下\n\n42\n00:15:28,735 --> 00:15:51,884\n我想以病人為中心是我們的目標但是我剛剛有報告過如果在品質上面或者他討論的內容AD討論的內容需要怎麼樣的專業人員當時會有一個諮商為什麼需要那些人其實是有原因的那這樣的品質如果能夠維護品質那當然我們以病人為中心\n\n43\n00:15:53,353 --> 00:16:14,082\n來調整我們就可以來討論了好我希望是以病人為中心而不是說團體之間各有成見說什麼團體不行那最後一個問題我問你就是說最近有一個有民間有醫師他們做一個調查就是說86%的民眾支持自主善中然後他們\n\n44\n00:16:15,973 --> 00:16:44,740\n就是提出來是一個PAD那衛福部你們對於他這樣子的一個調查跟他們的倡議你們的立場是什麼就是說他們的進一步是說醫師他可以給藥但是病人呢決定自己要不要服藥就是說醫師協助死亡就是台大公衛研究他們做出來的這一塊在台灣有討論空間嗎還是這只是民間的倡議衛福部怎麼看待這件事情\n\n45\n00:16:44,980 --> 00:16:51,084\n好的我們一切要以專業跟人性的關懷來看這件事情\n\n46\n00:16:52,833 --> 00:17:17,502\n支持自主善終這應該是要百分之百吧大家也要善終能夠自主性的那我們怎麼樣真正讓他有自主性怎麼樣讓他善終才是重要的事情那我只提醒一點就是說當澳洲在提倡所謂的讓他縮短生命的一個措施\n\n47\n00:17:19,064 --> 00:17:24,501\n來減少他痛苦這件事情我不想把它講成安樂死其實就是這種味道\n\n48\n00:17:25,831 --> 00:17:50,003\n這麼叫NERS就是Intention因為他太痛苦了所以你想要把他縮短生命所以澳洲馬上宣布就是說如果今天社會關注這個議題首先你應該去看看末期病人你是不是都把他照顧好了讓他不痛了讓他不要那麼辛苦讓他不要覺得他是家人的累贅讓家屬也可以安心的來照顧病人\n\n49\n00:17:51,043 --> 00:18:07,789\n如果你這樣的話他要珍惜每一天的生命啊怎麼會去想要去縮短生命所以他們說應該要先去推安寧環的醫療如果你把安寧環某幾病人的安寧環的醫療照顧好的話推得好的話不是沒有發生安樂死這個爭議就變成比較個案事件\n\n50\n00:18:08,709 --> 00:18:26,751\n所以我們台灣如果真的推自主三中的時候,還有一個很重要的工作,你有沒有把安寧反而醫療,把病人照顧好。如果把病人照顧好的話,我們再來談下一個沒辦法解決的時候,我們是不是有更加能夠讓他自主,我們再來談。\n\n51\n00:18:27,992 --> 00:18:42,456\n好那所以回到我們的病主法我們真的因為已經通過了法律我們就應該要好好的施行好好的落實那我們的重點應該先擺在這邊所以希望這個部長你們回去再好好研議今天委員提出非常多的議題\n\n52\n00:18:44,557 --> 00:19:04,006\n就是不要像你們今天的報告好像鐵板一塊每一橋都不可以每一橋都是緩疫我覺得可以你剛剛講一句話很好你是開放的那我們就用開放的態度大家好好的來研議以病人最好的為原則以病人為中心我們看這個法可以怎麼樣修得更好好不好好的好謝謝\n\n","tsv":"start\tend\ttext\n249\t27145\t你如果要加提案說明就一起會增加時間剛剛有宣布謝謝因為我沒有辦法提案說明好 謝謝我們的召委今天排這個很重要的病毒法他的整個修正的條文我想有關於病毒法這個是我們當時在2019年1月正式實施之後我們是亞洲第一部就是以病人為主體\n27885\t56038\t然後提供很完整的一方面去尊重醫療自主一方面去保障這個善終權益所以這個法我覺得整個亞洲地區來講台灣我們走在前面這個的確是我們應該要好好的來推動的那這六年來其實事情下來呢有出現一些的狀況跟問題就是說當時這個利益非常良善的法案但是上路之後\n56798\t59579\t至少這個整個執行的醫療簽署率其實並不高如果累計的話現在大概跟我們成人的比例站起來大概只有0.5%所以也代表說我們六年了應該回過頭來檢討我們有哪些地方可以好好的來\n72765\t101490\t改變那我想當時推動這部法案非常用力的楊玉欣委員那他雖然現在離開立法院但是他很關注這個法後續的實施所以基本上我想我跟劉建國委員我們其實都跟他有保持這個互動所以討論之後我們提出了這樣的一個修法的版本那很重要的幾個點第一個當然就是在這個醫療費用的部分這個是現在很多人\n102208\t123505\t可能覺得在醫療費用他其實是自己要負擔2000到3500那這個也會阻礙一些人就是說可能礙於費用他沒有辦法來做這個預理醫療的簽署所以費用的部分政府是使得來支應這個是這一次修法的重點那當然\n124287\t136814\t會希望說是不是健保這邊可以來給予支應所以這個部分這個是很大的一個重點另外一個就是現在可以進行這個育麗醫療照護諮商的單位除了原來在醫療機構裡面的區域醫院跟診所之外那是不是應該可以去開放一樣是很專業的團體\n147213\t175598\t包括這個有一些護理機構長照機構心理治療所心理諮商所還有社工事務所也都可以來參與因為主要是現在的這個等待的時間是比較長的就是醫院裡面能提供的量能其實也是比較低的所以這個部分也希望可以來開放那另外就是要實施病毒法怎麼樣真正去落實這個原來病人的意願\n176377\t184963\t那關係人也不可以再去妨礙醫師執行這個是在第4條裡面有提出來修訂那另外病毒法裡面第14條裡面\n187476\t206916\t特別去修訂就是不要讓這個執行的醫療機構或醫師再去擔負這個刑事行政的責任原本來就有規定那現在再增加一個是民事的責任所以我想這一次委員提出這樣的一個修法就是希望說讓我們這麼亞洲第一的我們的病毒法\n207423\t217798\t就是可以真正的落實然後去符合到他原來的這個我們希望病人自主而且呢可以善終這樣的一個目標\n219898\t236857\t那所以這個謝謝莊委給我提案說明的時間那接下來我們就請那個部長是不是我們針對這個議題我們好好的來討論一下第一個就是我想請教部長事實上你剛剛的發言我發現你也是非常支持這一個善終\n238683\t257214\t醫療這樣的一個方向喔那但是病毒法實施到現在你可以看到他的這個施行率的確是不高喔那所以這個就衛福部部長的角度的話第一個我要問你說你滿意現在的這一個育立醫療的人數嗎就是你是不是覺得他應該還有成長的空間\n260995\t273384\t我們當然希望它人數一個成長因為其實各個醫院已經都準備團隊在那邊準備服務了啦所以其實量能是有但是就是民眾有沒有意願\n275085\t299417\t那這個真的剛剛也有委員提到怎麼樣做生命的教育加強生命的教育讓大家能夠來注重這個他自然就覺得這個去簽有意義那這個也是七棟的聯誼可能也不止完全是經會的問題當然經會也是的確是一個原因但是如果生命教育夠讓大家知道這是重要的\n300157\t318543\t我相信這有更大的啟動力我覺得都要啦就是說讓民眾可以有這個比較好的認知願意接受另外一方面就是去排除他的那個障礙跟門檻那我想今天為什麼很具體的在這個法案裡面就是希望可以\n319043\t321565\t把這個經費放進來因為我想這個很多團體在第一線推他們的確發現民眾覺得說我很願意簽但是你還要我自己這套腰包再多花3500塊我要花時間然後我要花錢才能完成這個程序我覺得他的確是增加了他的困難度了\n337139\t354083\t所以這個部分呢這次才會有修法希望說在預算的部分是不是政府的力量可以就像宣導你今天去宣導也是政府的力量協助來宣導那今天要民眾再次多出這個錢我覺得政府相對也是有這個責任如果我們要去推動的話應該可以就是\n357263\t373382\t多增加這個補助的項目那當然你們原本有對外說2026年要全民免費你知不知道這件事媒體上面有報導原本衛福部是有打算2026年是要全民免費的\n374463\t397241\t那當時你們這樣的一個目標跟方向其實對於整體的推動是很好的一個方向但是後來為什麼又縮回來了你們現在限縮到五月開始你們只有65歲以上的重大傷病跟65歲以上的多重慢性病就是原本你們其實是有一個很大的目標跟理想就是說就推動全民免費為什麼後來這個政策又縮回來\n404231\t423948\t我想可能觀念上也不是錢免免費,而是說其實如果能夠早一點立下一些衣族其實未來在做默契的時候,選擇好的對象真的可以節省醫療費用這節省的醫療費用可能遠大於你這個諮商的費用\n425349\t451297\t所以這種健康投資是值得來評估但是在可能我想國家的財源一定或者健保的財源有限那什麼才是排比較重要的大家可以來討論大家可以討論譬如說剛剛說剛剛時事處長有提什麼藥品都想進來想提高價錢我們的健保就是這樣子今年已經是最大的大家的努力是像多了700多億\n455498\t480423\t可能還是要很多很多的要努力的空間所以進來他對財務的衝擊是怎麼樣這個的確是我們用開放的胸心用關懷的心那這一部分我可以拜託部長你們回去再研議一下你們現在是開放到65歲但是事實上這個重大傷病就是說你為什麼要用一個年紀來限制這個重大傷病\n481423\t510452\t可不可以就是以重大傷病或多重慢性病為前提你們去估算一下這樣的人口大概有多少如果你沒有辦法一步到位就是你任何年齡來你完全都免費但是至少我覺得當人開始生病的時候這個問題跟他就是越接近也越需要那你們可不可以再去估另外一部分的經費就是說只要他領有重大傷病卡或是多重慢性病他就可以因為他已經在這個健保體系\n511192\t532572\t如果他有意願你們就可以補助這部分會多花你們多少錢因為事實上你們現在所設定的一年健保支出3.6億不是一個非常大筆的數額那你如果再擴大一點的話你的總經費會增加多少我是覺得這部分的經費坦白講不是在你所有的健保預算裡面他真的不是最大筆\n536834\t561723\t我看署長其實也很用力在推動這一點我要肯定那你自己有沒有估算過這個都經過精算其實65歲我們先講重大傷病重大傷病大概是100萬人那麼這個65歲以上大概是50萬那麼底下這個65歲以上多重慢性病這邊大概在100多130萬左右所以兩個合起來是180萬\n563203\t583410\t所以光是180萬的人全部做一個人3000塊的話是54億啦那所以我們只是想說因為也不會一下子全部的180萬一年通通做完不可能所以我們才說那這樣我們健保應該還可以支撐這樣的費用那當然如果做的多了我們再爭取預算那也不要\n584410\t592899\t這個影響到整個健保的財務所以我們大概是這樣的方式先擴大到這個65歲以上的重大傷病跟多重慢性病這個涵蓋的範圍是180萬人\n597089\t622594\t因為其實這我們跟健保署有討論過就現況而言的宣導策略然後簽署的高峰會在60歲以上然後所以才會是說錢用在刀口上然後至於是說一些宣導策略如果有做一些改善的話其實擴大的這部分我們兩邊會密切的合作還有長照是這邊會一起以上你剛說的是60對不對 你現在設定65有沒有可能放寬到60\n624433\t638849\t我們先執行一步我想我們後面還會進入到主條我拜託衛福部一件事就是你去精算一下你的版本你現在65 60跟50你就提供這三種版本到底在你的健保經費裡面\n640010\t660778\t可能要多少因為我也可以理解很多東西可能很難一步到位但是如果在你們現行要擴大的可以再更擴大的話我覺得這個因為你們剛剛已經講了事實上這件事情一方面是保障病人本身一方面對你整個健保剛剛部長也有講如果越多人去預例這樣子的一個\n662560\t687377\t的這個去預列這個醫療的這個確認的話那事實上未來再節省你的健保支出那個其實是會有一個反饋機制你知道嗎你簽越多事實上你未來要支付的可能就是越少因為你一些無效醫療他會提前去終止所以你應該用一個比較大的水庫的概念來看待這件事而不是只有看說我現在要多支出3.6億10億你應該去精算每一個有簽署的你將來節省的醫療的\n693040\t707848\t無效的醫療支出可能會有多少你這樣算下來之後你就知道說它反而這邊越增加不是越增加你的健保支出而可能是越節省未來整個醫療的無效支出我覺得你們要有這樣的概念來看待這件事情\n708416\t736003\t所以我想這是很重要也是一直我們在研議的方向但是我剛剛有報告過其實簽了ADE以後到最後的話大概有七成是吻合的那是早期喔後來慢慢的吻合率比較低為什麼後來做ACP的過程比較變成比較不像引擎所以品質也很重要因為品質之後你才能夠復活到最後真的是在做的時候\n736724\t753318\t跟當時簽AD是吻合的 不然的話幹嘛當時簽AD變成生命教育而已啊所以我們不但要有生命教育 還要有真的能夠協助在他真正到末期的時候有一個很好的 合乎他的治療方向這個我同意啊 所以這個也是財務方面的部分我們來好啊 我希望你們提出一個財務評估的報告那另外一個\n760984\t788523\t這個就是說要不要開放其他機構可以進來做這個諮商你們反對你們在報告裡面就是反對那我也看到醫師公會幾大團體他們其實也是反對但是這件事情我是覺得有討論的空間就是說如果他們做到等同的水準我們應該不是從各團體它的出發點而是從一個病人他可以得到服務如果他可以得到同品質的諮商的\n789203\t806637\t這樣的一個品質那是不是可以去要求就是說你可以要求那些其他想參與的這些專業團體你要達到我這樣的要求就是你這個諮商過程你要達到我的標準而不是一開始就去否決掉說不行啊你們通通不能進來我覺得這件事情剛剛部長你在講說是開放的態度嘛在這件事情的討論我是蠻希望你也是秉持一個比較開放的態度\n813702\t833710\t態度而不是一開始就直接否決了應該是可以有討論的空間這個可不可以再演繹因為討論法條還有時間你們回去再想想看好不好那個意思是要不要回應一下簡單回應一下就是說現在講的執行場域其實我們覺得病人在哪裡這件事情會是比較重要\n834170\t860829\t所以我们才会觉得是说以现阶段直接的是说要修法改扩大场域这件事情不如是说我们回过头来在我们目前设定的target这边在执行的过程当中有没有什么可以去做调整的我们目前的方向上面会是这样为什么因为在做资商的过程当中我必须对医疗接触措施对这个疾病的预后要有很清楚的描述那个资商的跨体才会好\n861509\t886183\t那現階段的大家的各自的專業其實是因為太鑽了所以對HORZONTO這一塊怎麼樣去講的醫療接觸措施對羈絆與喉其實我們會覺得是說這個地方還需要一些共識這樣子的話才會有好的品質所以部長其實有特別講的是說現階段其實需要凝聚更多的共識 以上好 那如果是這樣子的話我覺得你們該去研議因為像護理機構跟長照機構其實會有蠻多是\n889305\t905189\t他可能要育立一組這樣的一個病人而且他本身其實也有醫事人員所以像這一個或許就是你們第一步可以優先去考量的就是說跟醫療更接近的更相近的他不見得都是在醫院這些人都是在護理之家他可能就在長照機構裡面那你這個就不開放嗎你還要他回到那個診所嗎或者是回到醫院才可以去做這樣的一個\n915913\t927866\t智商嗎我覺得剛剛市長講一句話很好病人在哪裡你就應該是以這個為前提吧對不對所以這一塊我覺得是有討論空間部長你怎麼表示一下\n928735\t951884\t我想以病人為中心是我們的目標但是我剛剛有報告過如果在品質上面或者他討論的內容AD討論的內容需要怎麼樣的專業人員當時會有一個諮商為什麼需要那些人其實是有原因的那這樣的品質如果能夠維護品質那當然我們以病人為中心\n953353\t974082\t來調整我們就可以來討論了好我希望是以病人為中心而不是說團體之間各有成見說什麼團體不行那最後一個問題我問你就是說最近有一個有民間有醫師他們做一個調查就是說86%的民眾支持自主善中然後他們\n975973\t1004740\t就是提出來是一個PAD那衛福部你們對於他這樣子的一個調查跟他們的倡議你們的立場是什麼就是說他們的進一步是說醫師他可以給藥但是病人呢決定自己要不要服藥就是說醫師協助死亡就是台大公衛研究他們做出來的這一塊在台灣有討論空間嗎還是這只是民間的倡議衛福部怎麼看待這件事情\n1004980\t1011084\t好的 我們一切要以專業跟人性的關懷來看這件事情\n1012833\t1037502\t支持自主善終這應該是要百分之百吧大家也要善終能夠自主性的那我們怎麼樣真正讓他有自主性怎麼樣讓他善終才是重要的事情那我只提醒一點就是說當澳洲在提倡所謂的讓他縮短生命的一個措施\n1039064\t1044501\t來減少他痛苦這件事情我不想把它講成安樂死其實就是這種味道\n1045831\t1070003\t這麼叫NERS就是Intention因為他太痛苦了所以你想要把他縮短生命所以澳洲馬上宣布就是說如果今天社會關注這個議題首先你應該去看看末期病人你是不是都把他照顧好了讓他不痛了讓他不要那麼辛苦讓他不要覺得他是家人的累贅讓家屬也可以安心的來照顧病人\n1071043\t1087789\t如果你這樣的話他要珍惜每一天的生命啊怎麼會去想要去縮短生命所以他們說應該要先去推安寧環的醫療如果你把安寧環某幾病人的安寧環的醫療照顧好的話推得好的話不是沒有發生安樂死這個爭議就變成比較個案事件\n1088709\t1106751\t所以我們台灣如果真的推自主三中的時候,還有一個很重要的工作,你有沒有把安寧反而醫療,把病人照顧好。如果把病人照顧好的話,我們再來談下一個沒辦法解決的時候,我們是不是有更加能夠讓他自主,我們再來談。\n1107992\t1122456\t好 那所以回到我們的病主法我們真的 因為已經通過了法律我們就應該要好好的施行 好好的落實那我們的重點應該先擺在這邊所以希望這個部長你們回去再好好研議今天委員提出非常多的議題\n1124557\t1144006\t就是不要像你們今天的報告好像鐵板一塊每一橋都不可以每一橋都是緩疫我覺得可以你剛剛講一句話很好你是開放的那我們就用開放的態度大家好好的來研議以病人最好的為原則以病人為中心我們看這個法可以怎麼樣修得更好好不好好的好謝謝\n","txt":"你如果要加提案說明就一起會增加時間剛剛有宣布謝謝因為我沒有辦法提案說明好 謝謝我們的召委今天排這個很重要的病毒法他的整個修正的條文我想有關於病毒法這個是我們當時在2019年1月正式實施之後我們是亞洲第一部就是以病人為主體\n然後提供很完整的一方面去尊重醫療自主一方面去保障這個善終權益所以這個法我覺得整個亞洲地區來講台灣我們走在前面這個的確是我們應該要好好的來推動的那這六年來其實事情下來呢有出現一些的狀況跟問題就是說當時這個利益非常良善的法案但是上路之後\n至少這個整個執行的醫療簽署率其實並不高如果累計的話現在大概跟我們成人的比例站起來大概只有0.5%所以也代表說我們六年了應該回過頭來檢討我們有哪些地方可以好好的來\n改變那我想當時推動這部法案非常用力的楊玉欣委員那他雖然現在離開立法院但是他很關注這個法後續的實施所以基本上我想我跟劉建國委員我們其實都跟他有保持這個互動所以討論之後我們提出了這樣的一個修法的版本那很重要的幾個點第一個當然就是在這個醫療費用的部分這個是現在很多人\n可能覺得在醫療費用他其實是自己要負擔2000到3500那這個也會阻礙一些人就是說可能礙於費用他沒有辦法來做這個預理醫療的簽署所以費用的部分政府是使得來支應這個是這一次修法的重點那當然\n會希望說是不是健保這邊可以來給予支應所以這個部分這個是很大的一個重點另外一個就是現在可以進行這個育麗醫療照護諮商的單位除了原來在醫療機構裡面的區域醫院跟診所之外那是不是應該可以去開放一樣是很專業的團體\n包括這個有一些護理機構長照機構心理治療所心理諮商所還有社工事務所也都可以來參與因為主要是現在的這個等待的時間是比較長的就是醫院裡面能提供的量能其實也是比較低的所以這個部分也希望可以來開放那另外就是要實施病毒法怎麼樣真正去落實這個原來病人的意願\n那關係人也不可以再去妨礙醫師執行這個是在第4條裡面有提出來修訂那另外病毒法裡面第14條裡面\n特別去修訂就是不要讓這個執行的醫療機構或醫師再去擔負這個刑事行政的責任原本來就有規定那現在再增加一個是民事的責任所以我想這一次委員提出這樣的一個修法就是希望說讓我們這麼亞洲第一的我們的病毒法\n就是可以真正的落實然後去符合到他原來的這個我們希望病人自主而且呢可以善終這樣的一個目標\n那所以這個謝謝莊委給我提案說明的時間那接下來我們就請那個部長是不是我們針對這個議題我們好好的來討論一下第一個就是我想請教部長事實上你剛剛的發言我發現你也是非常支持這一個善終\n醫療這樣的一個方向喔那但是病毒法實施到現在你可以看到他的這個施行率的確是不高喔那所以這個就衛福部部長的角度的話第一個我要問你說你滿意現在的這一個育立醫療的人數嗎就是你是不是覺得他應該還有成長的空間\n我們當然希望它人數一個成長因為其實各個醫院已經都準備團隊在那邊準備服務了啦所以其實量能是有但是就是民眾有沒有意願\n那這個真的剛剛也有委員提到怎麼樣做生命的教育加強生命的教育讓大家能夠來注重這個他自然就覺得這個去簽有意義那這個也是七棟的聯誼可能也不止完全是經會的問題當然經會也是的確是一個原因但是如果生命教育夠讓大家知道這是重要的\n我相信這有更大的啟動力我覺得都要啦就是說讓民眾可以有這個比較好的認知願意接受另外一方面就是去排除他的那個障礙跟門檻那我想今天為什麼很具體的在這個法案裡面就是希望可以\n把這個經費放進來因為我想這個很多團體在第一線推他們的確發現民眾覺得說我很願意簽但是你還要我自己這套腰包再多花3500塊我要花時間然後我要花錢才能完成這個程序我覺得他的確是增加了他的困難度了\n所以這個部分呢這次才會有修法希望說在預算的部分是不是政府的力量可以就像宣導你今天去宣導也是政府的力量協助來宣導那今天要民眾再次多出這個錢我覺得政府相對也是有這個責任如果我們要去推動的話應該可以就是\n多增加這個補助的項目那當然你們原本有對外說2026年要全民免費你知不知道這件事媒體上面有報導原本衛福部是有打算2026年是要全民免費的\n那當時你們這樣的一個目標跟方向其實對於整體的推動是很好的一個方向但是後來為什麼又縮回來了你們現在限縮到五月開始你們只有65歲以上的重大傷病跟65歲以上的多重慢性病就是原本你們其實是有一個很大的目標跟理想就是說就推動全民免費為什麼後來這個政策又縮回來\n我想可能觀念上也不是錢免免費,而是說其實如果能夠早一點立下一些衣族其實未來在做默契的時候,選擇好的對象真的可以節省醫療費用這節省的醫療費用可能遠大於你這個諮商的費用\n所以這種健康投資是值得來評估但是在可能我想國家的財源一定或者健保的財源有限那什麼才是排比較重要的大家可以來討論大家可以討論譬如說剛剛說剛剛時事處長有提什麼藥品都想進來想提高價錢我們的健保就是這樣子今年已經是最大的大家的努力是像多了700多億\n可能還是要很多很多的要努力的空間所以進來他對財務的衝擊是怎麼樣這個的確是我們用開放的胸心用關懷的心那這一部分我可以拜託部長你們回去再研議一下你們現在是開放到65歲但是事實上這個重大傷病就是說你為什麼要用一個年紀來限制這個重大傷病\n可不可以就是以重大傷病或多重慢性病為前提你們去估算一下這樣的人口大概有多少如果你沒有辦法一步到位就是你任何年齡來你完全都免費但是至少我覺得當人開始生病的時候這個問題跟他就是越接近也越需要那你們可不可以再去估另外一部分的經費就是說只要他領有重大傷病卡或是多重慢性病他就可以因為他已經在這個健保體系\n如果他有意願你們就可以補助這部分會多花你們多少錢因為事實上你們現在所設定的一年健保支出3.6億不是一個非常大筆的數額那你如果再擴大一點的話你的總經費會增加多少我是覺得這部分的經費坦白講不是在你所有的健保預算裡面他真的不是最大筆\n我看署長其實也很用力在推動這一點我要肯定那你自己有沒有估算過這個都經過精算其實65歲我們先講重大傷病重大傷病大概是100萬人那麼這個65歲以上大概是50萬那麼底下這個65歲以上多重慢性病這邊大概在100多130萬左右所以兩個合起來是180萬\n所以光是180萬的人全部做一個人3000塊的話是54億啦那所以我們只是想說因為也不會一下子全部的180萬一年通通做完不可能所以我們才說那這樣我們健保應該還可以支撐這樣的費用那當然如果做的多了我們再爭取預算那也不要\n這個影響到整個健保的財務所以我們大概是這樣的方式先擴大到這個65歲以上的重大傷病跟多重慢性病這個涵蓋的範圍是180萬人\n因為其實這我們跟健保署有討論過就現況而言的宣導策略然後簽署的高峰會在60歲以上然後所以才會是說錢用在刀口上然後至於是說一些宣導策略如果有做一些改善的話其實擴大的這部分我們兩邊會密切的合作還有長照是這邊會一起以上你剛說的是60對不對 你現在設定65有沒有可能放寬到60\n我們先執行一步我想我們後面還會進入到主條我拜託衛福部一件事就是你去精算一下你的版本你現在65 60跟50你就提供這三種版本到底在你的健保經費裡面\n可能要多少因為我也可以理解很多東西可能很難一步到位但是如果在你們現行要擴大的可以再更擴大的話我覺得這個因為你們剛剛已經講了事實上這件事情一方面是保障病人本身一方面對你整個健保剛剛部長也有講如果越多人去預例這樣子的一個\n的這個去預列這個醫療的這個確認的話那事實上未來再節省你的健保支出那個其實是會有一個反饋機制你知道嗎你簽越多事實上你未來要支付的可能就是越少因為你一些無效醫療他會提前去終止所以你應該用一個比較大的水庫的概念來看待這件事而不是只有看說我現在要多支出3.6億10億你應該去精算每一個有簽署的你將來節省的醫療的\n無效的醫療支出可能會有多少你這樣算下來之後你就知道說它反而這邊越增加不是越增加你的健保支出而可能是越節省未來整個醫療的無效支出我覺得你們要有這樣的概念來看待這件事情\n所以我想這是很重要也是一直我們在研議的方向但是我剛剛有報告過其實簽了ADE以後到最後的話大概有七成是吻合的那是早期喔後來慢慢的吻合率比較低為什麼後來做ACP的過程比較變成比較不像引擎所以品質也很重要因為品質之後你才能夠復活到最後真的是在做的時候\n跟當時簽AD是吻合的 不然的話幹嘛當時簽AD變成生命教育而已啊所以我們不但要有生命教育 還要有真的能夠協助在他真正到末期的時候有一個很好的 合乎他的治療方向這個我同意啊 所以這個也是財務方面的部分我們來好啊 我希望你們提出一個財務評估的報告那另外一個\n這個就是說要不要開放其他機構可以進來做這個諮商你們反對你們在報告裡面就是反對那我也看到醫師公會幾大團體他們其實也是反對但是這件事情我是覺得有討論的空間就是說如果他們做到等同的水準我們應該不是從各團體它的出發點而是從一個病人他可以得到服務如果他可以得到同品質的諮商的\n這樣的一個品質那是不是可以去要求就是說你可以要求那些其他想參與的這些專業團體你要達到我這樣的要求就是你這個諮商過程你要達到我的標準而不是一開始就去否決掉說不行啊你們通通不能進來我覺得這件事情剛剛部長你在講說是開放的態度嘛在這件事情的討論我是蠻希望你也是秉持一個比較開放的態度\n態度而不是一開始就直接否決了應該是可以有討論的空間這個可不可以再演繹因為討論法條還有時間你們回去再想想看好不好那個意思是要不要回應一下簡單回應一下就是說現在講的執行場域其實我們覺得病人在哪裡這件事情會是比較重要\n所以我们才会觉得是说以现阶段直接的是说要修法改扩大场域这件事情不如是说我们回过头来在我们目前设定的target这边在执行的过程当中有没有什么可以去做调整的我们目前的方向上面会是这样为什么因为在做资商的过程当中我必须对医疗接触措施对这个疾病的预后要有很清楚的描述那个资商的跨体才会好\n那現階段的大家的各自的專業其實是因為太鑽了所以對HORZONTO這一塊怎麼樣去講的醫療接觸措施對羈絆與喉其實我們會覺得是說這個地方還需要一些共識這樣子的話才會有好的品質所以部長其實有特別講的是說現階段其實需要凝聚更多的共識 以上好 那如果是這樣子的話我覺得你們該去研議因為像護理機構跟長照機構其實會有蠻多是\n他可能要育立一組這樣的一個病人而且他本身其實也有醫事人員所以像這一個或許就是你們第一步可以優先去考量的就是說跟醫療更接近的更相近的他不見得都是在醫院這些人都是在護理之家他可能就在長照機構裡面那你這個就不開放嗎你還要他回到那個診所嗎或者是回到醫院才可以去做這樣的一個\n智商嗎我覺得剛剛市長講一句話很好病人在哪裡你就應該是以這個為前提吧對不對所以這一塊我覺得是有討論空間部長你怎麼表示一下\n我想以病人為中心是我們的目標但是我剛剛有報告過如果在品質上面或者他討論的內容AD討論的內容需要怎麼樣的專業人員當時會有一個諮商為什麼需要那些人其實是有原因的那這樣的品質如果能夠維護品質那當然我們以病人為中心\n來調整我們就可以來討論了好我希望是以病人為中心而不是說團體之間各有成見說什麼團體不行那最後一個問題我問你就是說最近有一個有民間有醫師他們做一個調查就是說86%的民眾支持自主善中然後他們\n就是提出來是一個PAD那衛福部你們對於他這樣子的一個調查跟他們的倡議你們的立場是什麼就是說他們的進一步是說醫師他可以給藥但是病人呢決定自己要不要服藥就是說醫師協助死亡就是台大公衛研究他們做出來的這一塊在台灣有討論空間嗎還是這只是民間的倡議衛福部怎麼看待這件事情\n好的 我們一切要以專業跟人性的關懷來看這件事情\n支持自主善終這應該是要百分之百吧大家也要善終能夠自主性的那我們怎麼樣真正讓他有自主性怎麼樣讓他善終才是重要的事情那我只提醒一點就是說當澳洲在提倡所謂的讓他縮短生命的一個措施\n來減少他痛苦這件事情我不想把它講成安樂死其實就是這種味道\n這麼叫NERS就是Intention因為他太痛苦了所以你想要把他縮短生命所以澳洲馬上宣布就是說如果今天社會關注這個議題首先你應該去看看末期病人你是不是都把他照顧好了讓他不痛了讓他不要那麼辛苦讓他不要覺得他是家人的累贅讓家屬也可以安心的來照顧病人\n如果你這樣的話他要珍惜每一天的生命啊怎麼會去想要去縮短生命所以他們說應該要先去推安寧環的醫療如果你把安寧環某幾病人的安寧環的醫療照顧好的話推得好的話不是沒有發生安樂死這個爭議就變成比較個案事件\n所以我們台灣如果真的推自主三中的時候,還有一個很重要的工作,你有沒有把安寧反而醫療,把病人照顧好。如果把病人照顧好的話,我們再來談下一個沒辦法解決的時候,我們是不是有更加能夠讓他自主,我們再來談。\n好 那所以回到我們的病主法我們真的 因為已經通過了法律我們就應該要好好的施行 好好的落實那我們的重點應該先擺在這邊所以希望這個部長你們回去再好好研議今天委員提出非常多的議題\n就是不要像你們今天的報告好像鐵板一塊每一橋都不可以每一橋都是緩疫我覺得可以你剛剛講一句話很好你是開放的那我們就用開放的態度大家好好的來研議以病人最好的為原則以病人為中心我們看這個法可以怎麼樣修得更好好不好好的好謝謝\n","vtt":"WEBVTT\n\n00:00.249 --> 00:27.145\n你如果要加提案說明就一起會增加時間剛剛有宣布謝謝因為我沒有辦法提案說明好謝謝我們的召委今天排這個很重要的病毒法他的整個修正的條文我想有關於病毒法這個是我們當時在2019年1月正式實施之後我們是亞洲第一部就是以病人為主體\n\n00:27.885 --> 00:56.038\n然後提供很完整的一方面去尊重醫療自主一方面去保障這個善終權益所以這個法我覺得整個亞洲地區來講台灣我們走在前面這個的確是我們應該要好好的來推動的那這六年來其實事情下來呢有出現一些的狀況跟問題就是說當時這個利益非常良善的法案但是上路之後\n\n00:56.798 --> 00:59.579\n至少這個整個執行的醫療簽署率其實並不高如果累計的話現在大概跟我們成人的比例站起來大概只有0.5%所以也代表說我們六年了應該回過頭來檢討我們有哪些地方可以好好的來\n\n01:12.765 --> 01:41.490\n改變那我想當時推動這部法案非常用力的楊玉欣委員那他雖然現在離開立法院但是他很關注這個法後續的實施所以基本上我想我跟劉建國委員我們其實都跟他有保持這個互動所以討論之後我們提出了這樣的一個修法的版本那很重要的幾個點第一個當然就是在這個醫療費用的部分這個是現在很多人\n\n01:42.208 --> 02:03.505\n可能覺得在醫療費用他其實是自己要負擔2000到3500那這個也會阻礙一些人就是說可能礙於費用他沒有辦法來做這個預理醫療的簽署所以費用的部分政府是使得來支應這個是這一次修法的重點那當然\n\n02:04.287 --> 02:16.814\n會希望說是不是健保這邊可以來給予支應所以這個部分這個是很大的一個重點另外一個就是現在可以進行這個育麗醫療照護諮商的單位除了原來在醫療機構裡面的區域醫院跟診所之外那是不是應該可以去開放一樣是很專業的團體\n\n02:27.213 --> 02:55.598\n包括這個有一些護理機構長照機構心理治療所心理諮商所還有社工事務所也都可以來參與因為主要是現在的這個等待的時間是比較長的就是醫院裡面能提供的量能其實也是比較低的所以這個部分也希望可以來開放那另外就是要實施病毒法怎麼樣真正去落實這個原來病人的意願\n\n02:56.377 --> 03:04.963\n那關係人也不可以再去妨礙醫師執行這個是在第4條裡面有提出來修訂那另外病毒法裡面第14條裡面\n\n03:07.476 --> 03:26.916\n特別去修訂就是不要讓這個執行的醫療機構或醫師再去擔負這個刑事行政的責任原本來就有規定那現在再增加一個是民事的責任所以我想這一次委員提出這樣的一個修法就是希望說讓我們這麼亞洲第一的我們的病毒法\n\n03:27.423 --> 03:37.798\n就是可以真正的落實然後去符合到他原來的這個我們希望病人自主而且呢可以善終這樣的一個目標\n\n03:39.898 --> 03:56.857\n那所以這個謝謝莊委給我提案說明的時間那接下來我們就請那個部長是不是我們針對這個議題我們好好的來討論一下第一個就是我想請教部長事實上你剛剛的發言我發現你也是非常支持這一個善終\n\n03:58.683 --> 04:17.214\n醫療這樣的一個方向喔那但是病毒法實施到現在你可以看到他的這個施行率的確是不高喔那所以這個就衛福部部長的角度的話第一個我要問你說你滿意現在的這一個育立醫療的人數嗎就是你是不是覺得他應該還有成長的空間\n\n04:20.995 --> 04:33.384\n我們當然希望它人數一個成長因為其實各個醫院已經都準備團隊在那邊準備服務了啦所以其實量能是有但是就是民眾有沒有意願\n\n04:35.085 --> 04:59.417\n那這個真的剛剛也有委員提到怎麼樣做生命的教育加強生命的教育讓大家能夠來注重這個他自然就覺得這個去簽有意義那這個也是七棟的聯誼可能也不止完全是經會的問題當然經會也是的確是一個原因但是如果生命教育夠讓大家知道這是重要的\n\n05:00.157 --> 05:18.543\n我相信這有更大的啟動力我覺得都要啦就是說讓民眾可以有這個比較好的認知願意接受另外一方面就是去排除他的那個障礙跟門檻那我想今天為什麼很具體的在這個法案裡面就是希望可以\n\n05:19.043 --> 05:21.565\n把這個經費放進來因為我想這個很多團體在第一線推他們的確發現民眾覺得說我很願意簽但是你還要我自己這套腰包再多花3500塊我要花時間然後我要花錢才能完成這個程序我覺得他的確是增加了他的困難度了\n\n05:37.139 --> 05:54.083\n所以這個部分呢這次才會有修法希望說在預算的部分是不是政府的力量可以就像宣導你今天去宣導也是政府的力量協助來宣導那今天要民眾再次多出這個錢我覺得政府相對也是有這個責任如果我們要去推動的話應該可以就是\n\n05:57.263 --> 06:13.382\n多增加這個補助的項目那當然你們原本有對外說2026年要全民免費你知不知道這件事媒體上面有報導原本衛福部是有打算2026年是要全民免費的\n\n06:14.463 --> 06:37.241\n那當時你們這樣的一個目標跟方向其實對於整體的推動是很好的一個方向但是後來為什麼又縮回來了你們現在限縮到五月開始你們只有65歲以上的重大傷病跟65歲以上的多重慢性病就是原本你們其實是有一個很大的目標跟理想就是說就推動全民免費為什麼後來這個政策又縮回來\n\n06:44.231 --> 07:03.948\n我想可能觀念上也不是錢免免費,而是說其實如果能夠早一點立下一些衣族其實未來在做默契的時候,選擇好的對象真的可以節省醫療費用這節省的醫療費用可能遠大於你這個諮商的費用\n\n07:05.349 --> 07:31.297\n所以這種健康投資是值得來評估但是在可能我想國家的財源一定或者健保的財源有限那什麼才是排比較重要的大家可以來討論大家可以討論譬如說剛剛說剛剛時事處長有提什麼藥品都想進來想提高價錢我們的健保就是這樣子今年已經是最大的大家的努力是像多了700多億\n\n07:35.498 --> 08:00.423\n可能還是要很多很多的要努力的空間所以進來他對財務的衝擊是怎麼樣這個的確是我們用開放的胸心用關懷的心那這一部分我可以拜託部長你們回去再研議一下你們現在是開放到65歲但是事實上這個重大傷病就是說你為什麼要用一個年紀來限制這個重大傷病\n\n08:01.423 --> 08:30.452\n可不可以就是以重大傷病或多重慢性病為前提你們去估算一下這樣的人口大概有多少如果你沒有辦法一步到位就是你任何年齡來你完全都免費但是至少我覺得當人開始生病的時候這個問題跟他就是越接近也越需要那你們可不可以再去估另外一部分的經費就是說只要他領有重大傷病卡或是多重慢性病他就可以因為他已經在這個健保體系\n\n08:31.192 --> 08:52.572\n如果他有意願你們就可以補助這部分會多花你們多少錢因為事實上你們現在所設定的一年健保支出3.6億不是一個非常大筆的數額那你如果再擴大一點的話你的總經費會增加多少我是覺得這部分的經費坦白講不是在你所有的健保預算裡面他真的不是最大筆\n\n08:56.834 --> 09:21.723\n我看署長其實也很用力在推動這一點我要肯定那你自己有沒有估算過這個都經過精算其實65歲我們先講重大傷病重大傷病大概是100萬人那麼這個65歲以上大概是50萬那麼底下這個65歲以上多重慢性病這邊大概在100多130萬左右所以兩個合起來是180萬\n\n09:23.203 --> 09:43.410\n所以光是180萬的人全部做一個人3000塊的話是54億啦那所以我們只是想說因為也不會一下子全部的180萬一年通通做完不可能所以我們才說那這樣我們健保應該還可以支撐這樣的費用那當然如果做的多了我們再爭取預算那也不要\n\n09:44.410 --> 09:52.899\n這個影響到整個健保的財務所以我們大概是這樣的方式先擴大到這個65歲以上的重大傷病跟多重慢性病這個涵蓋的範圍是180萬人\n\n09:57.089 --> 10:22.594\n因為其實這我們跟健保署有討論過就現況而言的宣導策略然後簽署的高峰會在60歲以上然後所以才會是說錢用在刀口上然後至於是說一些宣導策略如果有做一些改善的話其實擴大的這部分我們兩邊會密切的合作還有長照是這邊會一起以上你剛說的是60對不對你現在設定65有沒有可能放寬到60\n\n10:24.433 --> 10:38.849\n我們先執行一步我想我們後面還會進入到主條我拜託衛福部一件事就是你去精算一下你的版本你現在6560跟50你就提供這三種版本到底在你的健保經費裡面\n\n10:40.010 --> 11:00.778\n可能要多少因為我也可以理解很多東西可能很難一步到位但是如果在你們現行要擴大的可以再更擴大的話我覺得這個因為你們剛剛已經講了事實上這件事情一方面是保障病人本身一方面對你整個健保剛剛部長也有講如果越多人去預例這樣子的一個\n\n11:02.560 --> 11:27.377\n的這個去預列這個醫療的這個確認的話那事實上未來再節省你的健保支出那個其實是會有一個反饋機制你知道嗎你簽越多事實上你未來要支付的可能就是越少因為你一些無效醫療他會提前去終止所以你應該用一個比較大的水庫的概念來看待這件事而不是只有看說我現在要多支出3.6億10億你應該去精算每一個有簽署的你將來節省的醫療的\n\n11:33.040 --> 11:47.848\n無效的醫療支出可能會有多少你這樣算下來之後你就知道說它反而這邊越增加不是越增加你的健保支出而可能是越節省未來整個醫療的無效支出我覺得你們要有這樣的概念來看待這件事情\n\n11:48.416 --> 12:16.003\n所以我想這是很重要也是一直我們在研議的方向但是我剛剛有報告過其實簽了ADE以後到最後的話大概有七成是吻合的那是早期喔後來慢慢的吻合率比較低為什麼後來做ACP的過程比較變成比較不像引擎所以品質也很重要因為品質之後你才能夠復活到最後真的是在做的時候\n\n12:16.724 --> 12:33.318\n跟當時簽AD是吻合的不然的話幹嘛當時簽AD變成生命教育而已啊所以我們不但要有生命教育還要有真的能夠協助在他真正到末期的時候有一個很好的合乎他的治療方向這個我同意啊所以這個也是財務方面的部分我們來好啊我希望你們提出一個財務評估的報告那另外一個\n\n12:40.984 --> 13:08.523\n這個就是說要不要開放其他機構可以進來做這個諮商你們反對你們在報告裡面就是反對那我也看到醫師公會幾大團體他們其實也是反對但是這件事情我是覺得有討論的空間就是說如果他們做到等同的水準我們應該不是從各團體它的出發點而是從一個病人他可以得到服務如果他可以得到同品質的諮商的\n\n13:09.203 --> 13:26.637\n這樣的一個品質那是不是可以去要求就是說你可以要求那些其他想參與的這些專業團體你要達到我這樣的要求就是你這個諮商過程你要達到我的標準而不是一開始就去否決掉說不行啊你們通通不能進來我覺得這件事情剛剛部長你在講說是開放的態度嘛在這件事情的討論我是蠻希望你也是秉持一個比較開放的態度\n\n13:33.702 --> 13:53.710\n態度而不是一開始就直接否決了應該是可以有討論的空間這個可不可以再演繹因為討論法條還有時間你們回去再想想看好不好那個意思是要不要回應一下簡單回應一下就是說現在講的執行場域其實我們覺得病人在哪裡這件事情會是比較重要\n\n13:54.170 --> 14:20.829\n所以我们才会觉得是说以现阶段直接的是说要修法改扩大场域这件事情不如是说我们回过头来在我们目前设定的target这边在执行的过程当中有没有什么可以去做调整的我们目前的方向上面会是这样为什么因为在做资商的过程当中我必须对医疗接触措施对这个疾病的预后要有很清楚的描述那个资商的跨体才会好\n\n14:21.509 --> 14:46.183\n那現階段的大家的各自的專業其實是因為太鑽了所以對HORZONTO這一塊怎麼樣去講的醫療接觸措施對羈絆與喉其實我們會覺得是說這個地方還需要一些共識這樣子的話才會有好的品質所以部長其實有特別講的是說現階段其實需要凝聚更多的共識以上好那如果是這樣子的話我覺得你們該去研議因為像護理機構跟長照機構其實會有蠻多是\n\n14:49.305 --> 15:05.189\n他可能要育立一組這樣的一個病人而且他本身其實也有醫事人員所以像這一個或許就是你們第一步可以優先去考量的就是說跟醫療更接近的更相近的他不見得都是在醫院這些人都是在護理之家他可能就在長照機構裡面那你這個就不開放嗎你還要他回到那個診所嗎或者是回到醫院才可以去做這樣的一個\n\n15:15.913 --> 15:27.866\n智商嗎我覺得剛剛市長講一句話很好病人在哪裡你就應該是以這個為前提吧對不對所以這一塊我覺得是有討論空間部長你怎麼表示一下\n\n15:28.735 --> 15:51.884\n我想以病人為中心是我們的目標但是我剛剛有報告過如果在品質上面或者他討論的內容AD討論的內容需要怎麼樣的專業人員當時會有一個諮商為什麼需要那些人其實是有原因的那這樣的品質如果能夠維護品質那當然我們以病人為中心\n\n15:53.353 --> 16:14.082\n來調整我們就可以來討論了好我希望是以病人為中心而不是說團體之間各有成見說什麼團體不行那最後一個問題我問你就是說最近有一個有民間有醫師他們做一個調查就是說86%的民眾支持自主善中然後他們\n\n16:15.973 --> 16:44.740\n就是提出來是一個PAD那衛福部你們對於他這樣子的一個調查跟他們的倡議你們的立場是什麼就是說他們的進一步是說醫師他可以給藥但是病人呢決定自己要不要服藥就是說醫師協助死亡就是台大公衛研究他們做出來的這一塊在台灣有討論空間嗎還是這只是民間的倡議衛福部怎麼看待這件事情\n\n16:44.980 --> 16:51.084\n好的我們一切要以專業跟人性的關懷來看這件事情\n\n16:52.833 --> 17:17.502\n支持自主善終這應該是要百分之百吧大家也要善終能夠自主性的那我們怎麼樣真正讓他有自主性怎麼樣讓他善終才是重要的事情那我只提醒一點就是說當澳洲在提倡所謂的讓他縮短生命的一個措施\n\n17:19.064 --> 17:24.501\n來減少他痛苦這件事情我不想把它講成安樂死其實就是這種味道\n\n17:25.831 --> 17:50.003\n這麼叫NERS就是Intention因為他太痛苦了所以你想要把他縮短生命所以澳洲馬上宣布就是說如果今天社會關注這個議題首先你應該去看看末期病人你是不是都把他照顧好了讓他不痛了讓他不要那麼辛苦讓他不要覺得他是家人的累贅讓家屬也可以安心的來照顧病人\n\n17:51.043 --> 18:07.789\n如果你這樣的話他要珍惜每一天的生命啊怎麼會去想要去縮短生命所以他們說應該要先去推安寧環的醫療如果你把安寧環某幾病人的安寧環的醫療照顧好的話推得好的話不是沒有發生安樂死這個爭議就變成比較個案事件\n\n18:08.709 --> 18:26.751\n所以我們台灣如果真的推自主三中的時候,還有一個很重要的工作,你有沒有把安寧反而醫療,把病人照顧好。如果把病人照顧好的話,我們再來談下一個沒辦法解決的時候,我們是不是有更加能夠讓他自主,我們再來談。\n\n18:27.992 --> 18:42.456\n好那所以回到我們的病主法我們真的因為已經通過了法律我們就應該要好好的施行好好的落實那我們的重點應該先擺在這邊所以希望這個部長你們回去再好好研議今天委員提出非常多的議題\n\n18:44.557 --> 19:04.006\n就是不要像你們今天的報告好像鐵板一塊每一橋都不可以每一橋都是緩疫我覺得可以你剛剛講一句話很好你是開放的那我們就用開放的態度大家好好的來研議以病人最好的為原則以病人為中心我們看這個法可以怎麼樣修得更好好不好好的好謝謝\n\n","segments":[{"start":0.249,"end":27.145,"text":"你如果要加提案說明就一起會增加時間剛剛有宣布謝謝因為我沒有辦法提案說明好 謝謝我們的召委今天排這個很重要的病毒法他的整個修正的條文我想有關於病毒法這個是我們當時在2019年1月正式實施之後我們是亞洲第一部就是以病人為主體"},{"start":27.885,"end":56.038,"text":"然後提供很完整的一方面去尊重醫療自主一方面去保障這個善終權益所以這個法我覺得整個亞洲地區來講台灣我們走在前面這個的確是我們應該要好好的來推動的那這六年來其實事情下來呢有出現一些的狀況跟問題就是說當時這個利益非常良善的法案但是上路之後"},{"start":56.798,"end":59.579,"text":"至少這個整個執行的醫療簽署率其實並不高如果累計的話現在大概跟我們成人的比例站起來大概只有0.5%所以也代表說我們六年了應該回過頭來檢討我們有哪些地方可以好好的來"},{"start":72.765,"end":101.49,"text":"改變那我想當時推動這部法案非常用力的楊玉欣委員那他雖然現在離開立法院但是他很關注這個法後續的實施所以基本上我想我跟劉建國委員我們其實都跟他有保持這個互動所以討論之後我們提出了這樣的一個修法的版本那很重要的幾個點第一個當然就是在這個醫療費用的部分這個是現在很多人"},{"start":102.208,"end":123.505,"text":"可能覺得在醫療費用他其實是自己要負擔2000到3500那這個也會阻礙一些人就是說可能礙於費用他沒有辦法來做這個預理醫療的簽署所以費用的部分政府是使得來支應這個是這一次修法的重點那當然"},{"start":124.287,"end":136.814,"text":"會希望說是不是健保這邊可以來給予支應所以這個部分這個是很大的一個重點另外一個就是現在可以進行這個育麗醫療照護諮商的單位除了原來在醫療機構裡面的區域醫院跟診所之外那是不是應該可以去開放一樣是很專業的團體"},{"start":147.213,"end":175.598,"text":"包括這個有一些護理機構長照機構心理治療所心理諮商所還有社工事務所也都可以來參與因為主要是現在的這個等待的時間是比較長的就是醫院裡面能提供的量能其實也是比較低的所以這個部分也希望可以來開放那另外就是要實施病毒法怎麼樣真正去落實這個原來病人的意願"},{"start":176.377,"end":184.963,"text":"那關係人也不可以再去妨礙醫師執行這個是在第4條裡面有提出來修訂那另外病毒法裡面第14條裡面"},{"start":187.476,"end":206.916,"text":"特別去修訂就是不要讓這個執行的醫療機構或醫師再去擔負這個刑事行政的責任原本來就有規定那現在再增加一個是民事的責任所以我想這一次委員提出這樣的一個修法就是希望說讓我們這麼亞洲第一的我們的病毒法"},{"start":207.423,"end":217.798,"text":"就是可以真正的落實然後去符合到他原來的這個我們希望病人自主而且呢可以善終這樣的一個目標"},{"start":219.898,"end":236.857,"text":"那所以這個謝謝莊委給我提案說明的時間那接下來我們就請那個部長是不是我們針對這個議題我們好好的來討論一下第一個就是我想請教部長事實上你剛剛的發言我發現你也是非常支持這一個善終"},{"start":238.683,"end":257.214,"text":"醫療這樣的一個方向喔那但是病毒法實施到現在你可以看到他的這個施行率的確是不高喔那所以這個就衛福部部長的角度的話第一個我要問你說你滿意現在的這一個育立醫療的人數嗎就是你是不是覺得他應該還有成長的空間"},{"start":260.995,"end":273.384,"text":"我們當然希望它人數一個成長因為其實各個醫院已經都準備團隊在那邊準備服務了啦所以其實量能是有但是就是民眾有沒有意願"},{"start":275.085,"end":299.417,"text":"那這個真的剛剛也有委員提到怎麼樣做生命的教育加強生命的教育讓大家能夠來注重這個他自然就覺得這個去簽有意義那這個也是七棟的聯誼可能也不止完全是經會的問題當然經會也是的確是一個原因但是如果生命教育夠讓大家知道這是重要的"},{"start":300.157,"end":318.543,"text":"我相信這有更大的啟動力我覺得都要啦就是說讓民眾可以有這個比較好的認知願意接受另外一方面就是去排除他的那個障礙跟門檻那我想今天為什麼很具體的在這個法案裡面就是希望可以"},{"start":319.043,"end":321.565,"text":"把這個經費放進來因為我想這個很多團體在第一線推他們的確發現民眾覺得說我很願意簽但是你還要我自己這套腰包再多花3500塊我要花時間然後我要花錢才能完成這個程序我覺得他的確是增加了他的困難度了"},{"start":337.139,"end":354.083,"text":"所以這個部分呢這次才會有修法希望說在預算的部分是不是政府的力量可以就像宣導你今天去宣導也是政府的力量協助來宣導那今天要民眾再次多出這個錢我覺得政府相對也是有這個責任如果我們要去推動的話應該可以就是"},{"start":357.263,"end":373.382,"text":"多增加這個補助的項目那當然你們原本有對外說2026年要全民免費你知不知道這件事媒體上面有報導原本衛福部是有打算2026年是要全民免費的"},{"start":374.463,"end":397.241,"text":"那當時你們這樣的一個目標跟方向其實對於整體的推動是很好的一個方向但是後來為什麼又縮回來了你們現在限縮到五月開始你們只有65歲以上的重大傷病跟65歲以上的多重慢性病就是原本你們其實是有一個很大的目標跟理想就是說就推動全民免費為什麼後來這個政策又縮回來"},{"start":404.231,"end":423.948,"text":"我想可能觀念上也不是錢免免費,而是說其實如果能夠早一點立下一些衣族其實未來在做默契的時候,選擇好的對象真的可以節省醫療費用這節省的醫療費用可能遠大於你這個諮商的費用"},{"start":425.349,"end":451.297,"text":"所以這種健康投資是值得來評估但是在可能我想國家的財源一定或者健保的財源有限那什麼才是排比較重要的大家可以來討論大家可以討論譬如說剛剛說剛剛時事處長有提什麼藥品都想進來想提高價錢我們的健保就是這樣子今年已經是最大的大家的努力是像多了700多億"},{"start":455.498,"end":480.423,"text":"可能還是要很多很多的要努力的空間所以進來他對財務的衝擊是怎麼樣這個的確是我們用開放的胸心用關懷的心那這一部分我可以拜託部長你們回去再研議一下你們現在是開放到65歲但是事實上這個重大傷病就是說你為什麼要用一個年紀來限制這個重大傷病"},{"start":481.423,"end":510.452,"text":"可不可以就是以重大傷病或多重慢性病為前提你們去估算一下這樣的人口大概有多少如果你沒有辦法一步到位就是你任何年齡來你完全都免費但是至少我覺得當人開始生病的時候這個問題跟他就是越接近也越需要那你們可不可以再去估另外一部分的經費就是說只要他領有重大傷病卡或是多重慢性病他就可以因為他已經在這個健保體系"},{"start":511.192,"end":532.572,"text":"如果他有意願你們就可以補助這部分會多花你們多少錢因為事實上你們現在所設定的一年健保支出3.6億不是一個非常大筆的數額那你如果再擴大一點的話你的總經費會增加多少我是覺得這部分的經費坦白講不是在你所有的健保預算裡面他真的不是最大筆"},{"start":536.834,"end":561.723,"text":"我看署長其實也很用力在推動這一點我要肯定那你自己有沒有估算過這個都經過精算其實65歲我們先講重大傷病重大傷病大概是100萬人那麼這個65歲以上大概是50萬那麼底下這個65歲以上多重慢性病這邊大概在100多130萬左右所以兩個合起來是180萬"},{"start":563.203,"end":583.41,"text":"所以光是180萬的人全部做一個人3000塊的話是54億啦那所以我們只是想說因為也不會一下子全部的180萬一年通通做完不可能所以我們才說那這樣我們健保應該還可以支撐這樣的費用那當然如果做的多了我們再爭取預算那也不要"},{"start":584.41,"end":592.899,"text":"這個影響到整個健保的財務所以我們大概是這樣的方式先擴大到這個65歲以上的重大傷病跟多重慢性病這個涵蓋的範圍是180萬人"},{"start":597.089,"end":622.594,"text":"因為其實這我們跟健保署有討論過就現況而言的宣導策略然後簽署的高峰會在60歲以上然後所以才會是說錢用在刀口上然後至於是說一些宣導策略如果有做一些改善的話其實擴大的這部分我們兩邊會密切的合作還有長照是這邊會一起以上你剛說的是60對不對 你現在設定65有沒有可能放寬到60"},{"start":624.433,"end":638.849,"text":"我們先執行一步我想我們後面還會進入到主條我拜託衛福部一件事就是你去精算一下你的版本你現在65 60跟50你就提供這三種版本到底在你的健保經費裡面"},{"start":640.01,"end":660.778,"text":"可能要多少因為我也可以理解很多東西可能很難一步到位但是如果在你們現行要擴大的可以再更擴大的話我覺得這個因為你們剛剛已經講了事實上這件事情一方面是保障病人本身一方面對你整個健保剛剛部長也有講如果越多人去預例這樣子的一個"},{"start":662.56,"end":687.377,"text":"的這個去預列這個醫療的這個確認的話那事實上未來再節省你的健保支出那個其實是會有一個反饋機制你知道嗎你簽越多事實上你未來要支付的可能就是越少因為你一些無效醫療他會提前去終止所以你應該用一個比較大的水庫的概念來看待這件事而不是只有看說我現在要多支出3.6億10億你應該去精算每一個有簽署的你將來節省的醫療的"},{"start":693.04,"end":707.848,"text":"無效的醫療支出可能會有多少你這樣算下來之後你就知道說它反而這邊越增加不是越增加你的健保支出而可能是越節省未來整個醫療的無效支出我覺得你們要有這樣的概念來看待這件事情"},{"start":708.416,"end":736.003,"text":"所以我想這是很重要也是一直我們在研議的方向但是我剛剛有報告過其實簽了ADE以後到最後的話大概有七成是吻合的那是早期喔後來慢慢的吻合率比較低為什麼後來做ACP的過程比較變成比較不像引擎所以品質也很重要因為品質之後你才能夠復活到最後真的是在做的時候"},{"start":736.724,"end":753.318,"text":"跟當時簽AD是吻合的 不然的話幹嘛當時簽AD變成生命教育而已啊所以我們不但要有生命教育 還要有真的能夠協助在他真正到末期的時候有一個很好的 合乎他的治療方向這個我同意啊 所以這個也是財務方面的部分我們來好啊 我希望你們提出一個財務評估的報告那另外一個"},{"start":760.984,"end":788.523,"text":"這個就是說要不要開放其他機構可以進來做這個諮商你們反對你們在報告裡面就是反對那我也看到醫師公會幾大團體他們其實也是反對但是這件事情我是覺得有討論的空間就是說如果他們做到等同的水準我們應該不是從各團體它的出發點而是從一個病人他可以得到服務如果他可以得到同品質的諮商的"},{"start":789.203,"end":806.637,"text":"這樣的一個品質那是不是可以去要求就是說你可以要求那些其他想參與的這些專業團體你要達到我這樣的要求就是你這個諮商過程你要達到我的標準而不是一開始就去否決掉說不行啊你們通通不能進來我覺得這件事情剛剛部長你在講說是開放的態度嘛在這件事情的討論我是蠻希望你也是秉持一個比較開放的態度"},{"start":813.702,"end":833.71,"text":"態度而不是一開始就直接否決了應該是可以有討論的空間這個可不可以再演繹因為討論法條還有時間你們回去再想想看好不好那個意思是要不要回應一下簡單回應一下就是說現在講的執行場域其實我們覺得病人在哪裡這件事情會是比較重要"},{"start":834.17,"end":860.829,"text":"所以我们才会觉得是说以现阶段直接的是说要修法改扩大场域这件事情不如是说我们回过头来在我们目前设定的target这边在执行的过程当中有没有什么可以去做调整的我们目前的方向上面会是这样为什么因为在做资商的过程当中我必须对医疗接触措施对这个疾病的预后要有很清楚的描述那个资商的跨体才会好"},{"start":861.509,"end":886.183,"text":"那現階段的大家的各自的專業其實是因為太鑽了所以對HORZONTO這一塊怎麼樣去講的醫療接觸措施對羈絆與喉其實我們會覺得是說這個地方還需要一些共識這樣子的話才會有好的品質所以部長其實有特別講的是說現階段其實需要凝聚更多的共識 以上好 那如果是這樣子的話我覺得你們該去研議因為像護理機構跟長照機構其實會有蠻多是"},{"start":889.305,"end":905.189,"text":"他可能要育立一組這樣的一個病人而且他本身其實也有醫事人員所以像這一個或許就是你們第一步可以優先去考量的就是說跟醫療更接近的更相近的他不見得都是在醫院這些人都是在護理之家他可能就在長照機構裡面那你這個就不開放嗎你還要他回到那個診所嗎或者是回到醫院才可以去做這樣的一個"},{"start":915.913,"end":927.866,"text":"智商嗎我覺得剛剛市長講一句話很好病人在哪裡你就應該是以這個為前提吧對不對所以這一塊我覺得是有討論空間部長你怎麼表示一下"},{"start":928.735,"end":951.884,"text":"我想以病人為中心是我們的目標但是我剛剛有報告過如果在品質上面或者他討論的內容AD討論的內容需要怎麼樣的專業人員當時會有一個諮商為什麼需要那些人其實是有原因的那這樣的品質如果能夠維護品質那當然我們以病人為中心"},{"start":953.353,"end":974.082,"text":"來調整我們就可以來討論了好我希望是以病人為中心而不是說團體之間各有成見說什麼團體不行那最後一個問題我問你就是說最近有一個有民間有醫師他們做一個調查就是說86%的民眾支持自主善中然後他們"},{"start":975.973,"end":1004.74,"text":"就是提出來是一個PAD那衛福部你們對於他這樣子的一個調查跟他們的倡議你們的立場是什麼就是說他們的進一步是說醫師他可以給藥但是病人呢決定自己要不要服藥就是說醫師協助死亡就是台大公衛研究他們做出來的這一塊在台灣有討論空間嗎還是這只是民間的倡議衛福部怎麼看待這件事情"},{"start":1004.98,"end":1011.084,"text":"好的 我們一切要以專業跟人性的關懷來看這件事情"},{"start":1012.833,"end":1037.502,"text":"支持自主善終這應該是要百分之百吧大家也要善終能夠自主性的那我們怎麼樣真正讓他有自主性怎麼樣讓他善終才是重要的事情那我只提醒一點就是說當澳洲在提倡所謂的讓他縮短生命的一個措施"},{"start":1039.064,"end":1044.501,"text":"來減少他痛苦這件事情我不想把它講成安樂死其實就是這種味道"},{"start":1045.831,"end":1070.003,"text":"這麼叫NERS就是Intention因為他太痛苦了所以你想要把他縮短生命所以澳洲馬上宣布就是說如果今天社會關注這個議題首先你應該去看看末期病人你是不是都把他照顧好了讓他不痛了讓他不要那麼辛苦讓他不要覺得他是家人的累贅讓家屬也可以安心的來照顧病人"},{"start":1071.043,"end":1087.789,"text":"如果你這樣的話他要珍惜每一天的生命啊怎麼會去想要去縮短生命所以他們說應該要先去推安寧環的醫療如果你把安寧環某幾病人的安寧環的醫療照顧好的話推得好的話不是沒有發生安樂死這個爭議就變成比較個案事件"},{"start":1088.709,"end":1106.751,"text":"所以我們台灣如果真的推自主三中的時候,還有一個很重要的工作,你有沒有把安寧反而醫療,把病人照顧好。如果把病人照顧好的話,我們再來談下一個沒辦法解決的時候,我們是不是有更加能夠讓他自主,我們再來談。"},{"start":1107.992,"end":1122.456,"text":"好 那所以回到我們的病主法我們真的 因為已經通過了法律我們就應該要好好的施行 好好的落實那我們的重點應該先擺在這邊所以希望這個部長你們回去再好好研議今天委員提出非常多的議題"},{"start":1124.557,"end":1144.006,"text":"就是不要像你們今天的報告好像鐵板一塊每一橋都不可以每一橋都是緩疫我覺得可以你剛剛講一句話很好你是開放的那我們就用開放的態度大家好好的來研議以病人最好的為原則以病人為中心我們看這個法可以怎麼樣修得更好好不好好的好謝謝"}]}}},"gazette":{"lineno":291,"blocks":[["王委員育敏：（10時13分）好，謝謝召委今天安排這個很重要的病主法條文修正草案。病主法在2019年1月正式實施之後，是亞洲第一部以病人為主體、提供完整制度的法案，一方面尊重醫療自主，一方面也保障善終權益，在整個亞洲地區來講，臺灣是走在前面，所以我們的確應該好好來推動。","本法施行6年下來，出現了一些狀況跟問題，當時立意非常良善的法案，在上路之後，事實上，整個預立醫療簽署率其實並不高，以我們成人比例來算，預立醫療簽署累計人數大概只占0.5%，代表經過這6年時間，是應該回過頭來檢討有哪些地方可以好好改變。當時推動這部法案非常用力的楊玉欣委員，雖然現在已經離開立法院，但是他很關注這個法後續的實施，基本上，我跟劉建國委員都有跟他保持互動，經過討論之後，我們提出了這樣一個修法版本，當中很重要的幾個點如下：","第一，當然就是醫療費用的部分。因為相關醫療費用自己要負擔2,000到3,500元，很多人可能礙於費用，而沒有辦法做這個預立醫療的簽署，所以費用的部分，本席認為政府應該適時支應，當然我們是希望由健保來支應，這是這次修法的一個很大重點。","第二，目前可以進行預立醫療照護諮商的單位，除了原來醫療機構裡的區域醫院和診所外，我們認為是不是應該開放一樣很專業的團體，包括護理機構、長照機構、心理治療所、心理諮商所，還有社工事務所等，也都可以參與，主要是因為現在等待的時間比較長，醫院能提供的量能其實比較低，所以希望這個部分也可以開放。","第三，實施病主法，要如何真正落實原來病人的意願，關係人不可以再去妨礙醫師執行？這個我們在第四條提出修正。","另外，病主法第十四條原來就有規定不讓執行的醫療機構或醫師去擔負刑事、行政責任，現在再增加民事責任。","這一次委員們提出這樣的修法，就是希望這個亞洲第一的病主法可以真正落實，符合我們原來所希望的讓病人自主，而且可以善終的這樣一個目標。謝謝召委給我提案說明的時間。","接下來我要請教部長，我們針對幾個議題好好來討論。"],["邱部長泰源：委員好。"],["王委員育敏：第一個我想請教部長的是，就你剛剛的發言，我發現你也是非常支持善終醫療這樣的方向，但是病主法實施到現在，可以看到它的施行率的確不高，所以就衛福部部長的角度，我第一個要問你的是，你滿意現在這個預立醫療的人數嗎？你是不是覺得它應該還有成長的空間？"],["邱部長泰源：我們當然希望人數可以成長，因為各個醫院以前都要準備團隊在那邊準備服務，所以量能其實是有，但就是民眾有沒有意願，這個真的……剛剛也有委員提到怎麼樣做生命的教育、加強生命的教育，讓大家能夠注重這個，他自然就覺得去簽是有意義的，這個也是驅動的原力，可能也不完全是經費的問題，當然經費的確也是一個原因，但是如果生命教育夠，讓大家知道這是重要的，我相信這是更大的驅動力。"],["王委員育敏：我是覺得都要，要讓民眾可以有比較好的認知願意接受，另外一方面就是去排除他的障礙跟門檻。我今天為什麼要很具體地在這個法案裡面……就是希望可以把這個經費放進來，因為我想很多團體在第一線推，他們的確發現民眾覺得，我很願意簽，但是你還要我自掏腰包再多花3,500塊，我要花時間，然後我要花錢才能完成這個程序，我覺得這的確是增加了他的困難度，所以這次對這個部分才會修法，希望在預算的部分是不是可以用政府的力量來做。就像宣導，你今天去宣導也是政府的力量在協助宣導，今天要民眾再多出這個錢，我覺得政府相對也是有這個責任，如果我們要去推動的話，應該可以多增加這個補助的項目。","當然你們原本有對外說，2026年要全民免費，你知不知道有這件事？媒體上面有報導，原本衛福部有打算2026年要全民免費的，當時你們這樣的一個目標跟方向，對於整體的推動是個很好的方向，但是為什麼後來又縮回來了？你們現在是限縮到5月開始，你們只限65歲以上的重大傷病，跟65歲以上的多重慢性病。原本你們其實是有一個很大的目標跟理想，就是推動全民免費，為什麼後來這個政策又縮回來了？"],["邱部長泰源：我想可能在觀念上也不是全民免費，而是如果能夠早一點立下一些醫囑，未來在默許的時候，選擇好的對象真的可以節省醫療費用，而節省的醫療費用可能遠大於諮商的費用。"],["王委員育敏：是啊！"],["邱部長泰源：所以這種健康投資是值得評估的，但是可能……我想國家的財源或是健保的財源有限，怎麼去排比較重要的，大家可以討論，譬如剛剛石署長也有提到，什麼藥品都想進來，而且還要提高價錢，但我們的健保就是這樣子，今年已經是最大的，在大家的努力之下多了七百多億，還是沒有辦法，可能還是有很多很多要努力的空間，所以進來後對財務的衝擊是怎麼樣，我們的確要用開放的胸襟、用關懷的心來處理這件事。"],["王委員育敏：這部分我可不可以拜託部長，你們回去再研議一下？你們現在是開放到65歲，但是事實上這個重大傷病……你為什麼要用年紀來限制這個重大傷病？可不可以用重大傷病或多重慢性病為前提，你們去估算一下這樣的人口大概有多少？如果你沒有辦法一步到位，就是任何年齡來，完全都免費，但是至少我覺得當人開始生病的時候，這個問題跟他就愈接近也愈需要。你們可不可以再去估另外一部分的經費，只要他領有重大傷病卡，或是有多重慢性病，他就可以……因為他已經在這個健保體系，如果他有意願，你們就可以補助，這部分會多花你們多少錢？","事實上你們現在所設定的，一年健保的支出是3.6億，不是一個非常大筆的數額，你如果再擴大一點的話，你的總經費會增加多少？我是覺得這部分的經費在你所有的健保預算裡面，坦白講，它真的不是最大筆的。"],["邱部長泰源：報告委員，可不可以請署長回應一下？"],["王委員育敏：我看署長其實也很用力在推動，這一點我要肯定，但你可不可以……你自己有沒有估算過？"],["石署長崇良：有，這個都經過精算了，其實65歲的部分，我們先講重大傷病，重大傷病大概有100萬人，65歲以上大概是50萬，底下這個65歲以上多重慢性病，這邊大概在130萬左右，所以兩個合起來就是180萬。光是180萬的人全部做，1個人3,000塊的話就是54億。我們只是想，這也不是一下子就把全部的180萬人在一年內通通做完。"],["王委員育敏：不會。"],["石署長崇良：不可能！所以我們才說，我們的健保應該還可以支撐這樣的費用。當然，如果做得多了，我們再爭取預算，也不要影響到整個健保的財務，所以我們大概是以這樣的方式，先擴大到65歲以上的重大傷病跟多重慢性病，這邊涵蓋的範圍是180萬人。"],["劉司長越萍：我要補充一下。"],["王委員育敏：好，司長。"],["劉司長越萍：我們其實有跟健保署有討論過，就現況而言的宣導策略，簽署的高峰會在60歲以上，所以才會說要把錢用在刀口上，至於一些宣導策略如果有做一些改善的話，其實擴大的部分，我們兩邊會密切地合作，還有長照司也會一起。以上。"],["王委員育敏：好，你剛剛說的是60歲，對不對？那你現在怎麼會設定65歲？"],["石署長崇良：是65歲。"],["王委員育敏：有沒有可能放寬到60歲？"],["石署長崇良：我們先執行一部分……"],["王委員育敏：我想這個部分，後面還會進入逐條，我拜託衛福部一件事情，你去精算一下你的版本，好不好？你現在是65歲，然後是60歲跟50歲，你就提供這三種版本，到底在你的健保經費裡面可能要多少？我也可以理解，很多東西可能很難一步到位，但是如果在你們現行要擴大的可以再更擴大的話，我覺得……因為你們剛剛已經講了，事實上這件事情一方面是保障病人本身，一方面對你整個健保，剛剛部長也有講，如果愈多人去預立醫療同意書的話，事實上未來就是在節省你的健保支出，那個其實是會有反饋機制的，你知道嗎？你簽愈多，事實上你未來要支付的可能就是愈少，因為一些無效醫療會提前終止，所以你應該要用一個比較大水庫的概念去看待這件事，而不是只看現在要多支出3.6億、10億。你應該去精算每一個有簽署的，將來會節省的無效醫療支出可能會有多少，這樣算下來之後就會知道，反而是這邊愈增加，並不會愈增加你的健保支出，反而是愈節省未來整個醫療的無效支出，我覺得你們要有這樣的概念去看待這件事情。"],["邱部長泰源：委員，我想這是很重要，也是我們一直在研議的方向。"],["王委員育敏：是。"],["邱部長泰源：但是我剛剛有報告過，其實簽了AD以後，到最後大概有七成是吻合的，那是指早期，後來慢慢地吻合率就比較低了，為什麼？因為後來做ACP的過程變成比較沒那麼嚴謹，所以品質也很重要。"],["王委員育敏：對啊！"],["邱部長泰源：有品質之後，才能符合最後真的在做的時候，跟當時簽的AD是吻合的，不然當時簽的AD就變成是生命教育而已啊！"],["王委員育敏：對。"],["邱部長泰源：所以我們不但要有生命教育，還要真的能夠協助在他到末期的時候，真的能有一個很好的、合乎他的治療方向。"],["王委員育敏：這個我同意，所以這個過程也是你們要去檢討的。"],["邱部長泰源：財務方面的預算我們來逐步評估。"],["王委員育敏：好，我希望你們提出一個財務評估的報告。另外一個是，要不要開放其他機構可以進來做諮商？你們在報告裡面反對，我也看到醫師公會等幾大團體，他們其實是反對的，但是對於這件事情，我是覺得有討論的空間。也就是說，如果他們能做到等同的水準，我們應該不是從各團體的出發點，而要從一個病人可以得到的服務來看。如果他可以得到相同的諮商品質，是不是就可以去要求那些其他想參與的這些專業團體也要達到我這樣的要求？也就是你的諮商過程要達到我的標準，而不是一開始就去否決掉，認為不行，你們通通都不能進來。我覺得這件事情，剛剛部長已經講了，要採開放的態度，對於這件事情的討論，我也滿希望你也能秉持一個比較開放的態度，而不是一開始就直接否決，應該是可以有討論的空間。這個可不可以再研議？因為討論法條還有時間，你們回去再想想看，好不好？"],["邱部長泰源：醫事司要不要回應一下你的意見？"],["王委員育敏：來，司長。"],["劉司長越萍：簡單回應一下，現在講的執行場域，其實我們覺得病人在哪裡這件事情會是比較重要的，所以我們才會覺得以現階段說要直接修法擴大場域這件事，不如說我們回過頭來在我們目前設定的target這邊，在執行的過程當中有沒有什麼可以調整的，我們目前的方向會是這樣，為什麼？因為在做諮商的過程當中，必須對醫療介入措施、對疾病的預後要有很清楚的描述，那個諮商的quality才會好。現階段大家各自的專業其實是因為太鑽了，所以對horizontal這一塊講的醫療介入措施、對疾病的預後，我們會覺得這個地方還需要一些共識，這樣子的話才會有好的品質，所以部長有特別講到現階段需要凝聚更多的共識。以上。"],["王委員育敏：好。如果是這樣子的話，我覺得你們該去研議，因為像護理機構及長照機構其實會有滿多是可能要預立醫囑的病人，而且它本身也有醫事人員，所以像這個或許就是你們第一步可以優先去考量的，就是跟醫療更接近的、更相近的，因為這些人不見得都是在醫院，而是在護理之家或長照機構裡面，你們這個部分就不開放嗎？還要他們回到診所嗎？或者是回到醫院才可以做這樣的諮商嗎？我覺得剛剛司長講一句話很好，就是病人在哪裡，你們就應該以這個為前提吧，對不對？所以這一塊我覺得有討論空間。部長，你表示一下。"],["邱部長泰源：以病人為中心是我們的目標，但是我剛剛有報告過，如果在品質上面，或者討論的內容、AD討論的內容需要怎麼樣的專業人員……諮商當時為什麼需要那些人其實是有原因的。"],["王委員育敏：是。"],["邱部長泰源：如果能夠維護品質，以病人為中心來調整都可以討論。"],["王委員育敏：好，我希望是以病人為中心，而不是團體之間各有成見，說什麼團體不行。","最後一個問題，最近民間的醫師做了一個調查，有86%的民眾支持自主善終，據此他們提出PAD，衛福部對於這樣的調查及倡議，你們的立場是什麼？他們進一步的倡議是醫師可以給藥，但是由病人自己決定要不要服藥，就是醫師協助死亡，這是臺大公衛做出來的研究。這一塊在臺灣有討論空間嗎？還是這只是民間的倡議？衛福部怎麼看待這件事情？"],["邱部長泰源：我們一切要以專業及人性的關懷來看這件事情，支持自主善終應該是要百分之百吧。大家都想要善終、能夠自主性的，我們怎麼樣真正讓他有自主性、讓他善終才是重要的事情。我只提醒一點，當澳洲在提倡所謂縮短生命的措施來減少病人的痛苦這件事情，我不想把它講成安樂死，但其實就是這種味道。什麼叫安樂死？就是intention，因為他太痛苦了，所以想要縮短生命。澳洲馬上宣布如果今天社會關注這個議題，首先應該去看看是不是把末期病人照顧好了，讓他不痛了，讓他不要那麼辛苦，讓他不要覺得是家人的累贅，讓家屬也可以安心地照顧病人，如果這樣的話，他要珍惜每一天的生命，怎麼會想要縮短生命？所以他們認為應該要先推動安寧緩和醫療，如果把末期病人的安寧緩和醫療推得好的話，不是沒有發生安樂死這個爭議，就變成比較個案事件。所以我們臺灣如果真的推自主善終的時候，還有一個很重要的工作，就是有沒有把安寧緩和醫療的病人照顧好？如果把病人照顧好的話，我們再來談下一個……沒辦法解決的時候，是不是有更加能夠讓他自主……那個我們再來談。"],["王委員育敏：好。回到病主法，已經通過了法律，我們就應該好好地施行、好好地落實，我們的重點應該先擺在這邊，所以希望部長你們回去再好好研議。"],["邱部長泰源：好。"],["王委員育敏：今天委員提出非常多議題，就是希望不要像你們今天的報告好像鐵板一塊，每一條都不可以，每一條都是緩議。我覺得你剛剛講一句話很好，你是開放的，我們就用開放的態度，大家好好地研議，以病人最好為原則，以病人為中心，我們看這個法可以怎麼樣修得更好，好不好？"],["邱部長泰源：好的。"],["王委員育敏：謝謝。"],["邱部長泰源：謝謝委員。"],["主席：謝謝王委員，謝謝部長。","接下來請楊瓊瓔委員詢答。"]],"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"}}}