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00:00:48,694\n伊利醫療就是希望民眾們能夠早一點來討論未來當他進入到幾種狀況不管是末期或者是足人或永久性的傷害沒辦法恢復的情況之下他的一個醫療的選擇有哪些他先做自主性的選擇\n\n3\n00:00:49,916 --> 00:01:10,612\n對所以簡單來講因為為什麼要先開這個頭我想很多人對於這個題目可能不是很清楚所以育立醫療就是簡單來講就是在自己還能夠清楚表達的時候先和醫療團隊討論然後寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候\n\n4\n00:01:11,553 --> 00:01:25,943\n可以想要接受或拒絕哪些維持生命治療或人工營養的正式決定確保自己的醫療選擇能被尊重簡單來講我們要做一個這個開頭也算是宣講宣導一下所以我們針對於這件事情現行的這個我們今天要討論的吳懷呼就是跟\n\n5\n00:01:33,849 --> 00:01:42,945\n成效到底是怎麼樣然後以及為什麼成效不佳他的障礙有哪些可能包含著費用包含著宣傳不佳包含著國人觀念\n\n6\n00:01:43,939 --> 00:02:06,164\n那所以第一個就是想要問現在育立醫療照護的這個諮商ACP是採取類似自費的制度那它是成為民眾參與的比較大的障礙那根據媒體的報導或者是叫做不完全統計從最便宜可能有兩千元到最貴八千元等等還有價格不低那收費標準也比較混亂一點\n\n7\n00:02:08,044 --> 00:02:29,803\n那根据统计嘛2023年全台签署这个预立医疗决定就是AD的部分人数仅占成年人口的可能0.35%那刚刚也有人讲到0.45%总之就是蛮低的啦所以简单来讲推行这个很好的政策但是成效不佳那当然显见的刚刚有讲到第一个障碍可能跟费用有关\n\n8\n00:02:30,464 --> 00:02:43,889\n那有關於這個部分呢嘉義的陽明醫院的院長謝錦祥有指出ACP的人力成本高昂那現行的健保未納入給付導致醫院這個轉嫁成本至民眾形成經濟篩選的現象\n\n9\n00:02:46,250 --> 00:03:13,613\n而且此问题在非都会区更严重那六都签署的量占总数的72%而且其中的台北市占36%那也凸显了这个城乡资源的差距所以目前这个ACP是纳入健保给付的现行事办计划是涵盖刚刚有提到的几种比如说比较严重的病患癌末、前途失智或是公告重症居家照顾等四大类\n\n10\n00:03:14,373 --> 00:03:35,120\n那我們就想要請問像這個部分未來我們是不是要擴大至全民因為我剛剛也有委員說2026年的時候你們過去有宣示說2026年要擴大至全民但是今天的書面報告又提到尚需要深入的政策研議與詳細的預算規劃然後帶各界達成共識及實務運作更趨完備再行通盤監討修正\n\n11\n00:03:43,163 --> 00:03:50,927\n那我是覺得說那這個好像是跟你們原本預期的有很大的差距喔所以想要請問部長那你們現在具體的規劃跟配套細節到底是什麼遇到了什麼困難\n\n12\n00:03:55,404 --> 00:04:18,910\n好我想如果能夠全民都來簽署這是非常好的理想那這當然牽涉到我們也檢討為什麼低的因素當然諮商費用是一個對剛剛講過費用一個重點那剛剛您一開始就幫忙先導真的很感謝我必須要再先導一下如果能夠簽討這個異例異組其實是愛的表現什麼叫愛的表現呢\n\n13\n00:04:24,867 --> 00:04:41,253\n就是愛你的家人因為你的子女到最後不曉得這個爸爸到底要不要插管要不要做什麼很痛苦如果你能夠事先表示好的話讓醫療人員能夠按照爸爸媽媽的一個心願去做\n\n14\n00:04:42,692 --> 00:04:59,968\n所以就是你去做好屹立一族其實是愛你家人的一個表現這個不是金錢所能衡量的那當然那個議事室也做了很多的一個規劃健保署也一直在努力啦當然這個要配合財務的規劃\n\n15\n00:05:01,810 --> 00:05:19,308\n對謝謝所以我再進一步問因為剛剛有提到目前規劃大概是目前有的這個事辦是大概180萬人大概是54億然後要分階段那你們現在有沒有比較具體的實施的方式因為其實很重要的一點就是剛剛你們都有提到\n\n16\n00:05:21,029 --> 00:05:27,513\n這個其實是健康投資所以你做得好其實這個應該是絕對長期對於健保的財務是更好的對吧對於這個對於整個財務的狀況應該是更好的是的所以你的問題是你們應該要具體的去\n\n17\n00:05:37,077 --> 00:06:01,063\n可不可以給本席報告因為你們目前就只講到這180萬人無私益的那這只是短期你們擔心短期一下子衝擊很大可是剛剛也講到不可能180萬人都去用嘛你要包含宣導還有包含觀念所以我在想這全民適用的部分是不是應該儘速推動你才有可能達到這個所謂的健康投資然後也可以在這個整個財務的狀況之下更加的有餘裕\n\n18\n00:06:04,544 --> 00:06:30,978\n我們一定循序漸進就好像說所以我知道你循序漸進但是部長我希望你們可以給本席一個具體的你們評估目前的衝擊以及你們打算的目標你到底在幾年你現在這一兩年你打算這樣子180萬人那明年達到多少什麼時候全民適用是不是可以在2026年達到你們所謂的標準或者是你做不到你要到2027年因為我想我們就在這裡做一個\n\n19\n00:06:31,758 --> 00:06:47,706\n做一個這個宣示所以希望請部長給我們一個具體的規劃不要用剛剛所謂說還要再討論還要再通盤檢討這樣子去拖延時間我相信你也是想要推動這個所以我覺得也要給自己一個目標去鞭策好不好\n\n20\n00:06:48,146 --> 00:07:00,010\n那再來喔因為剛剛有講到費用的部分啦所以就回扣到這個納入健保的部分所以剛剛有說有甚至有這個很多的有一個65歲的阿姨啊這個媒體訪問她這國際旅遊的這個領隊啊她退休之後其實她的這個財務狀況應該還不錯而且她觀念也算是比較開放但她還是不懂她就說她還是不懂為什麼要花錢去了解與選擇自己怎麼死\n\n21\n00:07:13,095 --> 00:07:34,531\n那最後也是聽到是免費他才去報名所以這在證明了剛剛就說這個要趕快把你們的目標達成然後另外呢目前醫院也採取這個團體諮商所以現在就講到觀念的部分雖然說他可以降低人均成本也是一個調整的方式可是現行的團體諮商很多都是數位評審的這個陌生人一體參加整個氣氛其實也是有點像是大型團購現場就會比較覺得跟我們國人的觀念有所衝擊\n\n22\n00:07:42,677 --> 00:07:49,751\n因為他對於生死的事情可能不像是國外可以接受這個陌生人一起的這種形式這部分是不是也有可以調整的空間\n\n23\n00:07:53,250 --> 00:08:15,916\n謝謝委員指教其實所以我們去年有針對團體智商這邊然後開始做一些算是輔導作業發現是說如果是家族朋友一起的這種效果最好對沒錯然後所以在這個地方我們其實已經開始針對醫院有做團體這邊有做一些輔導然後有一些給一些建議然後這些具體的建議要轉成文字變成\n\n24\n00:08:17,036 --> 00:08:24,340\n衛福部這邊出的一些所謂的建議或指引的部分的話應該是今年下半年才會逐步的討論不過已經有發現我們輔導團隊已經有發現相關的問題以上很好對這就是我要跟你們講的這個問題要\n\n25\n00:08:31,568 --> 00:08:46,162\n盡速的把它推動然後可以請到所有你們的具體的檢討報告和詳細的文字內容提供給本席辦公室好沒問題那再來就是全台約200多家的醫療機構有ACP服務可是全台的77%的鄉鎮市區是沒有諮商據點分佈不均\n\n26\n00:08:50,026 --> 00:09:12,529\n那今天的報告有提出要擴大ACP的規模但沒有具體寫到措施是什麼所以我們在想這部分是不是要針對偏鄉地區可不可以結合長照或銀髮關懷據點開設這種行動的諮商站那也參考這個日本的在宅醫療聯繫的模式與精神由巡迴的團隊提供服務也是一種推廣的方式\n\n27\n00:09:13,710 --> 00:09:35,407\n是不是可以這個都可以演繹演繹要做嘛要去做而且最重要是要維護他當時簽ACP的品質那我們也希望多利用到我們社區的醫療團隊是社區的醫療團隊我們鼓勵他們接受一定的訓練以後現在金手比便利商店多\n\n28\n00:09:35,947 --> 00:09:54,819\n所以部長我今天提出的問題都希望你們儘速研議完之後給本席一個報告因為我們都是針對剛剛講的三大方向提出的現在的困境要告訴部長請你們趕快去做出評估跟推動那再來還有一個也是觀念的部分民眾對於這個病毒存在三大誤解32%認同認為是這個安樂死28%擔心簽署後\n\n29\n00:10:01,303 --> 00:10:26,241\n遭放棄治療那19%認為是違反宗教教義然後此外還有家屬介入決策的傳統文化還很深那在2022年的高雄榮總的案例也顯示38%的這個AD簽署者遭親屬反對執行這都是實務上面你們要去克服的問題那另外我主要是要講那現行的法規的這個部分\n\n30\n00:10:26,761 --> 00:10:40,171\n第九條要求二等親的家屬參與諮商那是不是會造成這個反而造成家庭壓力那也是不是可以修法允許這個獨居者經社工評估後可以免除親屬認同\n\n31\n00:10:43,097 --> 00:11:07,043\n我先補充一下就是剛剛委員推行獨居者這部分其實目前如果獨居者自己簽主要的切結書其實醫院還是可以進行諮詢因為實務面就看到現在獨居長者其實相對逐步在增加當中這個在實務面已經做了相關的處理然後進一步我們在講的是其實要善終的部分的話剛剛委員有特別講到\n\n32\n00:11:08,323 --> 00:11:26,357\n周圍親友特別是家人的阻止的這件事也是當初在立法的時候為什麼希望家屬一起參與透過家屬參與的時候在最後那一個決定才比較容易尊重病人的一個自主這當初在設計的時候有這樣子的一個考量\n\n33\n00:11:27,077 --> 00:11:47,455\n結果論就是我剛剛講出來就是結果論所以還是一樣費用宣導跟觀念還是有很大的問題和精進的空間其實你們要去檢討這個部分所以我最後就要跟你們講到一件事情就是剛剛也有提到宣傳的部分我們有很多的政策宣傳宣導衛教說實在的內容都偏向深色難懂也很無趣\n\n34\n00:11:48,115 --> 00:11:58,798\n所以要做到好的效果蠻難的所以要請問部長一下如果某一個政令或是衛教宣導在你們臉書上要破千萬次的瀏覽量平均要花多少經費抓一個數字可以嗎我不知道請委員指教你抓不出來一個數字對不對其實以你們過去的你們過去的這些你看都才1.9萬次3208次1.6萬次其實都很少所以應該要去想更\n\n35\n00:12:17,483 --> 00:12:36,253\n更好更創意的方式所以我現在就告訴你一件事現在南投有一間醫院有一個小編他打破了宣導的困難內容無聊的刻板印象讓在他的衛教的宣導影片有很好的效果他大概的成績像下面半年內追蹤數增加了4.5萬單月瀏覽次數突破了數千萬互動也破了100多萬\n\n36\n00:12:40,916 --> 00:13:06,753\n所以你剛剛可能你們不曉得狀況可是你們在宣導上面的經費是非常高的所以我們在省經費預算的時候都知道可是這個小編他卻說他的薪水就是三萬元打死甚至沒有額外的花媒體採購的費用那院長這就是一個妥妥的人才所以他一PO出他三萬打死的時候他馬上一堆人下面挖角他然後可以印證這樣的人在我們的業界一定是很搶手\n\n37\n00:13:07,734 --> 00:13:35,633\n那釋逢今天是五一勞動節那我覺得當然講說這樣的薪水叫做壓榨可能過於沉重但現實面就是你們在這方面的宣導可能只靠這樣的熱情的小編是沒辦法留他太久所以我們是不是可以請我們的部長去了解一下這個案子然後也要真的下定決心讓這個在醫療體系裡面的行政人員這些人才應該要有更好的待遇才不會白白流失這個人才可以嗎\n\n38\n00:13:35,973 --> 00:13:43,968\n我們一定珍惜人才所以要改善他們的待遇這才是今天這個質詢的重要的意義謝謝部長好謝謝好謝謝廖瑞祥委員\n\n","tsv":"start\tend\ttext\n5445\t8586\t謝謝主席有請部長好請邱部長委員好部長好今天我們討論這個議題是非常有意義的是那我想要請教一下部長可不可以簡單的用一句話來告訴國人什麼是我們今天討論的育立醫療\n28396\t48694\t伊利醫療就是希望民眾們能夠早一點來討論未來當他進入到幾種狀況不管是末期或者是足人或永久性的傷害沒辦法恢復的情況之下他的一個醫療的選擇有哪些他先做自主性的選擇\n49916\t70612\t對所以簡單來講因為為什麼要先開這個頭我想很多人對於這個題目可能不是很清楚所以育立醫療就是簡單來講就是在自己還能夠清楚表達的時候先和醫療團隊討論然後寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候\n71553\t85943\t可以想要接受或拒絕哪些維持生命治療或人工營養的正式決定確保自己的醫療選擇能被尊重簡單來講我們要做一個這個開頭也算是宣講宣導一下所以我們針對於這件事情現行的這個我們今天要討論的吳懷呼就是跟\n93849\t102945\t成效到底是怎麼樣然後以及為什麼成效不佳他的障礙有哪些可能包含著費用包含著宣傳不佳包含著國人觀念\n103939\t126164\t那所以第一個就是想要問現在育立醫療照護的這個諮商ACP是採取類似自費的制度那它是成為民眾參與的比較大的障礙那根據媒體的報導或者是叫做不完全統計從最便宜可能有兩千元到最貴八千元等等還有價格不低那收費標準也比較混亂一點\n128044\t149803\t那根据统计嘛2023年全台签署这个预立医疗决定就是AD的部分人数仅占成年人口的可能0.35%那刚刚也有人讲到0.45%总之就是蛮低的啦所以简单来讲推行这个很好的政策但是成效不佳那当然显见的刚刚有讲到第一个障碍可能跟费用有关\n150464\t163889\t那有關於這個部分呢嘉義的陽明醫院的院長謝錦祥有指出ACP的人力成本高昂那現行的健保未納入給付導致醫院這個轉嫁成本至民眾形成經濟篩選的現象\n166250\t193613\t而且此问题在非都会区更严重那六都签署的量占总数的72%而且其中的台北市占36%那也凸显了这个城乡资源的差距所以目前这个ACP是纳入健保给付的现行事办计划是涵盖刚刚有提到的几种比如说比较严重的病患癌末、前途失智或是公告重症居家照顾等四大类\n194373\t215120\t那我們就想要請問像這個部分未來我們是不是要擴大至全民因為我剛剛也有委員說2026年的時候你們過去有宣示說2026年要擴大至全民但是今天的書面報告又提到尚需要深入的政策研議與詳細的預算規劃然後帶各界達成共識及實務運作更趨完備再行通盤監討修正\n223163\t230927\t那我是覺得說那這個好像是跟你們原本預期的有很大的差距喔所以想要請問部長那你們現在具體的規劃跟配套細節到底是什麼遇到了什麼困難\n235404\t258910\t好 我想如果能夠全民都來簽署這是非常好的理想那這當然牽涉到我們也檢討為什麼低的因素當然諮商費用是一個對 剛剛講過 費用一個重點那剛剛您一開始就幫忙先導真的很感謝我必須要再先導一下如果能夠簽討這個異例異組其實是愛的表現什麼叫愛的表現呢\n264867\t281253\t就是愛你的家人因為你的子女到最後不曉得這個爸爸到底要不要插管要不要做什麼很痛苦如果你能夠事先表示好的話讓醫療人員能夠按照爸爸媽媽的一個心願去做\n282692\t299968\t所以就是你去做好屹立一族其實是愛你家人的一個表現這個不是金錢所能衡量的那當然那個議事室也做了很多的一個規劃健保署也一直在努力啦當然這個要配合財務的規劃\n301810\t319308\t對 謝謝所以我再進一步問因為剛剛有提到目前規劃大概是目前有的這個事辦是大概180萬人大概是54億然後要分階段那你們現在有沒有比較具體的實施的方式因為其實很重要的一點就是剛剛你們都有提到\n321029\t327513\t這個其實是健康投資所以你做得好其實這個應該是絕對長期對於健保的財務是更好的對吧 對於這個對於整個財務的狀況應該是更好的是的所以你的問題是你們應該要具體的去\n337077\t361063\t可不可以給本席報告因為你們目前就只講到這180萬人無私益的那這只是短期你們擔心短期一下子衝擊很大可是剛剛也講到不可能180萬人都去用嘛你要包含宣導還有包含觀念所以我在想這全民適用的部分是不是應該儘速推動你才有可能達到這個所謂的健康投資然後也可以在這個整個財務的狀況之下更加的有餘裕\n364544\t390978\t我們一定循序漸進就好像說所以我知道你循序漸進但是部長我希望你們可以給本席一個具體的你們評估目前的衝擊以及你們打算的目標你到底在幾年你現在這一兩年你打算這樣子180萬人那明年達到多少什麼時候全民適用是不是可以在2026年達到你們所謂的標準或者是你做不到你要到2027年因為我想我們就在這裡做一個\n391758\t407706\t做一個這個宣示所以希望請部長給我們一個具體的規劃不要用剛剛所謂說還要再討論還要再通盤檢討這樣子去拖延時間我相信你也是想要推動這個所以我覺得也要給自己一個目標去鞭策好不好\n408146\t420010\t那再來喔因為剛剛有講到費用的部分啦所以就回扣到這個納入健保的部分所以剛剛有說有甚至有這個很多的有一個65歲的阿姨啊這個媒體訪問她這國際旅遊的這個領隊啊她退休之後其實她的這個財務狀況應該還不錯而且她觀念也算是比較開放但她還是不懂她就說她還是不懂為什麼要花錢去了解與選擇自己怎麼死\n433095\t454531\t那最後也是聽到是免費他才去報名所以這在證明了剛剛就說這個要趕快把你們的目標達成然後另外呢目前醫院也採取這個團體諮商所以現在就講到觀念的部分雖然說他可以降低人均成本也是一個調整的方式可是現行的團體諮商很多都是數位評審的這個陌生人一體參加整個氣氛其實也是有點像是大型團購現場就會比較覺得跟我們國人的觀念有所衝擊\n462677\t469751\t因為他對於生死的事情可能不像是國外可以接受這個陌生人一起的這種形式這部分是不是也有可以調整的空間\n473250\t495916\t謝謝委員指教其實所以我們去年有針對團體智商這邊然後開始做一些算是輔導作業發現是說如果是家族朋友一起的這種效果最好對沒錯然後所以在這個地方我們其實已經開始針對醫院有做團體這邊有做一些輔導然後有一些給一些建議然後這些具體的建議要轉成文字變成\n497036\t504340\t衛福部這邊出的一些所謂的建議或指引的部分的話應該是今年下半年才會逐步的討論不過已經有發現我們輔導團隊已經有發現相關的問題以上很好對這就是我要跟你們講的這個問題要\n511568\t526162\t盡速的把它推動然後可以請到所有你們的具體的檢討報告和詳細的文字內容提供給本席辦公室好沒問題那再來就是全台約200多家的醫療機構有ACP服務可是全台的77%的鄉鎮市區是沒有諮商據點分佈不均\n530026\t552529\t那今天的報告有提出要擴大ACP的規模但沒有具體寫到措施是什麼所以我們在想這部分是不是要針對偏鄉地區可不可以結合長照或銀髮關懷據點開設這種行動的諮商站那也參考這個日本的在宅醫療聯繫的模式與精神由巡迴的團隊提供服務也是一種推廣的方式\n553710\t575407\t是不是可以這個都可以演繹演繹要做嘛要去做而且最重要是要維護他當時簽ACP的品質那我們也希望多利用到我們社區的醫療團隊是社區的醫療團隊我們鼓勵他們接受一定的訓練以後現在金手比便利商店多\n575947\t594819\t所以部長我今天提出的問題都希望你們儘速研議完之後給本席一個報告因為我們都是針對剛剛講的三大方向提出的現在的困境要告訴部長請你們趕快去做出評估跟推動那再來還有一個也是觀念的部分民眾對於這個病毒存在三大誤解32%認同認為是這個安樂死28%擔心簽署後\n601303\t626241\t遭放棄治療那19%認為是違反宗教教義然後此外還有家屬介入決策的傳統文化還很深那在2022年的高雄榮總的案例也顯示38%的這個AD簽署者遭親屬反對執行這都是實務上面你們要去克服的問題那另外我主要是要講那現行的法規的這個部分\n626761\t640171\t第九條要求二等親的家屬參與諮商那是不是會造成這個反而造成家庭壓力那也是不是可以修法允許這個獨居者經社工評估後可以免除親屬認同\n643097\t667043\t我先補充一下就是剛剛委員推行獨居者這部分其實目前如果獨居者自己簽主要的切結書其實醫院還是可以進行諮詢因為實務面就看到現在獨居長者其實相對逐步在增加當中這個在實務面已經做了相關的處理然後進一步我們在講的是其實要善終的部分的話剛剛委員有特別講到\n668323\t686357\t周圍親友特別是家人的阻止的這件事也是當初在立法的時候為什麼希望家屬一起參與透過家屬參與的時候在最後那一個決定才比較容易尊重病人的一個自主這當初在設計的時候有這樣子的一個考量\n687077\t707455\t結果論就是我剛剛講出來就是結果論所以還是一樣費用宣導跟觀念還是有很大的問題和精進的空間其實你們要去檢討這個部分所以我最後就要跟你們講到一件事情就是剛剛也有提到宣傳的部分我們有很多的政策宣傳宣導衛教說實在的內容都偏向深色難懂也很無趣\n708115\t718798\t所以要做到好的效果蠻難的所以要請問部長一下如果某一個政令或是衛教宣導在你們臉書上要破千萬次的瀏覽量平均要花多少經費抓一個數字可以嗎我不知道請委員指教你抓不出來一個數字對不對其實以你們過去的你們過去的這些你看都才1.9萬次3208次1.6萬次其實都很少所以應該要去想更\n737483\t756253\t更好更創意的方式所以我現在就告訴你一件事現在南投有一間醫院有一個小編他打破了宣導的困難內容無聊的刻板印象讓在他的衛教的宣導影片有很好的效果他大概的成績像下面半年內追蹤數增加了4.5萬單月瀏覽次數突破了數千萬互動也破了100多萬\n760916\t786753\t所以你剛剛可能你們不曉得狀況可是你們在宣導上面的經費是非常高的所以我們在省經費預算的時候都知道可是這個小編他卻說他的薪水就是三萬元打死甚至沒有額外的花媒體採購的費用那院長這就是一個妥妥的人才所以他一PO出他三萬打死的時候他馬上一堆人下面挖角他然後可以印證這樣的人在我們的業界一定是很搶手\n787734\t815633\t那釋逢今天是五一勞動節那我覺得當然講說這樣的薪水叫做壓榨可能過於沉重但現實面就是你們在這方面的宣導可能只靠這樣的熱情的小編是沒辦法留他太久所以我們是不是可以請我們的部長去了解一下這個案子然後也要真的下定決心讓這個在醫療體系裡面的行政人員這些人才應該要有更好的待遇才不會白白流失這個人才可以嗎\n815973\t823968\t我們一定珍惜人才所以要改善他們的待遇這才是今天這個質詢的重要的意義謝謝部長好 謝謝好 謝謝廖瑞祥委員\n","txt":"謝謝主席有請部長好請邱部長委員好部長好今天我們討論這個議題是非常有意義的是那我想要請教一下部長可不可以簡單的用一句話來告訴國人什麼是我們今天討論的育立醫療\n伊利醫療就是希望民眾們能夠早一點來討論未來當他進入到幾種狀況不管是末期或者是足人或永久性的傷害沒辦法恢復的情況之下他的一個醫療的選擇有哪些他先做自主性的選擇\n對所以簡單來講因為為什麼要先開這個頭我想很多人對於這個題目可能不是很清楚所以育立醫療就是簡單來講就是在自己還能夠清楚表達的時候先和醫療團隊討論然後寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候\n可以想要接受或拒絕哪些維持生命治療或人工營養的正式決定確保自己的醫療選擇能被尊重簡單來講我們要做一個這個開頭也算是宣講宣導一下所以我們針對於這件事情現行的這個我們今天要討論的吳懷呼就是跟\n成效到底是怎麼樣然後以及為什麼成效不佳他的障礙有哪些可能包含著費用包含著宣傳不佳包含著國人觀念\n那所以第一個就是想要問現在育立醫療照護的這個諮商ACP是採取類似自費的制度那它是成為民眾參與的比較大的障礙那根據媒體的報導或者是叫做不完全統計從最便宜可能有兩千元到最貴八千元等等還有價格不低那收費標準也比較混亂一點\n那根据统计嘛2023年全台签署这个预立医疗决定就是AD的部分人数仅占成年人口的可能0.35%那刚刚也有人讲到0.45%总之就是蛮低的啦所以简单来讲推行这个很好的政策但是成效不佳那当然显见的刚刚有讲到第一个障碍可能跟费用有关\n那有關於這個部分呢嘉義的陽明醫院的院長謝錦祥有指出ACP的人力成本高昂那現行的健保未納入給付導致醫院這個轉嫁成本至民眾形成經濟篩選的現象\n而且此问题在非都会区更严重那六都签署的量占总数的72%而且其中的台北市占36%那也凸显了这个城乡资源的差距所以目前这个ACP是纳入健保给付的现行事办计划是涵盖刚刚有提到的几种比如说比较严重的病患癌末、前途失智或是公告重症居家照顾等四大类\n那我們就想要請問像這個部分未來我們是不是要擴大至全民因為我剛剛也有委員說2026年的時候你們過去有宣示說2026年要擴大至全民但是今天的書面報告又提到尚需要深入的政策研議與詳細的預算規劃然後帶各界達成共識及實務運作更趨完備再行通盤監討修正\n那我是覺得說那這個好像是跟你們原本預期的有很大的差距喔所以想要請問部長那你們現在具體的規劃跟配套細節到底是什麼遇到了什麼困難\n好 我想如果能夠全民都來簽署這是非常好的理想那這當然牽涉到我們也檢討為什麼低的因素當然諮商費用是一個對 剛剛講過 費用一個重點那剛剛您一開始就幫忙先導真的很感謝我必須要再先導一下如果能夠簽討這個異例異組其實是愛的表現什麼叫愛的表現呢\n就是愛你的家人因為你的子女到最後不曉得這個爸爸到底要不要插管要不要做什麼很痛苦如果你能夠事先表示好的話讓醫療人員能夠按照爸爸媽媽的一個心願去做\n所以就是你去做好屹立一族其實是愛你家人的一個表現這個不是金錢所能衡量的那當然那個議事室也做了很多的一個規劃健保署也一直在努力啦當然這個要配合財務的規劃\n對 謝謝所以我再進一步問因為剛剛有提到目前規劃大概是目前有的這個事辦是大概180萬人大概是54億然後要分階段那你們現在有沒有比較具體的實施的方式因為其實很重要的一點就是剛剛你們都有提到\n這個其實是健康投資所以你做得好其實這個應該是絕對長期對於健保的財務是更好的對吧 對於這個對於整個財務的狀況應該是更好的是的所以你的問題是你們應該要具體的去\n可不可以給本席報告因為你們目前就只講到這180萬人無私益的那這只是短期你們擔心短期一下子衝擊很大可是剛剛也講到不可能180萬人都去用嘛你要包含宣導還有包含觀念所以我在想這全民適用的部分是不是應該儘速推動你才有可能達到這個所謂的健康投資然後也可以在這個整個財務的狀況之下更加的有餘裕\n我們一定循序漸進就好像說所以我知道你循序漸進但是部長我希望你們可以給本席一個具體的你們評估目前的衝擊以及你們打算的目標你到底在幾年你現在這一兩年你打算這樣子180萬人那明年達到多少什麼時候全民適用是不是可以在2026年達到你們所謂的標準或者是你做不到你要到2027年因為我想我們就在這裡做一個\n做一個這個宣示所以希望請部長給我們一個具體的規劃不要用剛剛所謂說還要再討論還要再通盤檢討這樣子去拖延時間我相信你也是想要推動這個所以我覺得也要給自己一個目標去鞭策好不好\n那再來喔因為剛剛有講到費用的部分啦所以就回扣到這個納入健保的部分所以剛剛有說有甚至有這個很多的有一個65歲的阿姨啊這個媒體訪問她這國際旅遊的這個領隊啊她退休之後其實她的這個財務狀況應該還不錯而且她觀念也算是比較開放但她還是不懂她就說她還是不懂為什麼要花錢去了解與選擇自己怎麼死\n那最後也是聽到是免費他才去報名所以這在證明了剛剛就說這個要趕快把你們的目標達成然後另外呢目前醫院也採取這個團體諮商所以現在就講到觀念的部分雖然說他可以降低人均成本也是一個調整的方式可是現行的團體諮商很多都是數位評審的這個陌生人一體參加整個氣氛其實也是有點像是大型團購現場就會比較覺得跟我們國人的觀念有所衝擊\n因為他對於生死的事情可能不像是國外可以接受這個陌生人一起的這種形式這部分是不是也有可以調整的空間\n謝謝委員指教其實所以我們去年有針對團體智商這邊然後開始做一些算是輔導作業發現是說如果是家族朋友一起的這種效果最好對沒錯然後所以在這個地方我們其實已經開始針對醫院有做團體這邊有做一些輔導然後有一些給一些建議然後這些具體的建議要轉成文字變成\n衛福部這邊出的一些所謂的建議或指引的部分的話應該是今年下半年才會逐步的討論不過已經有發現我們輔導團隊已經有發現相關的問題以上很好對這就是我要跟你們講的這個問題要\n盡速的把它推動然後可以請到所有你們的具體的檢討報告和詳細的文字內容提供給本席辦公室好沒問題那再來就是全台約200多家的醫療機構有ACP服務可是全台的77%的鄉鎮市區是沒有諮商據點分佈不均\n那今天的報告有提出要擴大ACP的規模但沒有具體寫到措施是什麼所以我們在想這部分是不是要針對偏鄉地區可不可以結合長照或銀髮關懷據點開設這種行動的諮商站那也參考這個日本的在宅醫療聯繫的模式與精神由巡迴的團隊提供服務也是一種推廣的方式\n是不是可以這個都可以演繹演繹要做嘛要去做而且最重要是要維護他當時簽ACP的品質那我們也希望多利用到我們社區的醫療團隊是社區的醫療團隊我們鼓勵他們接受一定的訓練以後現在金手比便利商店多\n所以部長我今天提出的問題都希望你們儘速研議完之後給本席一個報告因為我們都是針對剛剛講的三大方向提出的現在的困境要告訴部長請你們趕快去做出評估跟推動那再來還有一個也是觀念的部分民眾對於這個病毒存在三大誤解32%認同認為是這個安樂死28%擔心簽署後\n遭放棄治療那19%認為是違反宗教教義然後此外還有家屬介入決策的傳統文化還很深那在2022年的高雄榮總的案例也顯示38%的這個AD簽署者遭親屬反對執行這都是實務上面你們要去克服的問題那另外我主要是要講那現行的法規的這個部分\n第九條要求二等親的家屬參與諮商那是不是會造成這個反而造成家庭壓力那也是不是可以修法允許這個獨居者經社工評估後可以免除親屬認同\n我先補充一下就是剛剛委員推行獨居者這部分其實目前如果獨居者自己簽主要的切結書其實醫院還是可以進行諮詢因為實務面就看到現在獨居長者其實相對逐步在增加當中這個在實務面已經做了相關的處理然後進一步我們在講的是其實要善終的部分的話剛剛委員有特別講到\n周圍親友特別是家人的阻止的這件事也是當初在立法的時候為什麼希望家屬一起參與透過家屬參與的時候在最後那一個決定才比較容易尊重病人的一個自主這當初在設計的時候有這樣子的一個考量\n結果論就是我剛剛講出來就是結果論所以還是一樣費用宣導跟觀念還是有很大的問題和精進的空間其實你們要去檢討這個部分所以我最後就要跟你們講到一件事情就是剛剛也有提到宣傳的部分我們有很多的政策宣傳宣導衛教說實在的內容都偏向深色難懂也很無趣\n所以要做到好的效果蠻難的所以要請問部長一下如果某一個政令或是衛教宣導在你們臉書上要破千萬次的瀏覽量平均要花多少經費抓一個數字可以嗎我不知道請委員指教你抓不出來一個數字對不對其實以你們過去的你們過去的這些你看都才1.9萬次3208次1.6萬次其實都很少所以應該要去想更\n更好更創意的方式所以我現在就告訴你一件事現在南投有一間醫院有一個小編他打破了宣導的困難內容無聊的刻板印象讓在他的衛教的宣導影片有很好的效果他大概的成績像下面半年內追蹤數增加了4.5萬單月瀏覽次數突破了數千萬互動也破了100多萬\n所以你剛剛可能你們不曉得狀況可是你們在宣導上面的經費是非常高的所以我們在省經費預算的時候都知道可是這個小編他卻說他的薪水就是三萬元打死甚至沒有額外的花媒體採購的費用那院長這就是一個妥妥的人才所以他一PO出他三萬打死的時候他馬上一堆人下面挖角他然後可以印證這樣的人在我們的業界一定是很搶手\n那釋逢今天是五一勞動節那我覺得當然講說這樣的薪水叫做壓榨可能過於沉重但現實面就是你們在這方面的宣導可能只靠這樣的熱情的小編是沒辦法留他太久所以我們是不是可以請我們的部長去了解一下這個案子然後也要真的下定決心讓這個在醫療體系裡面的行政人員這些人才應該要有更好的待遇才不會白白流失這個人才可以嗎\n我們一定珍惜人才所以要改善他們的待遇這才是今天這個質詢的重要的意義謝謝部長好 謝謝好 謝謝廖瑞祥委員\n","vtt":"WEBVTT\n\n00:05.445 --> 00:08.586\n謝謝主席有請部長好請邱部長委員好部長好今天我們討論這個議題是非常有意義的是那我想要請教一下部長可不可以簡單的用一句話來告訴國人什麼是我們今天討論的育立醫療\n\n00:28.396 --> 00:48.694\n伊利醫療就是希望民眾們能夠早一點來討論未來當他進入到幾種狀況不管是末期或者是足人或永久性的傷害沒辦法恢復的情況之下他的一個醫療的選擇有哪些他先做自主性的選擇\n\n00:49.916 --> 01:10.612\n對所以簡單來講因為為什麼要先開這個頭我想很多人對於這個題目可能不是很清楚所以育立醫療就是簡單來講就是在自己還能夠清楚表達的時候先和醫療團隊討論然後寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候\n\n01:11.553 --> 01:25.943\n可以想要接受或拒絕哪些維持生命治療或人工營養的正式決定確保自己的醫療選擇能被尊重簡單來講我們要做一個這個開頭也算是宣講宣導一下所以我們針對於這件事情現行的這個我們今天要討論的吳懷呼就是跟\n\n01:33.849 --> 01:42.945\n成效到底是怎麼樣然後以及為什麼成效不佳他的障礙有哪些可能包含著費用包含著宣傳不佳包含著國人觀念\n\n01:43.939 --> 02:06.164\n那所以第一個就是想要問現在育立醫療照護的這個諮商ACP是採取類似自費的制度那它是成為民眾參與的比較大的障礙那根據媒體的報導或者是叫做不完全統計從最便宜可能有兩千元到最貴八千元等等還有價格不低那收費標準也比較混亂一點\n\n02:08.044 --> 02:29.803\n那根据统计嘛2023年全台签署这个预立医疗决定就是AD的部分人数仅占成年人口的可能0.35%那刚刚也有人讲到0.45%总之就是蛮低的啦所以简单来讲推行这个很好的政策但是成效不佳那当然显见的刚刚有讲到第一个障碍可能跟费用有关\n\n02:30.464 --> 02:43.889\n那有關於這個部分呢嘉義的陽明醫院的院長謝錦祥有指出ACP的人力成本高昂那現行的健保未納入給付導致醫院這個轉嫁成本至民眾形成經濟篩選的現象\n\n02:46.250 --> 03:13.613\n而且此问题在非都会区更严重那六都签署的量占总数的72%而且其中的台北市占36%那也凸显了这个城乡资源的差距所以目前这个ACP是纳入健保给付的现行事办计划是涵盖刚刚有提到的几种比如说比较严重的病患癌末、前途失智或是公告重症居家照顾等四大类\n\n03:14.373 --> 03:35.120\n那我們就想要請問像這個部分未來我們是不是要擴大至全民因為我剛剛也有委員說2026年的時候你們過去有宣示說2026年要擴大至全民但是今天的書面報告又提到尚需要深入的政策研議與詳細的預算規劃然後帶各界達成共識及實務運作更趨完備再行通盤監討修正\n\n03:43.163 --> 03:50.927\n那我是覺得說那這個好像是跟你們原本預期的有很大的差距喔所以想要請問部長那你們現在具體的規劃跟配套細節到底是什麼遇到了什麼困難\n\n03:55.404 --> 04:18.910\n好我想如果能夠全民都來簽署這是非常好的理想那這當然牽涉到我們也檢討為什麼低的因素當然諮商費用是一個對剛剛講過費用一個重點那剛剛您一開始就幫忙先導真的很感謝我必須要再先導一下如果能夠簽討這個異例異組其實是愛的表現什麼叫愛的表現呢\n\n04:24.867 --> 04:41.253\n就是愛你的家人因為你的子女到最後不曉得這個爸爸到底要不要插管要不要做什麼很痛苦如果你能夠事先表示好的話讓醫療人員能夠按照爸爸媽媽的一個心願去做\n\n04:42.692 --> 04:59.968\n所以就是你去做好屹立一族其實是愛你家人的一個表現這個不是金錢所能衡量的那當然那個議事室也做了很多的一個規劃健保署也一直在努力啦當然這個要配合財務的規劃\n\n05:01.810 --> 05:19.308\n對謝謝所以我再進一步問因為剛剛有提到目前規劃大概是目前有的這個事辦是大概180萬人大概是54億然後要分階段那你們現在有沒有比較具體的實施的方式因為其實很重要的一點就是剛剛你們都有提到\n\n05:21.029 --> 05:27.513\n這個其實是健康投資所以你做得好其實這個應該是絕對長期對於健保的財務是更好的對吧對於這個對於整個財務的狀況應該是更好的是的所以你的問題是你們應該要具體的去\n\n05:37.077 --> 06:01.063\n可不可以給本席報告因為你們目前就只講到這180萬人無私益的那這只是短期你們擔心短期一下子衝擊很大可是剛剛也講到不可能180萬人都去用嘛你要包含宣導還有包含觀念所以我在想這全民適用的部分是不是應該儘速推動你才有可能達到這個所謂的健康投資然後也可以在這個整個財務的狀況之下更加的有餘裕\n\n06:04.544 --> 06:30.978\n我們一定循序漸進就好像說所以我知道你循序漸進但是部長我希望你們可以給本席一個具體的你們評估目前的衝擊以及你們打算的目標你到底在幾年你現在這一兩年你打算這樣子180萬人那明年達到多少什麼時候全民適用是不是可以在2026年達到你們所謂的標準或者是你做不到你要到2027年因為我想我們就在這裡做一個\n\n06:31.758 --> 06:47.706\n做一個這個宣示所以希望請部長給我們一個具體的規劃不要用剛剛所謂說還要再討論還要再通盤檢討這樣子去拖延時間我相信你也是想要推動這個所以我覺得也要給自己一個目標去鞭策好不好\n\n06:48.146 --> 07:00.010\n那再來喔因為剛剛有講到費用的部分啦所以就回扣到這個納入健保的部分所以剛剛有說有甚至有這個很多的有一個65歲的阿姨啊這個媒體訪問她這國際旅遊的這個領隊啊她退休之後其實她的這個財務狀況應該還不錯而且她觀念也算是比較開放但她還是不懂她就說她還是不懂為什麼要花錢去了解與選擇自己怎麼死\n\n07:13.095 --> 07:34.531\n那最後也是聽到是免費他才去報名所以這在證明了剛剛就說這個要趕快把你們的目標達成然後另外呢目前醫院也採取這個團體諮商所以現在就講到觀念的部分雖然說他可以降低人均成本也是一個調整的方式可是現行的團體諮商很多都是數位評審的這個陌生人一體參加整個氣氛其實也是有點像是大型團購現場就會比較覺得跟我們國人的觀念有所衝擊\n\n07:42.677 --> 07:49.751\n因為他對於生死的事情可能不像是國外可以接受這個陌生人一起的這種形式這部分是不是也有可以調整的空間\n\n07:53.250 --> 08:15.916\n謝謝委員指教其實所以我們去年有針對團體智商這邊然後開始做一些算是輔導作業發現是說如果是家族朋友一起的這種效果最好對沒錯然後所以在這個地方我們其實已經開始針對醫院有做團體這邊有做一些輔導然後有一些給一些建議然後這些具體的建議要轉成文字變成\n\n08:17.036 --> 08:24.340\n衛福部這邊出的一些所謂的建議或指引的部分的話應該是今年下半年才會逐步的討論不過已經有發現我們輔導團隊已經有發現相關的問題以上很好對這就是我要跟你們講的這個問題要\n\n08:31.568 --> 08:46.162\n盡速的把它推動然後可以請到所有你們的具體的檢討報告和詳細的文字內容提供給本席辦公室好沒問題那再來就是全台約200多家的醫療機構有ACP服務可是全台的77%的鄉鎮市區是沒有諮商據點分佈不均\n\n08:50.026 --> 09:12.529\n那今天的報告有提出要擴大ACP的規模但沒有具體寫到措施是什麼所以我們在想這部分是不是要針對偏鄉地區可不可以結合長照或銀髮關懷據點開設這種行動的諮商站那也參考這個日本的在宅醫療聯繫的模式與精神由巡迴的團隊提供服務也是一種推廣的方式\n\n09:13.710 --> 09:35.407\n是不是可以這個都可以演繹演繹要做嘛要去做而且最重要是要維護他當時簽ACP的品質那我們也希望多利用到我們社區的醫療團隊是社區的醫療團隊我們鼓勵他們接受一定的訓練以後現在金手比便利商店多\n\n09:35.947 --> 09:54.819\n所以部長我今天提出的問題都希望你們儘速研議完之後給本席一個報告因為我們都是針對剛剛講的三大方向提出的現在的困境要告訴部長請你們趕快去做出評估跟推動那再來還有一個也是觀念的部分民眾對於這個病毒存在三大誤解32%認同認為是這個安樂死28%擔心簽署後\n\n10:01.303 --> 10:26.241\n遭放棄治療那19%認為是違反宗教教義然後此外還有家屬介入決策的傳統文化還很深那在2022年的高雄榮總的案例也顯示38%的這個AD簽署者遭親屬反對執行這都是實務上面你們要去克服的問題那另外我主要是要講那現行的法規的這個部分\n\n10:26.761 --> 10:40.171\n第九條要求二等親的家屬參與諮商那是不是會造成這個反而造成家庭壓力那也是不是可以修法允許這個獨居者經社工評估後可以免除親屬認同\n\n10:43.097 --> 11:07.043\n我先補充一下就是剛剛委員推行獨居者這部分其實目前如果獨居者自己簽主要的切結書其實醫院還是可以進行諮詢因為實務面就看到現在獨居長者其實相對逐步在增加當中這個在實務面已經做了相關的處理然後進一步我們在講的是其實要善終的部分的話剛剛委員有特別講到\n\n11:08.323 --> 11:26.357\n周圍親友特別是家人的阻止的這件事也是當初在立法的時候為什麼希望家屬一起參與透過家屬參與的時候在最後那一個決定才比較容易尊重病人的一個自主這當初在設計的時候有這樣子的一個考量\n\n11:27.077 --> 11:47.455\n結果論就是我剛剛講出來就是結果論所以還是一樣費用宣導跟觀念還是有很大的問題和精進的空間其實你們要去檢討這個部分所以我最後就要跟你們講到一件事情就是剛剛也有提到宣傳的部分我們有很多的政策宣傳宣導衛教說實在的內容都偏向深色難懂也很無趣\n\n11:48.115 --> 11:58.798\n所以要做到好的效果蠻難的所以要請問部長一下如果某一個政令或是衛教宣導在你們臉書上要破千萬次的瀏覽量平均要花多少經費抓一個數字可以嗎我不知道請委員指教你抓不出來一個數字對不對其實以你們過去的你們過去的這些你看都才1.9萬次3208次1.6萬次其實都很少所以應該要去想更\n\n12:17.483 --> 12:36.253\n更好更創意的方式所以我現在就告訴你一件事現在南投有一間醫院有一個小編他打破了宣導的困難內容無聊的刻板印象讓在他的衛教的宣導影片有很好的效果他大概的成績像下面半年內追蹤數增加了4.5萬單月瀏覽次數突破了數千萬互動也破了100多萬\n\n12:40.916 --> 13:06.753\n所以你剛剛可能你們不曉得狀況可是你們在宣導上面的經費是非常高的所以我們在省經費預算的時候都知道可是這個小編他卻說他的薪水就是三萬元打死甚至沒有額外的花媒體採購的費用那院長這就是一個妥妥的人才所以他一PO出他三萬打死的時候他馬上一堆人下面挖角他然後可以印證這樣的人在我們的業界一定是很搶手\n\n13:07.734 --> 13:35.633\n那釋逢今天是五一勞動節那我覺得當然講說這樣的薪水叫做壓榨可能過於沉重但現實面就是你們在這方面的宣導可能只靠這樣的熱情的小編是沒辦法留他太久所以我們是不是可以請我們的部長去了解一下這個案子然後也要真的下定決心讓這個在醫療體系裡面的行政人員這些人才應該要有更好的待遇才不會白白流失這個人才可以嗎\n\n13:35.973 --> 13:43.968\n我們一定珍惜人才所以要改善他們的待遇這才是今天這個質詢的重要的意義謝謝部長好謝謝好謝謝廖瑞祥委員\n\n","segments":[{"start":5.445,"end":8.586,"text":"謝謝主席有請部長好請邱部長委員好部長好今天我們討論這個議題是非常有意義的是那我想要請教一下部長可不可以簡單的用一句話來告訴國人什麼是我們今天討論的育立醫療"},{"start":28.396,"end":48.694,"text":"伊利醫療就是希望民眾們能夠早一點來討論未來當他進入到幾種狀況不管是末期或者是足人或永久性的傷害沒辦法恢復的情況之下他的一個醫療的選擇有哪些他先做自主性的選擇"},{"start":49.916,"end":70.612,"text":"對所以簡單來講因為為什麼要先開這個頭我想很多人對於這個題目可能不是很清楚所以育立醫療就是簡單來講就是在自己還能夠清楚表達的時候先和醫療團隊討論然後寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候"},{"start":71.553,"end":85.943,"text":"可以想要接受或拒絕哪些維持生命治療或人工營養的正式決定確保自己的醫療選擇能被尊重簡單來講我們要做一個這個開頭也算是宣講宣導一下所以我們針對於這件事情現行的這個我們今天要討論的吳懷呼就是跟"},{"start":93.849,"end":102.945,"text":"成效到底是怎麼樣然後以及為什麼成效不佳他的障礙有哪些可能包含著費用包含著宣傳不佳包含著國人觀念"},{"start":103.939,"end":126.164,"text":"那所以第一個就是想要問現在育立醫療照護的這個諮商ACP是採取類似自費的制度那它是成為民眾參與的比較大的障礙那根據媒體的報導或者是叫做不完全統計從最便宜可能有兩千元到最貴八千元等等還有價格不低那收費標準也比較混亂一點"},{"start":128.044,"end":149.803,"text":"那根据统计嘛2023年全台签署这个预立医疗决定就是AD的部分人数仅占成年人口的可能0.35%那刚刚也有人讲到0.45%总之就是蛮低的啦所以简单来讲推行这个很好的政策但是成效不佳那当然显见的刚刚有讲到第一个障碍可能跟费用有关"},{"start":150.464,"end":163.889,"text":"那有關於這個部分呢嘉義的陽明醫院的院長謝錦祥有指出ACP的人力成本高昂那現行的健保未納入給付導致醫院這個轉嫁成本至民眾形成經濟篩選的現象"},{"start":166.25,"end":193.613,"text":"而且此问题在非都会区更严重那六都签署的量占总数的72%而且其中的台北市占36%那也凸显了这个城乡资源的差距所以目前这个ACP是纳入健保给付的现行事办计划是涵盖刚刚有提到的几种比如说比较严重的病患癌末、前途失智或是公告重症居家照顾等四大类"},{"start":194.373,"end":215.12,"text":"那我們就想要請問像這個部分未來我們是不是要擴大至全民因為我剛剛也有委員說2026年的時候你們過去有宣示說2026年要擴大至全民但是今天的書面報告又提到尚需要深入的政策研議與詳細的預算規劃然後帶各界達成共識及實務運作更趨完備再行通盤監討修正"},{"start":223.163,"end":230.927,"text":"那我是覺得說那這個好像是跟你們原本預期的有很大的差距喔所以想要請問部長那你們現在具體的規劃跟配套細節到底是什麼遇到了什麼困難"},{"start":235.404,"end":258.91,"text":"好 我想如果能夠全民都來簽署這是非常好的理想那這當然牽涉到我們也檢討為什麼低的因素當然諮商費用是一個對 剛剛講過 費用一個重點那剛剛您一開始就幫忙先導真的很感謝我必須要再先導一下如果能夠簽討這個異例異組其實是愛的表現什麼叫愛的表現呢"},{"start":264.867,"end":281.253,"text":"就是愛你的家人因為你的子女到最後不曉得這個爸爸到底要不要插管要不要做什麼很痛苦如果你能夠事先表示好的話讓醫療人員能夠按照爸爸媽媽的一個心願去做"},{"start":282.692,"end":299.968,"text":"所以就是你去做好屹立一族其實是愛你家人的一個表現這個不是金錢所能衡量的那當然那個議事室也做了很多的一個規劃健保署也一直在努力啦當然這個要配合財務的規劃"},{"start":301.81,"end":319.308,"text":"對 謝謝所以我再進一步問因為剛剛有提到目前規劃大概是目前有的這個事辦是大概180萬人大概是54億然後要分階段那你們現在有沒有比較具體的實施的方式因為其實很重要的一點就是剛剛你們都有提到"},{"start":321.029,"end":327.513,"text":"這個其實是健康投資所以你做得好其實這個應該是絕對長期對於健保的財務是更好的對吧 對於這個對於整個財務的狀況應該是更好的是的所以你的問題是你們應該要具體的去"},{"start":337.077,"end":361.063,"text":"可不可以給本席報告因為你們目前就只講到這180萬人無私益的那這只是短期你們擔心短期一下子衝擊很大可是剛剛也講到不可能180萬人都去用嘛你要包含宣導還有包含觀念所以我在想這全民適用的部分是不是應該儘速推動你才有可能達到這個所謂的健康投資然後也可以在這個整個財務的狀況之下更加的有餘裕"},{"start":364.544,"end":390.978,"text":"我們一定循序漸進就好像說所以我知道你循序漸進但是部長我希望你們可以給本席一個具體的你們評估目前的衝擊以及你們打算的目標你到底在幾年你現在這一兩年你打算這樣子180萬人那明年達到多少什麼時候全民適用是不是可以在2026年達到你們所謂的標準或者是你做不到你要到2027年因為我想我們就在這裡做一個"},{"start":391.758,"end":407.706,"text":"做一個這個宣示所以希望請部長給我們一個具體的規劃不要用剛剛所謂說還要再討論還要再通盤檢討這樣子去拖延時間我相信你也是想要推動這個所以我覺得也要給自己一個目標去鞭策好不好"},{"start":408.146,"end":420.01,"text":"那再來喔因為剛剛有講到費用的部分啦所以就回扣到這個納入健保的部分所以剛剛有說有甚至有這個很多的有一個65歲的阿姨啊這個媒體訪問她這國際旅遊的這個領隊啊她退休之後其實她的這個財務狀況應該還不錯而且她觀念也算是比較開放但她還是不懂她就說她還是不懂為什麼要花錢去了解與選擇自己怎麼死"},{"start":433.095,"end":454.531,"text":"那最後也是聽到是免費他才去報名所以這在證明了剛剛就說這個要趕快把你們的目標達成然後另外呢目前醫院也採取這個團體諮商所以現在就講到觀念的部分雖然說他可以降低人均成本也是一個調整的方式可是現行的團體諮商很多都是數位評審的這個陌生人一體參加整個氣氛其實也是有點像是大型團購現場就會比較覺得跟我們國人的觀念有所衝擊"},{"start":462.677,"end":469.751,"text":"因為他對於生死的事情可能不像是國外可以接受這個陌生人一起的這種形式這部分是不是也有可以調整的空間"},{"start":473.25,"end":495.916,"text":"謝謝委員指教其實所以我們去年有針對團體智商這邊然後開始做一些算是輔導作業發現是說如果是家族朋友一起的這種效果最好對沒錯然後所以在這個地方我們其實已經開始針對醫院有做團體這邊有做一些輔導然後有一些給一些建議然後這些具體的建議要轉成文字變成"},{"start":497.036,"end":504.34,"text":"衛福部這邊出的一些所謂的建議或指引的部分的話應該是今年下半年才會逐步的討論不過已經有發現我們輔導團隊已經有發現相關的問題以上很好對這就是我要跟你們講的這個問題要"},{"start":511.568,"end":526.162,"text":"盡速的把它推動然後可以請到所有你們的具體的檢討報告和詳細的文字內容提供給本席辦公室好沒問題那再來就是全台約200多家的醫療機構有ACP服務可是全台的77%的鄉鎮市區是沒有諮商據點分佈不均"},{"start":530.026,"end":552.529,"text":"那今天的報告有提出要擴大ACP的規模但沒有具體寫到措施是什麼所以我們在想這部分是不是要針對偏鄉地區可不可以結合長照或銀髮關懷據點開設這種行動的諮商站那也參考這個日本的在宅醫療聯繫的模式與精神由巡迴的團隊提供服務也是一種推廣的方式"},{"start":553.71,"end":575.407,"text":"是不是可以這個都可以演繹演繹要做嘛要去做而且最重要是要維護他當時簽ACP的品質那我們也希望多利用到我們社區的醫療團隊是社區的醫療團隊我們鼓勵他們接受一定的訓練以後現在金手比便利商店多"},{"start":575.947,"end":594.819,"text":"所以部長我今天提出的問題都希望你們儘速研議完之後給本席一個報告因為我們都是針對剛剛講的三大方向提出的現在的困境要告訴部長請你們趕快去做出評估跟推動那再來還有一個也是觀念的部分民眾對於這個病毒存在三大誤解32%認同認為是這個安樂死28%擔心簽署後"},{"start":601.303,"end":626.241,"text":"遭放棄治療那19%認為是違反宗教教義然後此外還有家屬介入決策的傳統文化還很深那在2022年的高雄榮總的案例也顯示38%的這個AD簽署者遭親屬反對執行這都是實務上面你們要去克服的問題那另外我主要是要講那現行的法規的這個部分"},{"start":626.761,"end":640.171,"text":"第九條要求二等親的家屬參與諮商那是不是會造成這個反而造成家庭壓力那也是不是可以修法允許這個獨居者經社工評估後可以免除親屬認同"},{"start":643.097,"end":667.043,"text":"我先補充一下就是剛剛委員推行獨居者這部分其實目前如果獨居者自己簽主要的切結書其實醫院還是可以進行諮詢因為實務面就看到現在獨居長者其實相對逐步在增加當中這個在實務面已經做了相關的處理然後進一步我們在講的是其實要善終的部分的話剛剛委員有特別講到"},{"start":668.323,"end":686.357,"text":"周圍親友特別是家人的阻止的這件事也是當初在立法的時候為什麼希望家屬一起參與透過家屬參與的時候在最後那一個決定才比較容易尊重病人的一個自主這當初在設計的時候有這樣子的一個考量"},{"start":687.077,"end":707.455,"text":"結果論就是我剛剛講出來就是結果論所以還是一樣費用宣導跟觀念還是有很大的問題和精進的空間其實你們要去檢討這個部分所以我最後就要跟你們講到一件事情就是剛剛也有提到宣傳的部分我們有很多的政策宣傳宣導衛教說實在的內容都偏向深色難懂也很無趣"},{"start":708.115,"end":718.798,"text":"所以要做到好的效果蠻難的所以要請問部長一下如果某一個政令或是衛教宣導在你們臉書上要破千萬次的瀏覽量平均要花多少經費抓一個數字可以嗎我不知道請委員指教你抓不出來一個數字對不對其實以你們過去的你們過去的這些你看都才1.9萬次3208次1.6萬次其實都很少所以應該要去想更"},{"start":737.483,"end":756.253,"text":"更好更創意的方式所以我現在就告訴你一件事現在南投有一間醫院有一個小編他打破了宣導的困難內容無聊的刻板印象讓在他的衛教的宣導影片有很好的效果他大概的成績像下面半年內追蹤數增加了4.5萬單月瀏覽次數突破了數千萬互動也破了100多萬"},{"start":760.916,"end":786.753,"text":"所以你剛剛可能你們不曉得狀況可是你們在宣導上面的經費是非常高的所以我們在省經費預算的時候都知道可是這個小編他卻說他的薪水就是三萬元打死甚至沒有額外的花媒體採購的費用那院長這就是一個妥妥的人才所以他一PO出他三萬打死的時候他馬上一堆人下面挖角他然後可以印證這樣的人在我們的業界一定是很搶手"},{"start":787.734,"end":815.633,"text":"那釋逢今天是五一勞動節那我覺得當然講說這樣的薪水叫做壓榨可能過於沉重但現實面就是你們在這方面的宣導可能只靠這樣的熱情的小編是沒辦法留他太久所以我們是不是可以請我們的部長去了解一下這個案子然後也要真的下定決心讓這個在醫療體系裡面的行政人員這些人才應該要有更好的待遇才不會白白流失這個人才可以嗎"},{"start":815.973,"end":823.968,"text":"我們一定珍惜人才所以要改善他們的待遇這才是今天這個質詢的重要的意義謝謝部長好 謝謝好 謝謝廖瑞祥委員"}]}}},"gazette":{"lineno":435,"blocks":[["廖委員偉翔：（10時55分）謝謝主席，有請部長。"],["主席：請邱部長。"],["邱部長泰源：委員好。"],["廖委員偉翔：部長好。今天我們討論這個議題是非常有意義的，我想要請教部長，可不可以簡單地用一句話來告訴國人什麼是我們今天討論的預立醫療？"],["邱部長泰源：預立醫療就是希望民眾能夠早一點來討論未來當他進入到幾種狀況，不管是末期或者是植物人，或永久性的傷害沒辦法恢復的情況之下，他的醫療選擇有哪些，先做自主性的選擇。"],["廖委員偉翔：為什麼要先開這個頭？我想很多人對於這個題目可能不是很清楚，簡單來講，預立醫療就是在自己還能夠清楚表達的時候，先和醫療團隊討論，寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候，可以接受或拒絕哪些維持生命治療或人工營養的正式決定，確保自己的醫療選擇能被尊重，對不對？簡單來講，我們要做一個開頭，也算是宣講、宣導一下。"],["邱部長泰源：謝謝。"],["廖委員偉翔：針對這件事情，我們今天要討論的無外乎就是成效到底怎麼樣，以及為什麼成效不佳，它的障礙有哪些，包含費用、宣傳不佳以及國人觀念。第一個，現在預立醫療照護諮商（ACP）是採取類似自費的制度，因此成為民眾參與比較大的障礙，根據媒體報導，或者是叫做不完全統計，從最便宜可能有2,000元到最貴8,000元等等，價格不低、收費標準也比較混亂一點。根據統計，2023年全臺簽署預立醫療決定（AD）的部分，人數僅占成年人口的0.35%，剛剛也有人提到0.45%，總之就是滿低的，所以推行這個很好的政策，但是成效不佳，顯見的，剛剛講到的第一個障礙可能跟費用有關。","關於這個部分，嘉義陽明醫院的院長謝景祥也指出，ACP的人力成本高昂，現行的健保未納入給付，導致醫院轉嫁成本至民眾，形成經濟篩選的現象，而且此問題在非都會區更嚴重，六都簽署的量占總數的72%，其中臺北市占36%，也凸顯了城鄉資源的差距。所以目前ACP納入健保給付的試辦計畫，涵蓋剛剛有提到的幾種，比如比較嚴重的病患，癌末、輕度失智或是公告重症、居家照護等四大類。我們想要請問，像這個部分，未來我們是不是要擴大至全民？因為剛剛也有委員說，你們過去有宣示2026年要擴大至全民，但是今天的書面報告又提到，尚需經深入的政策研議與詳細的預算規劃，待各界達成共識及實務運作更趨完備後，再行通盤檢討修正。我是覺得這個好像跟你們原本預期的有很大差距，所以想要請問部長，你們現在具體的規劃跟配套細節到底是什麼？遇到了什麼困難？"],["邱部長泰源：好，我想如果能夠全民都來簽署，這是非常好的理想，我們也檢討簽署率低的因素，當然，諮商費用是一個重點。"],["廖委員偉翔：對，剛剛講過，費用嘛。"],["邱部長泰源：剛剛您一開始就幫忙宣導，真的很感謝，但我必須要再宣導一下，如果能夠簽好預立醫囑，其實是愛的表現，什麼叫愛的表現？就是愛你的家人，因為你的子女到最後不曉得爸爸到底要不要插管、要不要做什麼，很痛苦！如果能事先預立，就可以讓醫療人員按照爸爸媽媽的心願去做，所以預立決定其實是愛家人的表現，這不是金錢所能衡量的。當然，醫事司也做了很多規劃，健保署也一直在努力，不過這也要配合財務規劃。"],["廖委員偉翔：對，謝謝。我再進一步問，剛剛提到目前試辦大概有一百八十萬人、約五十四億，分階段實施，你們現在有沒有比較具體的實施方式？其實很重要的一點，這點剛剛你們都有提到，這是健康投資。如果做得好，長期而言對健保財務來說是更好的，對吧？對整個健保財務狀況應該是更好的。"],["邱部長泰源：是的。"],["廖委員偉翔：你們可不可以給本席一份具體報告？你們目前只講到有一百八十萬人、五十四億經費，但這是短期經費，畢竟你們擔心一下子會衝擊很大。可是剛剛也講到，不可能一百八十萬人都使用，還包含宣導及觀念，因此，在全民適用上是不是應該儘速推動，才有可能達到健康投資，也才有可能讓健保財務有餘裕？"],["邱部長泰源：好，我們一定循序漸進來做。就好像說……"],["廖委員偉翔：我知道你們會循序漸進，但是部長，我希望你們可以給本席具體的評估，包括目前的衝擊以及打算的目標為何？到底在幾年內可以達成？這一、兩年有一百八十萬人，明年達到多少？什麼時候全民適用？是不是可以在2026年達到你們的標準？或者做不到，要到2027年？我想部長可以在這裡做個宣示，也希望部長給我們具體的規劃，不要用還要再討論、還要再通盤檢討當理由拖延時間。我相信部長也想推動，部長要給自己一個目標去鞭策，好不好？"],["邱部長泰源：好。"],["廖委員偉翔：再來，講到費用，也就是納入健保的部分。剛才提到有一個65歲的阿姨接受媒體訪問，他是國際旅遊領隊，即使退休了財務狀況應該還不錯，而且觀念也算比較開放。但他還是不懂，為什麼要花錢去選擇自己怎麼死？最後是聽到免費才去報名，這證明了你們要趕快達成目標。目前醫院採取團體諮商，所以現在就講到觀念問題，雖然可以降低人均成本，這也是一個調整方式，可是現行的團體諮商很多都是素昧平生的陌生人一起參加，整個氣氛有點像大型團購現場，對國人的觀念不免有所衝擊，畢竟事關生死，可能不像國外可以接受與陌生人一起諮商的形式，這部分是不是也有調整的空間？"],["劉司長越萍：謝謝委員指教，去年我們有團體諮商，之後也進行一些輔導作業，我們發現如果是家族、朋友一起的效果最好……"],["廖委員偉翔：對，沒錯。"],["劉司長越萍：就此，我們已經開始針對醫院的團體諮商輔導，也給一些建議，若這些具體的建議轉成文字，變成衛福部公告的建議或指引，在今年下半年才會逐步討論。不過，我們的輔導團隊已經有發現相關問題，以上。"],["廖委員偉翔：很好，這就是我要跟你們講的問題，你們要儘速推動，屆時也請將具體的檢討報告及詳細的文字內容提供給本席辦公室。"],["邱部長泰源：好，沒問題。"],["廖委員偉翔：再來，目前全臺大概有兩百多家醫療機構有ACP服務，可是全臺有77%的鄉鎮（市）區沒有諮商據點，足見分布不均。今天在報告裡有提出要擴大ACP規模，卻沒有寫出具體措施是什麼！針對偏鄉地區，可不可以結合長照或銀髮關懷據點來開設行動諮商站？我想可以參考日本在宅醫療聯繫的模式與精神，由巡迴團隊提供服務，這也是一種推廣方式，是不是可以推行？"],["邱部長泰源：這都可以研議。"],["廖委員偉翔：研議要去做啊！"],["邱部長泰源：不僅要去做，最重要是要維護預立人當時簽ACP的品質，我們也希望能多利用社區的醫療團隊，並鼓勵社區醫療團隊接受一定的訓練。現在診所數比便利商店還多……"],["廖委員偉翔：部長，針對我今天所提出的問題，希望你們儘速研議完之後能給本席一個報告，因為都是針對剛剛講的三大方向提出的困境與問題，所以我在這裡告訴部長，也請你們儘快評估與推動。"],["邱部長泰源：好。"],["廖委員偉翔：接下來也是觀念問題。民眾對於病主存在三大誤解，有32%認為是安樂死，有28%的人擔心簽署後會被放棄治療，有19%認為違反宗教教義。此外，家屬介入決策的傳統文化還是很深，2022年高雄榮總的案例也顯示，有38%的AD簽署者遭親屬反對執行，這些是實務上你們要去克服的問題。另外，主要是現行法規部分，現行法第九條要求二等親家屬參與諮商，這是不是反而會造成家庭壓力？是否可以修法允許獨居者經社工評估後免除親屬同意？"],["劉司長越萍：我先補充一下，就剛剛委員所垂詢獨居者這部分，目前若獨居者自己簽切結書的話，其實醫院還是可以進行諮商，實務面就看到現在獨居長者已相對、逐步在增加當中，在實務面上已經做了相關處理。進一步講，關於善終，剛剛委員特別提到周圍親友，特別是家人阻止這件事，當初在立法時我們為什麼會希望家屬一起參與？因為透過家屬的參與，在最後做決定時才能比較容易尊重病人的自主，這是當初在設計時的考量。"],["廖委員偉翔：以結果論來說，就是我剛剛講的，費用、宣導跟觀念還是有很大的問題與精進空間，這部分就請你們去檢討。最後要跟你們講的一件事，也就是宣傳，很多的政策宣傳、宣導與衛教，說實在，不僅內容偏向生澀難懂，也很無趣，想達到好的效果其實滿難的。請問部長，如果某一個政令或衛教宣導，在你們臉書上要破千萬次瀏覽量，平均要花多少經費？可以抓一個數字嗎？"],["邱部長泰源：我不知道，請委員指教。"],["廖委員偉翔：你抓不出數字，對不對？以你們過去的表現來看，才1.9萬次、3,208次、1.6萬次，其實都很少，所以你們應該要去想更好、更具創意的方式。我現在告訴你，南投有間醫院的小編打破了宣導的困難與內容無聊的刻板印象，讓衛教宣導影片有很好的效果，在半年內他的追蹤數增加了4.5萬，單月瀏覽次突破了數千萬，互動也破了一百多萬。你們剛剛可能不曉得狀況，你們在宣導經費上是非常高的，這點我們在審預算時都知道。但這個小編的薪水就是3萬元打死，甚至沒有額外花媒體採購費用，部長，這就是一個妥妥的人才！他一po出他薪水3萬打死的時候，一堆人馬上在下面留言要挖角他，足以印證這樣的人在業界一定很搶手。今天適逢五一勞動節，說這樣的薪水叫壓榨可能過於沉重，但現實面就是，你們在宣導上若只靠熱情的小編，是沒辦法留人太久的。所以是不是請部長去了解一下這個案子？然後也要真的下定決心，讓醫療體系裡面的行政人員、這些人才，應該要有更好的待遇，才不會白白流失人才，可以嗎？"],["邱部長泰源：我們一定珍惜人才……"],["廖委員偉翔：要改善他們的待遇，這才是今天質詢最重要的意義，謝謝部長。"],["邱部長泰源：當然，一定。謝謝。"],["主席：謝謝廖偉翔委員的質詢。","我們現在休息10分鐘。","休息（11時9分）","繼續開會（11時19分）"],["主席（劉委員建國）：現在繼續開會。","接下來請林淑芬委員詢答。"]],"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"}}}