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613.232, \"end\": 613.452, \"score\": 0.984}, {\"word\": \"如\", \"start\": 613.452, \"end\": 613.592, \"score\": 0.874}, {\"word\": \"果\", \"start\": 613.592, \"end\": 614.153, \"score\": 0.919}, {\"word\": \"將\"}, {\"word\": \"來\"}, {\"word\": \"有\", \"start\": 614.153, \"end\": 614.933, \"score\": 0.999}, {\"word\": \"需\", \"start\": 614.933, \"end\": 615.073, \"score\": 0.997}, {\"word\": \"要\", \"start\": 615.073, \"end\": 615.133, \"score\": 1.0}, {\"word\": \"討\"}, {\"word\": \"論\"}, {\"word\": \"的\", \"start\": 615.133, \"end\": 615.213, \"score\": 0.749}, {\"word\": \"時\"}, {\"word\": \"候\", \"start\": 615.213, \"end\": 615.233, \"score\": 0.0}]}, {\"start\": 616.414, \"end\": 638.88, \"text\": \"那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的\", \"words\": [{\"word\": \"那\", \"start\": 616.414, \"end\": 616.714, \"score\": 0.928}, {\"word\": \"這\"}, {\"word\": \"方\", \"start\": 616.714, \"end\": 616.834, \"score\": 0.976}, 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{\"word\": \"謝\"}, {\"word\": \"部\", \"start\": 825.451, \"end\": 826.253, \"score\": 0.965}, {\"word\": \"長\"}, {\"word\": \"大\", \"start\": 826.253, \"end\": 826.374, \"score\": 1.0}, {\"word\": \"家\", \"start\": 826.374, \"end\": 827.236, \"score\": 0.938}, {\"word\": \"繼\"}, {\"word\": \"續\"}, {\"word\": \"努\", \"start\": 827.236, \"end\": 827.397, \"score\": 0.981}, {\"word\": \"力\", \"start\": 827.397, \"end\": 827.818, \"score\": 0.989}, {\"word\": \"好\", \"start\": 827.818, \"end\": 827.838, \"score\": 0.923}, {\"word\": \"謝\"}, {\"word\": \"謝\"}], \"language\": \"zh\"}","srt":"1\n00:00:05,431 --> 00:00:07,335\n謝謝主席我們邱部長邱部長\n\n2\n00:00:13,323 --> 00:00:39,282\n委員好柏定今天真的是舌戰所謂的不是舌戰啦齁我意思是說讓大家討論啦這個真的是重要的議題因為進入到這個超高齡社會謝謝主席來這個議題謝謝是是啊啊我也知道你是在臨床上其實有很豐富的經驗甚至有名的專家所以這機會再跟柏定來討論今天就是針對病毒法\n\n3\n00:00:43,123 --> 00:00:58,656\n未來在落實上面這個人數還有品質可以兼顧不要說他就要增加這個比例然後就在這個品質上是無法兼顧這個就是今天我們要討論的地方其實我們也知道\n\n4\n00:01:01,059 --> 00:01:10,872\n在這個討論的前提就是有這幾個重點包括我們是要以人為本以人為本前幾天賴總統也在健康台灣全國論壇上面我強調以人為本的醫療基本上\n\n5\n00:01:15,698 --> 00:01:32,767\n還需要重視的就是推動安寧照護跟尊嚴善中的支持跟肯定這就是我們今天討論的主題可是我們也看到數據就是病處法已經實施了五年還是有不到1%的民眾來簽署這方面的處理需求\n\n6\n00:01:36,249 --> 00:01:59,821\n那可能曾經大家都已經分析得很清楚包括可見性不足諮商費一開始的時候是自費嘛後來才有健保的部分的處理還有就是民眾他剛才黃先生也有提醒民眾在這個接受度的部分到底會不會有根據他對知識對這個生命的理解能不能接受還有\n\n7\n00:02:01,202 --> 00:02:21,084\n我們目前的現場執行的確有他的一些在處理上他要求比較嚴謹的地方那我們也知道如果依照今天早上部長的報告是以比較採像暫時不修法來做討論的話那就是要改善我們的政策改善的政策呢就會包括\n\n8\n00:02:22,105 --> 00:02:37,913\n有沒有機會來提高這個至上的可敬性擴大大家益計畫擴大健保給付跟強化政策宣傳那剛剛那個金蘇委員也有提到這部分怎麼來加強那真的要修改法律的話那應該要注意哪一些的事情\n\n9\n00:02:39,873 --> 00:02:59,794\n的確我們知道從今天開始就會擴大這個餘地移足的這些給付對象希望能夠在未來的一年裡面能夠增加兩萬人為目標來讓有更多的民眾來做這方面的處理那這方面的處理當然就會需要有比較相關的配套剛剛提到的政策\n\n10\n00:03:00,895 --> 00:03:20,828\n我現在先請教一個問題剛剛部長也有討論到其實如果能夠善用我們目前的安寧照護條例的一些條件的話事實上是也可以讓這個品質得到很好的照顧模式有民眾參加過這個屬於我們的這個病毒法的\n\n11\n00:03:21,849 --> 00:03:33,121\n同意簽署以後同時又有參加那您知道我條例這些內容的不知道有沒有百分比上的數據可以呈現市長或是有沒有相關的數據\n\n12\n00:03:36,980 --> 00:04:02,841\n這邊我沒有手邊沒數據我要再確認一下我覺得如果能夠知道有這個數據的話如果一個人一個民眾他願意同時同意這兩點的話我相信未來照顧在品質上或者是在跟家屬的溝通上是有他一定的這種不會造成大家在做臨床決策上的困擾所以我們也希望能夠看到這個數據\n\n13\n00:04:04,229 --> 00:04:18,334\n好我們再整理一下OK好那在馬雲部裡面這邊來處理所以針對未來要再利用這個部分提高的話希望能夠增加2.5萬人部長覺得這個機會大嗎這個樂觀還是不樂觀嗯\n\n14\n00:04:29,075 --> 00:04:43,031\n我們相對樂觀的原因是因為過去的這五年我們發現是說簽署這個AD就是去做ACP諮商AD的人其實過去都有一些生命情境是有相關經驗的才有這樣子的意願\n\n15\n00:04:43,752 --> 00:05:11,307\n所以是說這次那個金毛鼠針對的這個其實像有重大傷病或者是在我們那個加一整合計畫或者是全社區照顧計畫這邊大概都跟基層醫師這邊有相對密切關係長期信任信賴關係的所以第一個65歲以上是過去的他過去PotentialTarget裡面的熱於就是比較多去簽意願的人\n\n16\n00:05:11,747 --> 00:05:27,101\n然後那個基層這邊是我們更希望能夠擴大的這一塊因為訓練的人數多了然後只是說踏出這一步能夠盡可能的來做他協助他的病人來簽署AD的這件事情的話是我們\n\n17\n00:05:27,862 --> 00:05:45,377\n今年下半年也希望跟健保署一起合作希望能夠擴大的然後我們這邊也會有輔導團隊大概先做示範看看那個怎麼輔導讓大家基層這邊更勇於跨出第一步這是我們所以我們相對而言是對增加兩萬再提高這件事情我們是樂觀的以上\n\n18\n00:05:46,474 --> 00:06:08,259\n好很期待這個樂觀可以有機會變成一個事實那如果我們希望讓這個樂觀更有機會的話那有沒有可能在以不修母法的前提之下針對我們目前的這幾個相關的管理辦法來做處理包括說因為我們現在知道依照現在的管理辦法就是要求相對嚴謹嘛你就要\n\n19\n00:06:09,119 --> 00:06:35,880\n有200床以上等等的一些限定條件我們也針對於護理機構或者是長照機構目前的話是無法如果現在以不修法為前提之下要做這個調整的話有沒有可能在辦法裡面去跟以護理或者是長照機構是跟醫院本身是有附設的條件的情形之下他們可以做同等的服務模式\n\n20\n00:06:36,936 --> 00:07:00,253\n我要講的是說過去這邊的這個管理辦法裡面在處理的一個是特殊專長的診所或醫院他的人員組成的資格其實並沒有說我講的是像護理社心這些一定要專屬在那家機構所以大家在社區裡面怎麼做協作的方式其實在過去的5年裡面我們有處理過然後\n\n21\n00:07:01,473 --> 00:07:20,119\n為什麼要不同的角度然後為什麼一定要就是醫療機構的原因是因為在解釋這一段的時候有很多對於疾病的預後對於後來的介入措施這個產生的一些衝擊好處壞處這個一定要相當臨床經驗的人所以在現行的狀況下面的時候\n\n22\n00:07:21,259 --> 00:07:46,835\n從不同的角度因為像譬如說社新這些的他們對於病人的同理心得更高度所以我們才覺得是說用協作的方式其實可以達成目前是說可不可以擴大領域因為不需要這些人專屬在哪一家醫院也可以或者是用協作的方式避典我舉個例子好了我舉個例子譬如說以部立基隆醫院為例它自己有一個複測長照機構這個複測長照機構依照現況可以做這個服務嗎\n\n23\n00:07:50,410 --> 00:08:16,589\n他的醫師團隊可以他可以進到那個輻射機構裡面因為就是說健保署他在擴大這個計畫的時候我們要的ACP簽出來的AD要有醫療機構蓋章然後像以剛剛那個委員在講的部立基隆醫院外展的服務到他的輻射的護理之家然後評估完以後這件事情其實現況是可以的\n\n24\n00:08:16,749 --> 00:08:32,285\n是所以如果說依照剛剛的說明看起來的話依照目前的管理辦法事實上是可以做好外展就能夠增加這個量能而且可以維持品質ok了解好那我們期待這方面在執行上可以更落實\n\n25\n00:08:33,987 --> 00:08:39,772\n我們知道如果真的是要修法的話有一些增點包括說開放諮商機構的條件跟範圍還有就是有關於人員的資格跟訓練\n\n26\n00:08:48,360 --> 00:09:09,277\n當然也希望這個人員在做服務的時候都要有實務的經驗因為畢竟這是跟生命有直接相關的一種服務模式所以這個經驗上也必須要能夠堅持還有就是法源這個裁員到底是要政府編列預算啊或者是要透過健保的模式還有剛剛一直在討論的就是那個現場決策機制\n\n27\n00:09:11,238 --> 00:09:34,180\n怎麼樣才能夠讓他可以在一定的品質之下不要造成這個醫病或者是醫師跟這個他的家人之間的一些處理上的一些干擱所以看起來如果要往修法方向的話似乎要進入主條討論之前如果有一個公聽會應該更能夠引起大家不同的意見或者是需求\n\n28\n00:09:34,961 --> 00:09:54,659\n那召委剛好也是相關有認為需要修法那是不是也麻煩召委這邊等一下看能不能也讓大家知道說那我們委員會是不是需要再舉辦一個公聽會來再收集更多的一些想法跟意見當作未來修法的一個參考\n\n29\n00:09:56,120 --> 00:10:15,233\n這個是我針對第一部分跟這個部長討論那後面很快的就針對醫療資訊的傳播正確性跟部長也來討論一下我們也知道今天其實有很多委員一直在討論說這個預例一組安寧緩和安樂死如果將來有需要討論的時候\n\n30\n00:10:16,414 --> 00:10:38,880\n那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的\n\n31\n00:10:39,720 --> 00:10:58,742\n那這方面如果能夠處理到的話我相信對於未來在溝通的時候會有更好的一些引導方面那我們也知道其實最後就是有關於剛剛針對這個資訊的透明還有正確性真的非常非常的重要因為我們目前也知道\n\n32\n00:11:00,244 --> 00:11:15,126\n比較屬於針對學者或者是臨床很希望針對我們這個健保是否能夠在現有的制度之下能夠持續永續那他們發出一些看法那他偷到一個\n\n33\n00:11:16,907 --> 00:11:39,817\n這個頂尖的期刊結果大家也發現說原來這個資訊不是那麼樣的完整或者是不是那麼樣的一個正確的情形下會導致可能國外或者是這個期刊的這個讀者可能對於台灣這個醫療體制是會造成不當的認知那部長這邊也希望能夠有更有效去處理這個部分\n\n34\n00:11:41,098 --> 00:12:05,268\n那這邊部長不知道能不能夠再做簡短的處理的方式讓我們知道好前面這一張PowerPoint跟這一張我回應一下第一個就是不管是安寧環的醫療的內容或者是說大家關心的醫師協助自殺等等的相關的議題我覺得應該要更多的對話那我們也有在做這方面的努力\n\n35\n00:12:06,868 --> 00:12:30,113\n希望讓各位對這個名詞的內容能夠更加了解來保護自己第二個部分這個部分因為我們這位年輕的醫師他引用的數據錯誤我們的Omicron的死亡率是0.16%他用一個\n\n36\n00:12:34,311 --> 00:12:59,916\n58%這樣子那不是很可怕了嗎這樣的錯誤也寫出去我們也覺得Lancet在那個審查當中因為他有reference英文已經寫得很清楚我覺得他們的審查真的也是我也覺得說沒有仔細去看一下因為那個的確是很不合理那其他的數據當然有所錯誤所以然後因為錯誤的\n\n37\n00:13:01,209 --> 00:13:10,897\n的一個數據導致以錯誤的解讀導致以錯誤的結論我想中醫大非常嚴肅的開了兩次的協助的理委員會\n\n38\n00:13:12,239 --> 00:13:40,562\n正是在前天晚上就發出要求撤稿衛福部也是在昨天的下午也是做了一個論述也呈現我們台灣健保其實的成就以及我們醫療防疫體系的努力希望能夠不但要求撤稿也希望刊登出來能夠讓期間的讀者知道台灣的努力這樣才對得起我們過去醫療人員\n\n39\n00:13:42,361 --> 00:13:47,838\n以及政府的努力好謝謝部長大家繼續努力好謝謝\n\n","tsv":"start\tend\ttext\n5431\t7335\t謝謝主席 我們邱部長邱部長\n13323\t39282\t委員好柏定今天真的是舌戰所謂的不是舌戰啦齁我意思是說讓大家討論啦這個真的是重要的議題因為進入到這個超高齡社會謝謝主席來這個議題謝謝是是啊啊我也知道你是在臨床上其實有很豐富的經驗甚至有名的專家所以這機會再跟柏定來討論今天就是針對病毒法\n43123\t58656\t未來在落實上面這個人數還有品質可以兼顧不要說他就要增加這個比例然後就在這個品質上是無法兼顧這個就是今天我們要討論的地方其實我們也知道\n61059\t70872\t在這個討論的前提就是有這幾個重點包括我們是要以人為本以人為本前幾天賴總統也在健康台灣全國論壇上面我強調以人為本的醫療基本上\n75698\t92767\t還需要重視的就是推動安寧照護跟尊嚴善中的支持跟肯定這就是我們今天討論的主題可是我們也看到數據就是病處法已經實施了五年還是有不到1%的民眾來簽署這方面的處理需求\n96249\t119821\t那可能曾經大家都已經分析得很清楚包括可見性不足諮商費一開始的時候是自費嘛後來才有健保的部分的處理還有就是民眾他剛才黃先生也有提醒民眾在這個接受度的部分到底會不會有根據他對知識對這個生命的理解能不能接受還有\n121202\t141084\t我們目前的現場執行的確有他的一些在處理上他要求比較嚴謹的地方那我們也知道如果依照今天早上部長的報告是以比較採像暫時不修法來做討論的話那就是要改善我們的政策改善的政策呢就會包括\n142105\t157913\t有沒有機會來提高這個至上的可敬性擴大大家益計畫擴大健保給付跟強化政策宣傳那剛剛那個金蘇委員也有提到這部分怎麼來加強那真的要修改法律的話那應該要注意哪一些的事情\n159873\t179794\t的確我們知道從今天開始就會擴大這個餘地移足的這些給付對象希望能夠在未來的一年裡面能夠增加兩萬人為目標來讓有更多的民眾來做這方面的處理那這方面的處理當然就會需要有比較相關的配套剛剛提到的政策\n180895\t200828\t我現在先請教一個問題剛剛部長也有討論到其實如果能夠善用我們目前的安寧照護條例的一些條件的話事實上是也可以讓這個品質得到很好的照顧模式有民眾參加過這個屬於我們的這個病毒法的\n201849\t213121\t同意簽署以後同時又有參加那您知道我條例這些內容的不知道有沒有百分比上的數據可以呈現市長或是有沒有相關的數據\n216980\t242841\t這邊我沒有手邊沒數據我要再確認一下我覺得如果能夠知道有這個數據的話如果一個人一個民眾他願意同時同意這兩點的話我相信未來照顧在品質上或者是在跟家屬的溝通上是有他一定的這種不會造成大家在做臨床決策上的困擾所以我們也希望能夠看到這個數據\n244229\t258334\t好我們再整理一下OK好那在馬雲部裡面這邊來處理所以針對未來要再利用這個部分提高的話希望能夠增加2.5萬人部長覺得這個機會大嗎這個樂觀還是不樂觀嗯\n269075\t283031\t我們相對樂觀的原因是因為過去的這五年我們發現是說簽署這個AD就是去做ACP諮商AD的人其實過去都有一些生命情境是有相關經驗的才有這樣子的意願\n283752\t311307\t所以是說這次那個金毛鼠針對的這個其實像有重大傷病或者是在我們那個加一整合計畫或者是全社區照顧計畫這邊大概都跟基層醫師這邊有相對密切關係長期信任信賴關係的所以第一個65歲以上是過去的他過去Potential Target裡面的熱於就是比較多去簽意願的人\n311747\t327101\t然後那個基層這邊是我們更希望能夠擴大的這一塊因為訓練的人數多了然後只是說踏出這一步能夠盡可能的來做他協助他的病人來簽署AD的這件事情的話是我們\n327862\t345377\t今年下半年也希望跟健保署一起合作希望能夠擴大的然後我們這邊也會有輔導團隊大概先做示範看看那個怎麼輔導讓大家基層這邊更勇於跨出第一步這是我們所以我們相對而言是對增加兩萬再提高這件事情我們是樂觀的以上\n346474\t368259\t好 很期待這個樂觀可以有機會變成一個事實那如果我們希望讓這個樂觀更有機會的話那有沒有可能在以不修母法的前提之下針對我們目前的這幾個相關的管理辦法來做處理包括說 因為我們現在知道依照現在的管理辦法就是要求相對嚴謹嘛 你就要\n369119\t395880\t有200床以上等等的一些限定條件我們也針對於護理機構或者是長照機構目前的話是無法如果現在以不修法為前提之下要做這個調整的話有沒有可能在辦法裡面去跟以護理或者是長照機構是跟醫院本身是有附設的條件的情形之下他們可以做同等的服務模式\n396936\t420253\t我要講的是說過去這邊的這個管理辦法裡面在處理的一個是特殊專長的診所或醫院他的人員組成的資格其實並沒有說我講的是像護理社心這些一定要專屬在那家機構所以大家在社區裡面怎麼做協作的方式其實在過去的5年裡面我們有處理過然後\n421473\t440119\t為什麼要不同的角度然後為什麼一定要就是醫療機構的原因是因為在解釋這一段的時候有很多對於疾病的預後對於後來的介入措施這個產生的一些衝擊好處壞處這個一定要相當臨床經驗的人所以在現行的狀況下面的時候\n441259\t466835\t從不同的角度因為像譬如說社新這些的他們對於病人的同理心得更高度所以我們才覺得是說用協作的方式其實可以達成目前是說可不可以擴大領域因為不需要這些人專屬在哪一家醫院也可以或者是用協作的方式避典我舉個例子好了我舉個例子譬如說以部立基隆醫院為例它自己有一個複測長照機構這個複測長照機構依照現況可以做這個服務嗎\n470410\t496589\t他的醫師團隊可以他可以進到那個輻射機構裡面因為就是說健保署他在擴大這個計畫的時候我們要的ACP簽出來的AD要有醫療機構蓋章然後像以剛剛那個委員在講的部立基隆醫院外展的服務到他的輻射的護理之家然後評估完以後這件事情其實現況是可以的\n496749\t512285\t是所以如果說依照剛剛的說明看起來的話依照目前的管理辦法事實上是可以做好外展就能夠增加這個量能而且可以維持品質ok了解好那我們期待這方面在執行上可以更落實\n513987\t519772\t我們知道如果真的是要修法的話有一些增點包括說開放諮商機構的條件跟範圍還有就是有關於人員的資格跟訓練\n528360\t549277\t當然也希望這個人員在做服務的時候都要有實務的經驗因為畢竟這是跟生命有直接相關的一種服務模式所以這個經驗上也必須要能夠堅持還有就是法源這個裁員到底是要政府編列預算啊或者是要透過健保的模式還有剛剛一直在討論的就是那個現場決策機制\n551238\t574180\t怎麼樣才能夠讓他可以在一定的品質之下不要造成這個醫病或者是醫師跟這個他的家人之間的一些處理上的一些干擱所以看起來如果要往修法方向的話似乎要進入主條討論之前如果有一個公聽會應該更能夠引起大家不同的意見或者是需求\n574961\t594659\t那召委剛好也是相關有認為需要修法那是不是也麻煩召委這邊等一下看能不能也讓大家知道說那我們委員會是不是需要再舉辦一個公聽會來再收集更多的一些想法跟意見當作未來修法的一個參考\n596120\t615233\t這個是我針對第一部分跟這個部長討論那後面很快的就針對醫療資訊的傳播正確性跟部長也來討論一下我們也知道今天其實有很多委員一直在討論說這個預例一組安寧緩和安樂死如果將來有需要討論的時候\n616414\t638880\t那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的\n639720\t658742\t那這方面如果能夠處理到的話我相信對於未來在溝通的時候會有更好的一些引導方面那我們也知道其實最後就是有關於剛剛針對這個資訊的透明還有正確性真的非常非常的重要因為我們目前也知道\n660244\t675126\t比較屬於針對學者或者是臨床很希望針對我們這個健保是否能夠在現有的制度之下能夠持續永續那他們發出一些看法那他偷到一個\n676907\t699817\t這個頂尖的期刊結果大家也發現說原來這個資訊不是那麼樣的完整或者是不是那麼樣的一個正確的情形下會導致可能國外或者是這個期刊的這個讀者可能對於台灣這個醫療體制是會造成不當的認知那部長這邊也希望能夠有更有效去處理這個部分\n701098\t725268\t那這邊部長不知道能不能夠再做簡短的處理的方式讓我們知道好 前面這一張PowerPoint跟這一張我回應一下第一個就是不管是安寧環的醫療的內容或者是說大家關心的醫師協助自殺等等的相關的議題我覺得應該要更多的對話那我們也有在做這方面的努力\n726868\t750113\t希望讓各位對這個名詞的內容能夠更加了解來保護自己第二個部分這個部分因為我們這位年輕的醫師他引用的數據錯誤我們的Omicron的死亡率是0.16%他用一個\n754311\t779916\t58%這樣子那不是很可怕了嗎這樣的錯誤也寫出去我們也覺得Lancet在那個審查當中因為他有reference英文已經寫得很清楚我覺得他們的審查真的也是我也覺得說沒有仔細去看一下因為那個的確是很不合理那其他的數據當然有所錯誤所以然後因為錯誤的\n781209\t790897\t的一個數據 導致以錯誤的解讀導致以錯誤的結論我想中醫大非常嚴肅的開了兩次的協助的理委員會\n792239\t820562\t正是在前天晚上就發出要求撤稿衛福部也是在昨天的下午也是做了一個論述也呈現我們台灣健保其實的成就以及我們醫療防疫體系的努力希望能夠不但要求撤稿也希望刊登出來能夠讓期間的讀者知道台灣的努力這樣才對得起我們過去醫療人員\n822361\t827838\t以及政府的努力好 謝謝部長大家繼續努力好 謝謝\n","txt":"謝謝主席 我們邱部長邱部長\n委員好柏定今天真的是舌戰所謂的不是舌戰啦齁我意思是說讓大家討論啦這個真的是重要的議題因為進入到這個超高齡社會謝謝主席來這個議題謝謝是是啊啊我也知道你是在臨床上其實有很豐富的經驗甚至有名的專家所以這機會再跟柏定來討論今天就是針對病毒法\n未來在落實上面這個人數還有品質可以兼顧不要說他就要增加這個比例然後就在這個品質上是無法兼顧這個就是今天我們要討論的地方其實我們也知道\n在這個討論的前提就是有這幾個重點包括我們是要以人為本以人為本前幾天賴總統也在健康台灣全國論壇上面我強調以人為本的醫療基本上\n還需要重視的就是推動安寧照護跟尊嚴善中的支持跟肯定這就是我們今天討論的主題可是我們也看到數據就是病處法已經實施了五年還是有不到1%的民眾來簽署這方面的處理需求\n那可能曾經大家都已經分析得很清楚包括可見性不足諮商費一開始的時候是自費嘛後來才有健保的部分的處理還有就是民眾他剛才黃先生也有提醒民眾在這個接受度的部分到底會不會有根據他對知識對這個生命的理解能不能接受還有\n我們目前的現場執行的確有他的一些在處理上他要求比較嚴謹的地方那我們也知道如果依照今天早上部長的報告是以比較採像暫時不修法來做討論的話那就是要改善我們的政策改善的政策呢就會包括\n有沒有機會來提高這個至上的可敬性擴大大家益計畫擴大健保給付跟強化政策宣傳那剛剛那個金蘇委員也有提到這部分怎麼來加強那真的要修改法律的話那應該要注意哪一些的事情\n的確我們知道從今天開始就會擴大這個餘地移足的這些給付對象希望能夠在未來的一年裡面能夠增加兩萬人為目標來讓有更多的民眾來做這方面的處理那這方面的處理當然就會需要有比較相關的配套剛剛提到的政策\n我現在先請教一個問題剛剛部長也有討論到其實如果能夠善用我們目前的安寧照護條例的一些條件的話事實上是也可以讓這個品質得到很好的照顧模式有民眾參加過這個屬於我們的這個病毒法的\n同意簽署以後同時又有參加那您知道我條例這些內容的不知道有沒有百分比上的數據可以呈現市長或是有沒有相關的數據\n這邊我沒有手邊沒數據我要再確認一下我覺得如果能夠知道有這個數據的話如果一個人一個民眾他願意同時同意這兩點的話我相信未來照顧在品質上或者是在跟家屬的溝通上是有他一定的這種不會造成大家在做臨床決策上的困擾所以我們也希望能夠看到這個數據\n好我們再整理一下OK好那在馬雲部裡面這邊來處理所以針對未來要再利用這個部分提高的話希望能夠增加2.5萬人部長覺得這個機會大嗎這個樂觀還是不樂觀嗯\n我們相對樂觀的原因是因為過去的這五年我們發現是說簽署這個AD就是去做ACP諮商AD的人其實過去都有一些生命情境是有相關經驗的才有這樣子的意願\n所以是說這次那個金毛鼠針對的這個其實像有重大傷病或者是在我們那個加一整合計畫或者是全社區照顧計畫這邊大概都跟基層醫師這邊有相對密切關係長期信任信賴關係的所以第一個65歲以上是過去的他過去Potential Target裡面的熱於就是比較多去簽意願的人\n然後那個基層這邊是我們更希望能夠擴大的這一塊因為訓練的人數多了然後只是說踏出這一步能夠盡可能的來做他協助他的病人來簽署AD的這件事情的話是我們\n今年下半年也希望跟健保署一起合作希望能夠擴大的然後我們這邊也會有輔導團隊大概先做示範看看那個怎麼輔導讓大家基層這邊更勇於跨出第一步這是我們所以我們相對而言是對增加兩萬再提高這件事情我們是樂觀的以上\n好 很期待這個樂觀可以有機會變成一個事實那如果我們希望讓這個樂觀更有機會的話那有沒有可能在以不修母法的前提之下針對我們目前的這幾個相關的管理辦法來做處理包括說 因為我們現在知道依照現在的管理辦法就是要求相對嚴謹嘛 你就要\n有200床以上等等的一些限定條件我們也針對於護理機構或者是長照機構目前的話是無法如果現在以不修法為前提之下要做這個調整的話有沒有可能在辦法裡面去跟以護理或者是長照機構是跟醫院本身是有附設的條件的情形之下他們可以做同等的服務模式\n我要講的是說過去這邊的這個管理辦法裡面在處理的一個是特殊專長的診所或醫院他的人員組成的資格其實並沒有說我講的是像護理社心這些一定要專屬在那家機構所以大家在社區裡面怎麼做協作的方式其實在過去的5年裡面我們有處理過然後\n為什麼要不同的角度然後為什麼一定要就是醫療機構的原因是因為在解釋這一段的時候有很多對於疾病的預後對於後來的介入措施這個產生的一些衝擊好處壞處這個一定要相當臨床經驗的人所以在現行的狀況下面的時候\n從不同的角度因為像譬如說社新這些的他們對於病人的同理心得更高度所以我們才覺得是說用協作的方式其實可以達成目前是說可不可以擴大領域因為不需要這些人專屬在哪一家醫院也可以或者是用協作的方式避典我舉個例子好了我舉個例子譬如說以部立基隆醫院為例它自己有一個複測長照機構這個複測長照機構依照現況可以做這個服務嗎\n他的醫師團隊可以他可以進到那個輻射機構裡面因為就是說健保署他在擴大這個計畫的時候我們要的ACP簽出來的AD要有醫療機構蓋章然後像以剛剛那個委員在講的部立基隆醫院外展的服務到他的輻射的護理之家然後評估完以後這件事情其實現況是可以的\n是所以如果說依照剛剛的說明看起來的話依照目前的管理辦法事實上是可以做好外展就能夠增加這個量能而且可以維持品質ok了解好那我們期待這方面在執行上可以更落實\n我們知道如果真的是要修法的話有一些增點包括說開放諮商機構的條件跟範圍還有就是有關於人員的資格跟訓練\n當然也希望這個人員在做服務的時候都要有實務的經驗因為畢竟這是跟生命有直接相關的一種服務模式所以這個經驗上也必須要能夠堅持還有就是法源這個裁員到底是要政府編列預算啊或者是要透過健保的模式還有剛剛一直在討論的就是那個現場決策機制\n怎麼樣才能夠讓他可以在一定的品質之下不要造成這個醫病或者是醫師跟這個他的家人之間的一些處理上的一些干擱所以看起來如果要往修法方向的話似乎要進入主條討論之前如果有一個公聽會應該更能夠引起大家不同的意見或者是需求\n那召委剛好也是相關有認為需要修法那是不是也麻煩召委這邊等一下看能不能也讓大家知道說那我們委員會是不是需要再舉辦一個公聽會來再收集更多的一些想法跟意見當作未來修法的一個參考\n這個是我針對第一部分跟這個部長討論那後面很快的就針對醫療資訊的傳播正確性跟部長也來討論一下我們也知道今天其實有很多委員一直在討論說這個預例一組安寧緩和安樂死如果將來有需要討論的時候\n那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的\n那這方面如果能夠處理到的話我相信對於未來在溝通的時候會有更好的一些引導方面那我們也知道其實最後就是有關於剛剛針對這個資訊的透明還有正確性真的非常非常的重要因為我們目前也知道\n比較屬於針對學者或者是臨床很希望針對我們這個健保是否能夠在現有的制度之下能夠持續永續那他們發出一些看法那他偷到一個\n這個頂尖的期刊結果大家也發現說原來這個資訊不是那麼樣的完整或者是不是那麼樣的一個正確的情形下會導致可能國外或者是這個期刊的這個讀者可能對於台灣這個醫療體制是會造成不當的認知那部長這邊也希望能夠有更有效去處理這個部分\n那這邊部長不知道能不能夠再做簡短的處理的方式讓我們知道好 前面這一張PowerPoint跟這一張我回應一下第一個就是不管是安寧環的醫療的內容或者是說大家關心的醫師協助自殺等等的相關的議題我覺得應該要更多的對話那我們也有在做這方面的努力\n希望讓各位對這個名詞的內容能夠更加了解來保護自己第二個部分這個部分因為我們這位年輕的醫師他引用的數據錯誤我們的Omicron的死亡率是0.16%他用一個\n58%這樣子那不是很可怕了嗎這樣的錯誤也寫出去我們也覺得Lancet在那個審查當中因為他有reference英文已經寫得很清楚我覺得他們的審查真的也是我也覺得說沒有仔細去看一下因為那個的確是很不合理那其他的數據當然有所錯誤所以然後因為錯誤的\n的一個數據 導致以錯誤的解讀導致以錯誤的結論我想中醫大非常嚴肅的開了兩次的協助的理委員會\n正是在前天晚上就發出要求撤稿衛福部也是在昨天的下午也是做了一個論述也呈現我們台灣健保其實的成就以及我們醫療防疫體系的努力希望能夠不但要求撤稿也希望刊登出來能夠讓期間的讀者知道台灣的努力這樣才對得起我們過去醫療人員\n以及政府的努力好 謝謝部長大家繼續努力好 謝謝\n","vtt":"WEBVTT\n\n00:05.431 --> 00:07.335\n謝謝主席我們邱部長邱部長\n\n00:13.323 --> 00:39.282\n委員好柏定今天真的是舌戰所謂的不是舌戰啦齁我意思是說讓大家討論啦這個真的是重要的議題因為進入到這個超高齡社會謝謝主席來這個議題謝謝是是啊啊我也知道你是在臨床上其實有很豐富的經驗甚至有名的專家所以這機會再跟柏定來討論今天就是針對病毒法\n\n00:43.123 --> 00:58.656\n未來在落實上面這個人數還有品質可以兼顧不要說他就要增加這個比例然後就在這個品質上是無法兼顧這個就是今天我們要討論的地方其實我們也知道\n\n01:01.059 --> 01:10.872\n在這個討論的前提就是有這幾個重點包括我們是要以人為本以人為本前幾天賴總統也在健康台灣全國論壇上面我強調以人為本的醫療基本上\n\n01:15.698 --> 01:32.767\n還需要重視的就是推動安寧照護跟尊嚴善中的支持跟肯定這就是我們今天討論的主題可是我們也看到數據就是病處法已經實施了五年還是有不到1%的民眾來簽署這方面的處理需求\n\n01:36.249 --> 01:59.821\n那可能曾經大家都已經分析得很清楚包括可見性不足諮商費一開始的時候是自費嘛後來才有健保的部分的處理還有就是民眾他剛才黃先生也有提醒民眾在這個接受度的部分到底會不會有根據他對知識對這個生命的理解能不能接受還有\n\n02:01.202 --> 02:21.084\n我們目前的現場執行的確有他的一些在處理上他要求比較嚴謹的地方那我們也知道如果依照今天早上部長的報告是以比較採像暫時不修法來做討論的話那就是要改善我們的政策改善的政策呢就會包括\n\n02:22.105 --> 02:37.913\n有沒有機會來提高這個至上的可敬性擴大大家益計畫擴大健保給付跟強化政策宣傳那剛剛那個金蘇委員也有提到這部分怎麼來加強那真的要修改法律的話那應該要注意哪一些的事情\n\n02:39.873 --> 02:59.794\n的確我們知道從今天開始就會擴大這個餘地移足的這些給付對象希望能夠在未來的一年裡面能夠增加兩萬人為目標來讓有更多的民眾來做這方面的處理那這方面的處理當然就會需要有比較相關的配套剛剛提到的政策\n\n03:00.895 --> 03:20.828\n我現在先請教一個問題剛剛部長也有討論到其實如果能夠善用我們目前的安寧照護條例的一些條件的話事實上是也可以讓這個品質得到很好的照顧模式有民眾參加過這個屬於我們的這個病毒法的\n\n03:21.849 --> 03:33.121\n同意簽署以後同時又有參加那您知道我條例這些內容的不知道有沒有百分比上的數據可以呈現市長或是有沒有相關的數據\n\n03:36.980 --> 04:02.841\n這邊我沒有手邊沒數據我要再確認一下我覺得如果能夠知道有這個數據的話如果一個人一個民眾他願意同時同意這兩點的話我相信未來照顧在品質上或者是在跟家屬的溝通上是有他一定的這種不會造成大家在做臨床決策上的困擾所以我們也希望能夠看到這個數據\n\n04:04.229 --> 04:18.334\n好我們再整理一下OK好那在馬雲部裡面這邊來處理所以針對未來要再利用這個部分提高的話希望能夠增加2.5萬人部長覺得這個機會大嗎這個樂觀還是不樂觀嗯\n\n04:29.075 --> 04:43.031\n我們相對樂觀的原因是因為過去的這五年我們發現是說簽署這個AD就是去做ACP諮商AD的人其實過去都有一些生命情境是有相關經驗的才有這樣子的意願\n\n04:43.752 --> 05:11.307\n所以是說這次那個金毛鼠針對的這個其實像有重大傷病或者是在我們那個加一整合計畫或者是全社區照顧計畫這邊大概都跟基層醫師這邊有相對密切關係長期信任信賴關係的所以第一個65歲以上是過去的他過去PotentialTarget裡面的熱於就是比較多去簽意願的人\n\n05:11.747 --> 05:27.101\n然後那個基層這邊是我們更希望能夠擴大的這一塊因為訓練的人數多了然後只是說踏出這一步能夠盡可能的來做他協助他的病人來簽署AD的這件事情的話是我們\n\n05:27.862 --> 05:45.377\n今年下半年也希望跟健保署一起合作希望能夠擴大的然後我們這邊也會有輔導團隊大概先做示範看看那個怎麼輔導讓大家基層這邊更勇於跨出第一步這是我們所以我們相對而言是對增加兩萬再提高這件事情我們是樂觀的以上\n\n05:46.474 --> 06:08.259\n好很期待這個樂觀可以有機會變成一個事實那如果我們希望讓這個樂觀更有機會的話那有沒有可能在以不修母法的前提之下針對我們目前的這幾個相關的管理辦法來做處理包括說因為我們現在知道依照現在的管理辦法就是要求相對嚴謹嘛你就要\n\n06:09.119 --> 06:35.880\n有200床以上等等的一些限定條件我們也針對於護理機構或者是長照機構目前的話是無法如果現在以不修法為前提之下要做這個調整的話有沒有可能在辦法裡面去跟以護理或者是長照機構是跟醫院本身是有附設的條件的情形之下他們可以做同等的服務模式\n\n06:36.936 --> 07:00.253\n我要講的是說過去這邊的這個管理辦法裡面在處理的一個是特殊專長的診所或醫院他的人員組成的資格其實並沒有說我講的是像護理社心這些一定要專屬在那家機構所以大家在社區裡面怎麼做協作的方式其實在過去的5年裡面我們有處理過然後\n\n07:01.473 --> 07:20.119\n為什麼要不同的角度然後為什麼一定要就是醫療機構的原因是因為在解釋這一段的時候有很多對於疾病的預後對於後來的介入措施這個產生的一些衝擊好處壞處這個一定要相當臨床經驗的人所以在現行的狀況下面的時候\n\n07:21.259 --> 07:46.835\n從不同的角度因為像譬如說社新這些的他們對於病人的同理心得更高度所以我們才覺得是說用協作的方式其實可以達成目前是說可不可以擴大領域因為不需要這些人專屬在哪一家醫院也可以或者是用協作的方式避典我舉個例子好了我舉個例子譬如說以部立基隆醫院為例它自己有一個複測長照機構這個複測長照機構依照現況可以做這個服務嗎\n\n07:50.410 --> 08:16.589\n他的醫師團隊可以他可以進到那個輻射機構裡面因為就是說健保署他在擴大這個計畫的時候我們要的ACP簽出來的AD要有醫療機構蓋章然後像以剛剛那個委員在講的部立基隆醫院外展的服務到他的輻射的護理之家然後評估完以後這件事情其實現況是可以的\n\n08:16.749 --> 08:32.285\n是所以如果說依照剛剛的說明看起來的話依照目前的管理辦法事實上是可以做好外展就能夠增加這個量能而且可以維持品質ok了解好那我們期待這方面在執行上可以更落實\n\n08:33.987 --> 08:39.772\n我們知道如果真的是要修法的話有一些增點包括說開放諮商機構的條件跟範圍還有就是有關於人員的資格跟訓練\n\n08:48.360 --> 09:09.277\n當然也希望這個人員在做服務的時候都要有實務的經驗因為畢竟這是跟生命有直接相關的一種服務模式所以這個經驗上也必須要能夠堅持還有就是法源這個裁員到底是要政府編列預算啊或者是要透過健保的模式還有剛剛一直在討論的就是那個現場決策機制\n\n09:11.238 --> 09:34.180\n怎麼樣才能夠讓他可以在一定的品質之下不要造成這個醫病或者是醫師跟這個他的家人之間的一些處理上的一些干擱所以看起來如果要往修法方向的話似乎要進入主條討論之前如果有一個公聽會應該更能夠引起大家不同的意見或者是需求\n\n09:34.961 --> 09:54.659\n那召委剛好也是相關有認為需要修法那是不是也麻煩召委這邊等一下看能不能也讓大家知道說那我們委員會是不是需要再舉辦一個公聽會來再收集更多的一些想法跟意見當作未來修法的一個參考\n\n09:56.120 --> 10:15.233\n這個是我針對第一部分跟這個部長討論那後面很快的就針對醫療資訊的傳播正確性跟部長也來討論一下我們也知道今天其實有很多委員一直在討論說這個預例一組安寧緩和安樂死如果將來有需要討論的時候\n\n10:16.414 --> 10:38.880\n那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的\n\n10:39.720 --> 10:58.742\n那這方面如果能夠處理到的話我相信對於未來在溝通的時候會有更好的一些引導方面那我們也知道其實最後就是有關於剛剛針對這個資訊的透明還有正確性真的非常非常的重要因為我們目前也知道\n\n11:00.244 --> 11:15.126\n比較屬於針對學者或者是臨床很希望針對我們這個健保是否能夠在現有的制度之下能夠持續永續那他們發出一些看法那他偷到一個\n\n11:16.907 --> 11:39.817\n這個頂尖的期刊結果大家也發現說原來這個資訊不是那麼樣的完整或者是不是那麼樣的一個正確的情形下會導致可能國外或者是這個期刊的這個讀者可能對於台灣這個醫療體制是會造成不當的認知那部長這邊也希望能夠有更有效去處理這個部分\n\n11:41.098 --> 12:05.268\n那這邊部長不知道能不能夠再做簡短的處理的方式讓我們知道好前面這一張PowerPoint跟這一張我回應一下第一個就是不管是安寧環的醫療的內容或者是說大家關心的醫師協助自殺等等的相關的議題我覺得應該要更多的對話那我們也有在做這方面的努力\n\n12:06.868 --> 12:30.113\n希望讓各位對這個名詞的內容能夠更加了解來保護自己第二個部分這個部分因為我們這位年輕的醫師他引用的數據錯誤我們的Omicron的死亡率是0.16%他用一個\n\n12:34.311 --> 12:59.916\n58%這樣子那不是很可怕了嗎這樣的錯誤也寫出去我們也覺得Lancet在那個審查當中因為他有reference英文已經寫得很清楚我覺得他們的審查真的也是我也覺得說沒有仔細去看一下因為那個的確是很不合理那其他的數據當然有所錯誤所以然後因為錯誤的\n\n13:01.209 --> 13:10.897\n的一個數據導致以錯誤的解讀導致以錯誤的結論我想中醫大非常嚴肅的開了兩次的協助的理委員會\n\n13:12.239 --> 13:40.562\n正是在前天晚上就發出要求撤稿衛福部也是在昨天的下午也是做了一個論述也呈現我們台灣健保其實的成就以及我們醫療防疫體系的努力希望能夠不但要求撤稿也希望刊登出來能夠讓期間的讀者知道台灣的努力這樣才對得起我們過去醫療人員\n\n13:42.361 --> 13:47.838\n以及政府的努力好謝謝部長大家繼續努力好謝謝\n\n","segments":[{"start":5.431,"end":7.335,"text":"謝謝主席 我們邱部長邱部長"},{"start":13.323,"end":39.282,"text":"委員好柏定今天真的是舌戰所謂的不是舌戰啦齁我意思是說讓大家討論啦這個真的是重要的議題因為進入到這個超高齡社會謝謝主席來這個議題謝謝是是啊啊我也知道你是在臨床上其實有很豐富的經驗甚至有名的專家所以這機會再跟柏定來討論今天就是針對病毒法"},{"start":43.123,"end":58.656,"text":"未來在落實上面這個人數還有品質可以兼顧不要說他就要增加這個比例然後就在這個品質上是無法兼顧這個就是今天我們要討論的地方其實我們也知道"},{"start":61.059,"end":70.872,"text":"在這個討論的前提就是有這幾個重點包括我們是要以人為本以人為本前幾天賴總統也在健康台灣全國論壇上面我強調以人為本的醫療基本上"},{"start":75.698,"end":92.767,"text":"還需要重視的就是推動安寧照護跟尊嚴善中的支持跟肯定這就是我們今天討論的主題可是我們也看到數據就是病處法已經實施了五年還是有不到1%的民眾來簽署這方面的處理需求"},{"start":96.249,"end":119.821,"text":"那可能曾經大家都已經分析得很清楚包括可見性不足諮商費一開始的時候是自費嘛後來才有健保的部分的處理還有就是民眾他剛才黃先生也有提醒民眾在這個接受度的部分到底會不會有根據他對知識對這個生命的理解能不能接受還有"},{"start":121.202,"end":141.084,"text":"我們目前的現場執行的確有他的一些在處理上他要求比較嚴謹的地方那我們也知道如果依照今天早上部長的報告是以比較採像暫時不修法來做討論的話那就是要改善我們的政策改善的政策呢就會包括"},{"start":142.105,"end":157.913,"text":"有沒有機會來提高這個至上的可敬性擴大大家益計畫擴大健保給付跟強化政策宣傳那剛剛那個金蘇委員也有提到這部分怎麼來加強那真的要修改法律的話那應該要注意哪一些的事情"},{"start":159.873,"end":179.794,"text":"的確我們知道從今天開始就會擴大這個餘地移足的這些給付對象希望能夠在未來的一年裡面能夠增加兩萬人為目標來讓有更多的民眾來做這方面的處理那這方面的處理當然就會需要有比較相關的配套剛剛提到的政策"},{"start":180.895,"end":200.828,"text":"我現在先請教一個問題剛剛部長也有討論到其實如果能夠善用我們目前的安寧照護條例的一些條件的話事實上是也可以讓這個品質得到很好的照顧模式有民眾參加過這個屬於我們的這個病毒法的"},{"start":201.849,"end":213.121,"text":"同意簽署以後同時又有參加那您知道我條例這些內容的不知道有沒有百分比上的數據可以呈現市長或是有沒有相關的數據"},{"start":216.98,"end":242.841,"text":"這邊我沒有手邊沒數據我要再確認一下我覺得如果能夠知道有這個數據的話如果一個人一個民眾他願意同時同意這兩點的話我相信未來照顧在品質上或者是在跟家屬的溝通上是有他一定的這種不會造成大家在做臨床決策上的困擾所以我們也希望能夠看到這個數據"},{"start":244.229,"end":258.334,"text":"好我們再整理一下OK好那在馬雲部裡面這邊來處理所以針對未來要再利用這個部分提高的話希望能夠增加2.5萬人部長覺得這個機會大嗎這個樂觀還是不樂觀嗯"},{"start":269.075,"end":283.031,"text":"我們相對樂觀的原因是因為過去的這五年我們發現是說簽署這個AD就是去做ACP諮商AD的人其實過去都有一些生命情境是有相關經驗的才有這樣子的意願"},{"start":283.752,"end":311.307,"text":"所以是說這次那個金毛鼠針對的這個其實像有重大傷病或者是在我們那個加一整合計畫或者是全社區照顧計畫這邊大概都跟基層醫師這邊有相對密切關係長期信任信賴關係的所以第一個65歲以上是過去的他過去Potential Target裡面的熱於就是比較多去簽意願的人"},{"start":311.747,"end":327.101,"text":"然後那個基層這邊是我們更希望能夠擴大的這一塊因為訓練的人數多了然後只是說踏出這一步能夠盡可能的來做他協助他的病人來簽署AD的這件事情的話是我們"},{"start":327.862,"end":345.377,"text":"今年下半年也希望跟健保署一起合作希望能夠擴大的然後我們這邊也會有輔導團隊大概先做示範看看那個怎麼輔導讓大家基層這邊更勇於跨出第一步這是我們所以我們相對而言是對增加兩萬再提高這件事情我們是樂觀的以上"},{"start":346.474,"end":368.259,"text":"好 很期待這個樂觀可以有機會變成一個事實那如果我們希望讓這個樂觀更有機會的話那有沒有可能在以不修母法的前提之下針對我們目前的這幾個相關的管理辦法來做處理包括說 因為我們現在知道依照現在的管理辦法就是要求相對嚴謹嘛 你就要"},{"start":369.119,"end":395.88,"text":"有200床以上等等的一些限定條件我們也針對於護理機構或者是長照機構目前的話是無法如果現在以不修法為前提之下要做這個調整的話有沒有可能在辦法裡面去跟以護理或者是長照機構是跟醫院本身是有附設的條件的情形之下他們可以做同等的服務模式"},{"start":396.936,"end":420.253,"text":"我要講的是說過去這邊的這個管理辦法裡面在處理的一個是特殊專長的診所或醫院他的人員組成的資格其實並沒有說我講的是像護理社心這些一定要專屬在那家機構所以大家在社區裡面怎麼做協作的方式其實在過去的5年裡面我們有處理過然後"},{"start":421.473,"end":440.119,"text":"為什麼要不同的角度然後為什麼一定要就是醫療機構的原因是因為在解釋這一段的時候有很多對於疾病的預後對於後來的介入措施這個產生的一些衝擊好處壞處這個一定要相當臨床經驗的人所以在現行的狀況下面的時候"},{"start":441.259,"end":466.835,"text":"從不同的角度因為像譬如說社新這些的他們對於病人的同理心得更高度所以我們才覺得是說用協作的方式其實可以達成目前是說可不可以擴大領域因為不需要這些人專屬在哪一家醫院也可以或者是用協作的方式避典我舉個例子好了我舉個例子譬如說以部立基隆醫院為例它自己有一個複測長照機構這個複測長照機構依照現況可以做這個服務嗎"},{"start":470.41,"end":496.589,"text":"他的醫師團隊可以他可以進到那個輻射機構裡面因為就是說健保署他在擴大這個計畫的時候我們要的ACP簽出來的AD要有醫療機構蓋章然後像以剛剛那個委員在講的部立基隆醫院外展的服務到他的輻射的護理之家然後評估完以後這件事情其實現況是可以的"},{"start":496.749,"end":512.285,"text":"是所以如果說依照剛剛的說明看起來的話依照目前的管理辦法事實上是可以做好外展就能夠增加這個量能而且可以維持品質ok了解好那我們期待這方面在執行上可以更落實"},{"start":513.987,"end":519.772,"text":"我們知道如果真的是要修法的話有一些增點包括說開放諮商機構的條件跟範圍還有就是有關於人員的資格跟訓練"},{"start":528.36,"end":549.277,"text":"當然也希望這個人員在做服務的時候都要有實務的經驗因為畢竟這是跟生命有直接相關的一種服務模式所以這個經驗上也必須要能夠堅持還有就是法源這個裁員到底是要政府編列預算啊或者是要透過健保的模式還有剛剛一直在討論的就是那個現場決策機制"},{"start":551.238,"end":574.18,"text":"怎麼樣才能夠讓他可以在一定的品質之下不要造成這個醫病或者是醫師跟這個他的家人之間的一些處理上的一些干擱所以看起來如果要往修法方向的話似乎要進入主條討論之前如果有一個公聽會應該更能夠引起大家不同的意見或者是需求"},{"start":574.961,"end":594.659,"text":"那召委剛好也是相關有認為需要修法那是不是也麻煩召委這邊等一下看能不能也讓大家知道說那我們委員會是不是需要再舉辦一個公聽會來再收集更多的一些想法跟意見當作未來修法的一個參考"},{"start":596.12,"end":615.233,"text":"這個是我針對第一部分跟這個部長討論那後面很快的就針對醫療資訊的傳播正確性跟部長也來討論一下我們也知道今天其實有很多委員一直在討論說這個預例一組安寧緩和安樂死如果將來有需要討論的時候"},{"start":616.414,"end":638.88,"text":"那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的"},{"start":639.72,"end":658.742,"text":"那這方面如果能夠處理到的話我相信對於未來在溝通的時候會有更好的一些引導方面那我們也知道其實最後就是有關於剛剛針對這個資訊的透明還有正確性真的非常非常的重要因為我們目前也知道"},{"start":660.244,"end":675.126,"text":"比較屬於針對學者或者是臨床很希望針對我們這個健保是否能夠在現有的制度之下能夠持續永續那他們發出一些看法那他偷到一個"},{"start":676.907,"end":699.817,"text":"這個頂尖的期刊結果大家也發現說原來這個資訊不是那麼樣的完整或者是不是那麼樣的一個正確的情形下會導致可能國外或者是這個期刊的這個讀者可能對於台灣這個醫療體制是會造成不當的認知那部長這邊也希望能夠有更有效去處理這個部分"},{"start":701.098,"end":725.268,"text":"那這邊部長不知道能不能夠再做簡短的處理的方式讓我們知道好 前面這一張PowerPoint跟這一張我回應一下第一個就是不管是安寧環的醫療的內容或者是說大家關心的醫師協助自殺等等的相關的議題我覺得應該要更多的對話那我們也有在做這方面的努力"},{"start":726.868,"end":750.113,"text":"希望讓各位對這個名詞的內容能夠更加了解來保護自己第二個部分這個部分因為我們這位年輕的醫師他引用的數據錯誤我們的Omicron的死亡率是0.16%他用一個"},{"start":754.311,"end":779.916,"text":"58%這樣子那不是很可怕了嗎這樣的錯誤也寫出去我們也覺得Lancet在那個審查當中因為他有reference英文已經寫得很清楚我覺得他們的審查真的也是我也覺得說沒有仔細去看一下因為那個的確是很不合理那其他的數據當然有所錯誤所以然後因為錯誤的"},{"start":781.209,"end":790.897,"text":"的一個數據 導致以錯誤的解讀導致以錯誤的結論我想中醫大非常嚴肅的開了兩次的協助的理委員會"},{"start":792.239,"end":820.562,"text":"正是在前天晚上就發出要求撤稿衛福部也是在昨天的下午也是做了一個論述也呈現我們台灣健保其實的成就以及我們醫療防疫體系的努力希望能夠不但要求撤稿也希望刊登出來能夠讓期間的讀者知道台灣的努力這樣才對得起我們過去醫療人員"},{"start":822.361,"end":827.838,"text":"以及政府的努力好 謝謝部長大家繼續努力好 謝謝"}]}}},"gazette":{"lineno":624,"blocks":[["王委員正旭：（12時4分）謝謝主席，麻煩請邱部長。"],["主席：請部長。"],["邱部長泰源：委員好。"],["王委員正旭：部長，今天真的是舌戰所有的……不是舌戰啦，我的意思是說跟大家討論啦！"],["邱部長泰源：是。"],["王委員正旭：這個真的是重要的議題，因為進入到超高齡社會，遇到的問題很多……"],["邱部長泰源：謝謝主席安排這個議題，謝謝。"],["王委員正旭：我也知道你臨床上的經驗其實很豐富，也算是這方面的專家……"],["邱部長泰源：不敢、不敢。"],["王委員正旭：所以利用這個機會來跟部長好好討論今天的這個病主法，未來在落實上，要如何讓人數和品質可以兼顧，不要為了要增加比例而無法兼顧品質，這個就是今天我們要討論的地方。","其實我們都知道這個討論的前提有幾個重點，包括要以人為本，前幾天賴總統在健康台灣全國論壇上也強調以人為本的醫療，基本上需要重視的就是推動安寧照護跟尊嚴善終的支持和肯定，這就是今天我們要討論的主題。"],["邱部長泰源：是。"],["王委員正旭：可是我們看到數據，病主法已經實施5年，只有不到1%的民眾簽署這方面的處理需求，原因大家可能都已經分析得很清楚，包括可近性不足、諮商費一開始是自費，後來才有健保部分處理；還有剛剛黃秀芳委員一再提醒的民眾接受度的部分，到底會不會根據他對知識、對生命的理解而能不能接受？還有我們目前的現場執行，的確在一些處理上是有要求比較嚴謹的地方。","如果依照今天早上部長的報告，是比較傾向採暫時不修法來討論，那就要改善我們的政策；改善政策部分，包括有沒有機會提高諮商的可近性、擴大大家醫計畫、擴大健保給付和強化政策宣傳。剛剛林淑芬委員也提到這部分要怎麼加強，真的要修改法律的話，應該要注意哪一些事情。我們知道從今天開始會擴大預立醫囑的給付對象，希望在未來的一年裡，能夠以增加2萬人為目標，讓更多的民眾可以做這方面的處理；而要做這方面的處理，當然就需要相關配套，也就是剛剛提到的政策改善。剛剛部長提到，如果能夠善用目前安寧照護條例的一些條件，事實上是可以讓病人得到很好品質的照顧模式。在此，請教部長，有民眾參加過病主法的同意簽署後，同時又參加安寧照護條例的這些內容，不知道你們有沒有百分比上的數據可以呈現？司長有沒有相關數據？"],["劉司長越萍：我手邊沒有數據，要再確認一下。"],["王委員正旭：我覺得如果能夠知道這個數據，一個民眾願意同時同意這兩點，我相信未來在照顧的品質上，或者是在跟家屬的溝通上，是有其一定的……不會造成大家在臨床決策上的困擾，所以我們希望可以看到這個數據。"],["邱部長泰源：好，我們再整理一下。"],["王委員正旭：OK，再麻煩部裡面來處理。針對未來這個部分要再提高，希望增加2.5萬人，部長覺得機會大嗎？樂觀還是不樂觀？"],["邱部長泰源：嗯！司長……"],["劉司長越萍：我們相對樂觀，原因是因為過去這五年，我們發現去做ACP諮商、簽AD的人，過去都有一些生命情境相關經驗，才有這樣子的意願。這次健保署針對的，像有重大傷病、家醫整合計畫或者是全人全社區照護計畫，大概都是跟基層醫師有相對密切關係、長期信賴關係的。所以第一個，65歲以上是過去的potential target，裡面比較多有意願去簽的人，然後基層這塊是我們更希望能夠擴大的部分，因為訓練的人數多了，只是說踏出這一步，能夠盡可能協助他的病人來簽署AD。我們今年下半年也希望跟健保署一起合作，希望能夠擴大，我們這邊也會有輔導團隊先試辦，看看怎麼輔導，讓基層更勇於跨出第一步，所以對簽署人數再提高這件事情我們是樂觀的，以上。"],["王委員正旭：好，很期待這個樂觀可以有機會變成一個事實，如果我們希望讓這個樂觀更有機會的話，有沒有可能在不修母法的前提之下，針對於目前這些相關的管理辦法處理？因為我們知道，現在的管理辦法要求相對嚴謹，要有200床以上等等的限定條件，護理機構或者是長照機構目前是無法處理的。如果現在以不修法為前提，要做這個調整的話，有沒有可能在辦法裡面修正，讓醫院附設的護理或者是長照機構可以做同等的服務模式？"],["劉司長越萍：過去這個管理辦法在處理的是特殊專長的診所或醫院，它的人員組成資格其實並沒有一定要專屬在那家機構，我講的是像護理、社心這些職類。所以大家在社區裡面怎麼做協作的方式，其實在過去的5年裡面我們有處理過。為什麼要有不同的角度，以及為什麼一定要醫療機構的原因，是因為在解釋這一段的時候，有很多對於疾病的預後、對於後來的介入措施，這個產生的一些衝擊、好處、壞處，一定要有相當臨床經驗的人才有辦法處理。所以在現行的狀況下，從不同的角度，譬如像社心這些，他們對於病人的同理心是更高度的，所以我們才覺得用協作的方式其實可以達成目前希望的擴大領域，因為不需要這些人專屬在哪一家醫院也可以，或者是用協作的方式……"],["王委員正旭：我舉個例子好了，譬如說，以部立基隆醫院為例，它自己有一個附設長照機構，依照現況，這個附設長照機構可以做這個服務嗎？"],["劉司長越萍：他的醫師團隊可以。"],["王委員正旭：他可以進到那個附設機構裡面？"],["劉司長越萍：因為健保署在擴大這個計畫的時候，我們要的ACP簽出來的AD要有醫療機構蓋章，像剛剛委員講的，部立基隆醫院外展服務到它附設的護理之家，評估完以後，這件事情其實現況是可以的。"],["王委員正旭：是，如果依照剛剛的說明，看起來目前的管理辦法事實上可以做好外展，就能夠增加量能，而且可以維持品質。"],["劉司長越萍：對。"],["王委員正旭：OK，了解。我們很期待這方面在執行上可以更落實。","我們知道如果真的要修法的話也有一些爭點，包括開放諮商機構的條件跟範圍，還有有關於諮商人員的資格跟訓練。我們當然也希望人員在做服務的時候都要有實務經驗，畢竟這是跟生命直接相關的一種服務模式，所以經驗也必須要堅實。還有財源到底是要政府編列預算，或者是要透過健保的模式。再來，剛剛一直在討論的就是現場決策機制，怎麼樣才能夠讓它可以在一定的品質之下，不要造成醫病或者是醫師跟他的家人之間在處理上有一些扞格。如果要往修法方向的話，在進入逐條討論之前，如果有一個公聽會，應該更能夠聆聽大家不同的意見或者是需求。召委剛好也認為需要修法，是不是也麻煩召委，等一下看能不能讓大家知道，我們委員會是不是需要再舉辦一個公聽會，再蒐集更多的想法跟意見，當作未來修法的參考？這個是我針對第一部分跟部長討論的。","後面很快的針對醫療資訊的傳播正確性跟部長討論一下。我們也知道今天有很多委員一直在討論預立醫囑、安寧緩和、安樂死，如果將來有需要討論的時候，這方面其實大家的資訊非常非常的多元，很難一下子搞懂這幾個概念上的問題，所以未來有沒有機會請部裡能夠提供更為透明且正確的相關資訊，至少讓民眾在這方面的認知是有所本的？這方面如果能夠處理到的話，我相信未來在溝通的時候會有一些更好的引導。","剛才提到的資訊透明及正確性真的非常非常重要，因為我們也知道，針對我們的健保是否能夠在現有的制度之下持續、永續，學者或者是臨床有發出一些看法，也有醫師投書到一個頂尖的期刊，結果大家發現，原來在資訊不是那麼完整或者不是那麼正確的情形之下，可能導致國外或者是這個期刊的讀者，對於臺灣的醫療體制產生不當的認知。也希望部長能夠更有效去處理這個部分，不知道部長能不能夠最後做簡短的回應，讓我們知道這個處理的方式？"],["邱部長泰源：我回應一下前一張和這一張PowerPoint，第一個，不管是安寧緩和醫療的內容，或者是大家關心的醫師協助自殺等等相關的議題，我覺得應該要有更多的對話，我們也有在做這方面的努力，希望讓國人對這個名詞的內容能夠更加了解，來保護自己。","第二個部分，這位年輕醫師引用的數據錯誤，我們Omicron的死亡率是0.16%，他用58%，那不是很可怕嗎？即使是這樣的錯誤也寫出去，我們也覺得Lancet的審查真的也是沒有仔細去看，因為他有reference，英文已經寫得很清楚，那個的確是很不合理的，其他的數據當然也有錯誤。因為錯誤的數據導致出錯誤的解讀、導致出錯誤的結論，我想中醫大非常嚴肅的開了兩次學術倫理委員會，正式在前天晚上要求Lancet撤稿。我們衛福部也在昨天下午做了一個論述，呈現我們臺灣健保的成就，以及我們醫療防疫體系的努力；不但要求撤稿，也希望刊登出來，能夠讓期刊的讀者知道臺灣的努力，這樣才對得起我們過去醫療人員以及政府的努力。"],["王委員正旭：好，謝謝部長，大家繼續努力。"],["邱部長泰源：謝謝委員。"],["主席（王委員正旭代）：下一位請劉建國召委發言。"]],"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"}}}