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1413.561, \"end\": 1413.581, \"score\": 0.0}, {\"word\": \"們\"}, {\"word\": \"啦\", \"start\": 1413.581, \"end\": 1413.601, \"score\": 0.001}], \"language\": \"zh\"}","srt":"1\n00:00:10,034 --> 00:00:27,524\n好謝謝召委是不是請我們部長和署長江署長委員好委員請多保重對我也希望不要感冒\n\n2\n00:00:30,242 --> 00:00:56,318\n這個署長曾經在2021年說過當時是教授的身份嘛那以Codex的標準每天要吃6公斤的萊豬連續吃好幾年才會超標但是這跟中毒優勢兩件事政府會把關請大家買豬肉食的時候要放輕鬆如果依照署長這個標準大概食安就是沒有食安的問題只有吃到毒物才會死的問題那我今天講說\n\n3\n00:00:58,160 --> 00:01:20,482\n這六天裡面來從短短六天就有驗出三批來寄的這個豬肉產品雖然都在那個我們的標準裡面但六天就有三批其實我剛才有沒有提到有退回去的有幾批減出啦減出但沒鈔票有三批那有退關的嗎\n\n4\n00:01:22,652 --> 00:01:39,953\n從租業方面沒有都沒有好因為署長部長和署長要提醒你喔這個對於食安的態度要兢兢業業尤其是我自己做一個媽媽作為一個家庭裡面會開火的\n\n5\n00:01:41,252 --> 00:01:58,188\n食安的把關者其實我的標準我個人的標準不是只有吃了會中毒吃了會有落毒的方向我自己個人是我不想要吃到那我想很多媽媽跟我一樣的心情\n\n6\n00:01:59,039 --> 00:02:15,412\n那我們想的說那就是透明知的權利知的權利其實就是這樣子而已你其實對抗WTO的貿易架構就是這樣子你強迫我們開了邊界我們就讓你進來但我消費者可以不買啊\n\n7\n00:02:16,485 --> 00:02:44,605\n就全體的世界貿易都一直都有這種情節啊你強迫我開放那我就是我可以選擇不吃不買但是國家要扮演什麼你沒有去標籤化它但是你不可以講說這個署長你丟了一句說沒見過有人吃萊克多巴胺牛肉中毒的用這種態度來善效擔心的民眾我覺得唯一不需要的是這樣子你應該想的是\n\n8\n00:02:45,626 --> 00:03:09,596\n人民真的很擔心因為我有選擇不吃的這個權利啊我自己因為每個人的健康管理風險都是每個人在負責的我不想要而我有慢性的我代謝疾病我慢性三高的所以這種狀況裡面你在講講得很得意洋洋說你們科學的方法在把關你們的這個borderprotectionwhatBPI你們在做什麼其實\n\n9\n00:03:13,652 --> 00:03:23,414\n我們都希望有政府是邊境裡面源頭把關邊境如果6天就也撿到3批雖然沒有超標那有沒有可能\n\n10\n00:03:23,959 --> 00:03:40,871\n在邊境裡面其實就應該要把查驗的這個強度稍微提高一下加強邊境和後市場的稽查那你在這個過程當中你一直以幾個數據來告訴我們譬如說你的新聞稿寫2021年1月1號到2025年4月30邊境報驗的豬肉和豬雜碎共計兩萬\n\n11\n00:03:48,556 --> 00:03:51,098\n5466批110年到114年4月間後市場對進口及國產豬肉的產品共檢驗18501件檢驗這個萊克多巴胺結果皆合格\n\n12\n00:04:04,103 --> 00:04:19,151\n你是這樣寫的嘛但是我要問你是說你是不是應該公佈的不是這五年裡面我減了多少每一年你減多少因為我們知道剛開始的那一年減的數量是最多的也就是2021年110年減的批次最多那到2024、2025年其實都遞減了\n\n13\n00:04:29,167 --> 00:04:43,571\n所以邊境抽驗的比例其實是大幅遞減的在用遞減裡面六天就檢驗出三批含有萊劑雖然沒有超標但是我們說如果在那個主管機關的立場你應該告訴大家說那我來加強邊境的把關我是不是要把抽驗的批次再增加一點當你增加了檢驗出來了覺得風險沒有增加\n\n14\n00:04:57,130 --> 00:05:15,956\n那這樣子對人民才有交代啊而不是在這裡說吃了要吃沒多少啦這都合格吃不死啦我們的標準你的如果你要講科學數據科學分析那麼你應該把每一年減幾批公佈出來啊每一年啊讓我們看到從2021到2025是逐年遞減的你就不要糊弄我們用一個總的數據嘛所以\n\n15\n00:05:22,459 --> 00:05:39,075\n萊劑的安全容許量是一回事我們有標準也是一回事但我們也有不想吃到的權利所以不要以每天吃也不會死沒看到過有人因為吃萊劑而中毒這樣的說法太輕率了\n\n16\n00:05:42,398 --> 00:06:05,284\n這個凸顯了官僚的心態以外也忽視了民眾對於自我健康管理的這個差異和我選擇的自由所以每個人的身體狀況不一樣代謝功能也不一樣你吃了沒事不代表我不會不舒服或不是或者是他不會生病可是我吃了就不舒服我就沒有辦法適應或是我就是根本就不想吃嘛\n\n17\n00:06:09,245 --> 00:06:35,984\n所以民眾做飲食選擇的依據食安的標準從來都不該指示會不會吃了會不會死吃了以後會不會生病或者你上次罵我們的是知識的缺乏才會擔心不是不是你上次罵我上次質詢你罵我們的會擔心的都是因為知識的缺乏而非基於科學的風險評估\n\n18\n00:06:38,218 --> 00:06:46,689\n我覺得這個態度才是最重要的不然說我吃不死啊我對食安的標準不是吃了會死的也不是說吃了會中毒的不是你要安人民的心啊沒錯你說看嘛對不對\n\n19\n00:06:54,278 --> 00:07:16,148\n報告委員,我想我們都是天下父母親,我完全了解我們吃東西要怎麼吃,那署長他也是人家的天下父母親,但是他以他過去的...對啊,他是食藥署署長啊,你不可以做一個父母說你快點吃,吃了就不會中毒,吃了就不會死,用這種標準來看待食安啊\n\n20\n00:07:16,448 --> 00:07:42,706\n他的意思是說他用的專業事實上真的希望讓大家安心好啦署長你再看一下啦我剛剛講的當你檢驗你邊境查驗逐年遞減而六天查到3P有減出雖然沒有超標但是不是應該要稍微提高一下你的邊境的抽驗原來你源頭把關好了不要流落到後市場去嘛\n\n21\n00:07:43,226 --> 00:07:44,047\n我們最討厭聽到業者自律,因為的確業者不可能自律\n\n22\n00:08:06,415 --> 00:08:33,260\n從所有食品安全破功我們都是建立在業者自律結果我們發現屢屢發現業者自律要求業者自律這個事情是不可能存在的都必須要他律啊對我的意思是說這次呢業者自己跳出來說他不需要銷出去然後暫時都沒有要我是說他這個部分他要做這件事其實我們都尊重他們啊對啦我的意思是說你不應該告訴人民說這吃了沒中毒吃了沒死不是用這個標準\n\n23\n00:08:35,880 --> 00:08:59,767\n報告委員我們對食安的標準不是這樣子我的意思是說對於食品安全的這個風險的評估裡面我們知道科學上的風險是什麼是是但我們要有知的權利我沒有說不定標準或是不准進來但我可以選擇不要不吃到不買對我說所以我在也非常同意委員這邊的提點但你這我責任是你必須要趕快掐牆查驗看看有沒有超標的\n\n24\n00:09:05,441 --> 00:09:32,159\n你應該提高查驗的這個批次然後告訴我們超標的幾乎沒有雖然都有檢出但澳洲的全部都有檢出譬如說是不是這樣子讓我們有知道風險把關風險的能力要先有資訊啊我們針對這個抽驗的部分我們會持續的去做一些積極的評估我們也待會去做一些考慮謝謝委員的支持好\n\n25\n00:09:32,839 --> 00:09:48,522\n因為你的數據其實也有一點玩弄你不敢講逐年遞減這種事好沒關係我來問一下長照的事情部長這個台灣進入超高齡社會這個平均壽命是80.2男生76.9女生83.7那特別要強調這個數據是因為這個數據關係到整體長照的負荷和效能你從2.0要到3.0但是人力和財源要同時到位\n\n26\n00:10:02,085 --> 00:10:21,780\n因為它影響到服務的品質還有它的可進性如果前端階段有效介入那麼延後減緩進入長照體系的速度所以資源的配置要很精準要提升照顧的品質這個是制度設計的這個關鍵也是政策精準化的重要方向好那我現在要跟你討論的是腦中風年輕化這件事\n\n27\n00:10:25,622 --> 00:10:51,233\n腦中風年輕化我們的長照體系可以接得住這一群45歲以下就中風失能的人嗎你回答我45歲以下就失能的人我們的長照有辦法接得住他們嗎那報告委員喔這個也是很重要的議題所以我們在長照3.0會把這個部分你要怎麼接進去\n\n28\n00:10:52,250 --> 00:11:08,588\n那個請次長回答一下非常感謝委員我想三個重點第一個我們現在3.0我們現在會來放寬就是說如果說有這一個有這個部分的話我們之前大概都是65歲以上對等等那些嘛那我們現在如果說有這個部分的話我們會來放寬\n\n29\n00:11:10,350 --> 00:11:31,091\n你是要從年齡去放寬還是要從什麼資格因為你就室內的資格我跟委員報告其實主要是從我們住院那個PAC就是那個基金後期你都青菜公共幫委員這不是青菜公共我也知道就是現在目前中風確實有年輕化的現象你知道有多嚴重中風的人裡面幾個有一個是年輕人45歲以下你知道嗎\n\n30\n00:11:32,686 --> 00:12:01,769\n你知不知道以前中風的比例年輕人大概占5到6%現在到幾%你知道嗎你沒有去正視這個問題你連數據都沒有幾%你知道嗎中風的人裡面有幾%是年輕人啊45歲以下你不知道我告訴你不用叫他們給你數據了15到18%而且每七個就有一個是45歲以下而且45歲以下青壯年正值事業的巔峰啊\n\n31\n00:12:02,429 --> 00:12:18,166\n在這種狀況對家庭對他個人對整個社會的衝擊何其大那我們在講是說你知道而且都以哪一種中風有兩種出血型還有阻射型嘛你知道年輕人的中風跟老年人的中風有沒有顯著的不一樣你知道嗎\n\n32\n00:12:18,966 --> 00:12:35,483\n年輕人是出血型比較多年輕人是出血型比較多年老的人出血型中風只佔了兩成但年輕人的中風大概五六成都是出血性的中風而且男生佔了六七成我講男生而且都是家計負擔者\n\n33\n00:12:36,984 --> 00:13:05,933\n這很重要所以在這種狀況裡面他的代謝疾病很多人都不知道自己糖尿病不曉得自己高血脂都不知道自己有三高45歲以下誰會想到自己離死神有多遠或多近那我要問你一次說你剛剛講說PAC我現在要問你喔中風的黃金復健期是多久半年半年好那你的PAC要接觸的人有辦法接觸這一群嗎\n\n34\n00:13:07,151 --> 00:13:26,486\n包委我們現在目前的做法是這樣現在就是在出院準備之後我們現在目前當然就是說我們現在一方面當然是縮短嘛對不對縮短之後然後現在我們也跟健保署這邊在加強加強合作就是說整個天數上面的那個縮短還有另外一個就是說我們就是沒有啦你不是天數而已啦\n\n35\n00:13:26,886 --> 00:13:34,850\n還有中介機構就是說你現在目前整個你要回到家中間呢我們現在也在輔導你們PAC從2014年開始做這個名稱叫腦中風急性後期的照護他要解決住院的天數的問題還有復健連續性的問題然後呢在急性後期的照護進入穩定期以後轉介到復健的專門醫院在這種狀況裡面我們要講的是說他為什麼\n\n36\n00:13:55,880 --> 00:14:05,165\n這個東西很好效果很好成效很好可是很多人沒有辦法使用的原因是在他的門檻很高他的門檻有多高你知道嗎\n\n37\n00:14:06,394 --> 00:14:30,373\n要使用PAC計畫必須個案本身體力需要承受大量密集的復健運動醫療團隊判斷需要具備積極復健的潛能者第一要具備基本認知學習能力和意願第二要具備足夠的體力支撐下能於輪椅或船員至少為止一個小時的坐姿自己有辦法坐一小時的啊\n\n38\n00:14:33,695 --> 00:15:01,617\n我現在要說的是說能夠進入PAC計畫的腦中風患者相對的都是失能的程度沒有那麼嚴重的啦沒有那麼嚴重的所以你這一個條件沒有改變其實年輕人一中風失能程度嚴重他沒有辦法進入PAC啊甚至他沒有任何可以接住他們因為你長照服務的四大類型適用資格是什麼\n\n39\n00:15:02,738 --> 00:15:21,441\n保委我們現在主要大概就是那個65歲以上CMS2-8另外就是我們原住民55歲還有那個還有身障身障還有50歲以上失智但是如果年輕的中風者要符合哪一個條件\n\n40\n00:15:22,362 --> 00:15:37,916\n只能夠等到身心障礙者的身份我們現在目前在3.0的時候我們現在目前會在整個資格上面來說來做放寬你要放寬到哪裡我現在跟你講你要先知道問題在哪裡因為你要等到他確定是殘障領到殘障所措才能進入失能的體系去\n\n41\n00:15:38,857 --> 00:16:02,688\n那要經過半年觀察他不會認為醫療機構還有這個鑑定機構不會認為你一中風就是永久性的失能所以一定要失能一陣子確認你失能了才要給你證明你才有辦法進入長照體系那可是跟我們的黃金復健期剛好是衝突的我必須在黃金復健期馬上做這個復健然後呢否則的話\n\n42\n00:16:06,512 --> 00:16:30,290\n可是跟黃金復健期這個年輕的中風者必須要幹什麼嗎他必須要不斷的換醫院不斷的轉換醫院雖然你們從109年開始就刪除了住院日數30天的品質指標但是每個大型醫院都會告訴腦中風的患者管你45歲以下還是45歲以上28天通通要出院\n\n43\n00:16:31,190 --> 00:16:58,805\n理由就是病情穩定了你希望後面還有很多人中風的要用這個資源所以這復健科還不到一個月28天的年輕的中風的人他就要開始找醫院然後呢他的復健之路何其漫長他的黃金復原期很重要可是呢如果一個年輕人你在做黃金復健的時候你沒有接住他你讓他變成永久失能永久躺在那裡\n\n44\n00:17:00,086 --> 00:17:11,783\n這個國家的長照未來的長照體系國家的醫療資源這樣不好啊你在黃金時期讓他趕快的復原能夠復原到相當程度能夠生活自理能夠照顧自己\n\n45\n00:17:14,631 --> 00:17:37,052\n這個頭三個月這樣的一個黃金的恢復期物理治療職能治療語言治療在這種狀況裡面他才是要搶救我們第一優先資源要配置在他們身上可是我們就目前的制度沒有接觸他們沒有所以照顧者45歲以下有可能剛結婚耶他的配偶或是他的貓\n\n46\n00:17:38,134 --> 00:17:42,157\n父母誰可以放下手邊的家庭和工作甚至小孩2歲3歲5歲10歲\n\n47\n00:17:45,243 --> 00:18:11,741\n誰可以來接住他們他光是在都市裡面尋求大型醫院的復健科要銜接黃金復健期都已經很困難了如果你在鄉下地區醫療資源相對不特別充裕的縣市其實這些年輕的中風者會出現不論是醫療體系或是健保甚至是患者家庭最不願意看的狀況他們會躺好躺滿一直躺到生命結束\n\n48\n00:18:13,286 --> 00:18:36,615\n這是不應該的所以這是不應該的你覺得我們部長你覺得我們要讓他們這樣子吧年輕中風七個就有一個這麼嚴重報告委員真的很感謝齁您把這個重要的問題也是一直長期這幾年來大家心中的覺得比較需要解決的問題提出來沒有啦說真的說的空的我沒理由我就跟你說啦所以你們回去要想3.0的會努力\n\n49\n00:18:41,437 --> 00:18:48,401\n3.0要怎麼努力好好的想一下要第一優先要接觸的是年輕的中風的人中風和醫療和長照的關係是什麼\n\n50\n00:18:53,957 --> 00:19:13,140\n跟委員報告這個從開始早先的這個症狀就要警覺啦然後呢我們健保現在有擴大那個取栓數的黃金時間最早的那段時間所以取栓數我們擴大到24小時血栓溶解劑你現在講治療醫療你現在講醫療我現在講的是長照體系要怎麼先接住他們所以我剛剛講了幾個課題嘛醫療長照\n\n51\n00:19:23,363 --> 00:19:23,384\n哼\n\n52\n00:19:25,306 --> 00:19:51,660\n醫療和長照和復健所以私能的部分我們現在的PAC有三種樣態啦有住院PAC有日間照護的PAC跟居家的PAC那剛剛委員講的是說要不要再把這個進PAC的條件再放寬一些因為過去呢大家討論的都是比較有potential復健的那一些才進PAC相對輕症啦不是potential啦\n\n53\n00:19:53,911 --> 00:20:10,134\n相對輕症因為對你們來講相對輕症這種看起來改善率很好嘛可是我要告訴你是說即使不符合住院型PAC收案的條件但也不代表要放棄他們也不代表說他們沒有需求\n\n54\n00:20:10,615 --> 00:20:18,262\n他也是會進入尋常的復健他還是有復健尋常的哪裡有尋常的復健過去衛福部示範過護理之交的PAC啦但是這個非醫院主導模式的rolemodel\n\n55\n00:20:25,908 --> 00:20:30,269\n沒有後續沒有繼續試辦你們的PAC健保給醫院你們沒有下放到地區的這種護理之家住宿型的復健照顧機構你們這個體制我不管你用什麼方法我只想要看到年輕的腦中風的這一些人我們要在黃金時期整個長照體系照護體系要接住他們\n\n56\n00:20:55,619 --> 00:21:15,084\n對不對我想我們會把醫療跟長照結合起來如果接不住那些有需求的年輕人未來累積的醫療費用更多長照支出更多社會支援成本更多都變成個人和整個社會難以承擔的壓力一個是走壞地方跟一個不會走壞地方\n\n57\n00:21:17,826 --> 00:21:35,483\n你要照顧的時間不一樣資源不一樣所以你一定要讓他避免越年輕師能照顧越沉重的狀況所以你PAC跟長照銜接的好你資格要放寬你的3.0就是要計畫到那這裡來如果年輕型的腦中風依然沒有辦法納入的話\n\n58\n00:21:37,125 --> 00:21:57,034\n那這個問題就根本沒有接觸我們醫療跟長照結合一定會接觸每一個病人我現在告訴你這裡就是沒有接觸的啊我現在告訴你這裡就是沒有被接觸的我們來演繹來改善台灣人長照制度已經涵蓋了重症兒童到高齡的長者逐步來形成這個全民式的照顧的架構可是呢\n\n59\n00:21:57,554 --> 00:22:26,127\n透過早期的復健和這個功能的促進要減少後續的醫療支出和長照的支出而年輕型的腦狀風這一類型就是最關鍵的一個族群了是我們台灣醫療水準很高不能不容許讓我們的病人不是醫療水準而已啦醫療跟長照跟長照我請問一下那個署長那個復健不是在長照也都有護嗎\n\n60\n00:22:27,387 --> 00:22:56,094\n你們不是都有延伸到那個長照機構裡面也有回診那個附件還是有附的你去看也要擺落骨因為都需要大附件因為前三個月前六個月大概都還需要附件床然後住在那裡然後要去附件但是大型的醫院都沒有床位啦然後這個非大型的醫院的附件人家不會認為他們的附件設施專業是到位的而年輕人需要的就是\n\n61\n00:22:56,814 --> 00:23:09,401\n搶救他關鍵那六個月所以這個他的PAC計畫要不要放寬資格因為他很嚴格你自己我都支撐1.1億以上這中方我都自己支撐1.1億以上的中方都是相對比較輕度的再來就是說你的PAC你只有健保給付連動到大醫院沒有連動到護理之家也沒有連動到這個長照的機構沒有給沒有給付點數啦\n\n62\n00:23:24,929 --> 00:23:33,601\n都沒有,所以這問題很嚴重,就是床也不夠可是我想講的是,45歲以下,他真的是關鍵啦要接觸他們啦\n\n","tsv":"start\tend\ttext\n10034\t27524\t好 謝謝召委是不是請我們部長和署長江署長委員好 委員請多保重對 我也希望不要感冒\n30242\t56318\t這個署長曾經在2021年說過當時是教授的身份嘛那以Codex的標準每天要吃6公斤的萊豬連續吃好幾年才會超標但是這跟中毒優勢兩件事政府會把關請大家買豬肉食的時候要放輕鬆如果依照署長這個標準大概食安就是沒有食安的問題只有吃到毒物才會死的問題那我今天講說\n58160\t80482\t這六天裡面來從短短六天就有驗出三批來寄的這個豬肉產品雖然都在那個我們的標準裡面但六天就有三批其實我剛才有沒有提到有退回去的有幾批減出啦減出但沒鈔票有三批那有退關的嗎\n82652\t99953\t從租業方面沒有都沒有好因為署長部長和署長要提醒你喔這個對於食安的態度要兢兢業業尤其是我自己做一個媽媽作為一個家庭裡面會開火的\n101252\t118188\t食安的把關者其實我的標準我個人的標準不是只有吃了會中毒吃了會有落毒的方向我自己個人是我不想要吃到那我想很多媽媽跟我一樣的心情\n119039\t135412\t那我們想的說那就是透明知的權利知的權利其實就是這樣子而已你其實對抗WTO的貿易架構就是這樣子你強迫我們開了邊界我們就讓你進來但我消費者可以不買啊\n136485\t164605\t就全體的世界貿易都一直都有這種情節啊你強迫我開放那我就是我可以選擇不吃不買但是國家要扮演什麼你沒有去標籤化它但是你不可以講說這個署長你丟了一句說沒見過有人吃萊克多巴胺牛肉中毒的用這種態度來善效擔心的民眾我覺得唯一不需要的是這樣子你應該想的是\n165626\t189596\t人民真的很擔心因為我有選擇不吃的這個權利啊我自己因為每個人的健康管理風險都是每個人在負責的我不想要而我有慢性的我代謝疾病我慢性三高的所以這種狀況裡面你在講講得很得意洋洋說你們科學的方法在把關你們的這個border protection whatBPI你們在做什麼其實\n193652\t203414\t我們都希望有政府是邊境裡面源頭把關邊境如果6天就也撿到3批雖然沒有超標那有沒有可能\n203959\t220871\t在邊境裡面其實就應該要把查驗的這個強度稍微提高一下加強邊境和後市場的稽查那你在這個過程當中你一直以幾個數據來告訴我們譬如說你的新聞稿寫2021年1月1號到2025年4月30邊境報驗的豬肉和豬雜碎共計兩萬\n228556\t231098\t5466批110年到114年4月間後市場對進口及國產豬肉的產品共檢驗18501件檢驗這個萊克多巴胺結果皆合格\n244103\t259151\t你是這樣寫的嘛但是我要問你是說你是不是應該公佈的不是這五年裡面我減了多少每一年你減多少因為我們知道剛開始的那一年減的數量是最多的也就是2021年110年減的批次最多那到2024、2025年其實都遞減了\n269167\t283571\t所以邊境抽驗的比例其實是大幅遞減的在用遞減裡面六天就檢驗出三批含有萊劑雖然沒有超標但是我們說如果在那個主管機關的立場你應該告訴大家說那我來加強邊境的把關我是不是要把抽驗的批次再增加一點當你增加了檢驗出來了覺得風險沒有增加\n297130\t315956\t那這樣子對人民才有交代啊而不是在這裡說吃了要吃沒多少啦 這都合格吃不死啦我們的標準你的 如果你要講科學數據 科學分析那麼你應該把每一年減幾批公佈出來啊 每一年啊讓我們看到從2021到2025是逐年遞減的你就不要糊弄我們用一個總的數據嘛所以\n322459\t339075\t萊劑的安全容許量是一回事我們有標準也是一回事但我們也有不想吃到的權利所以不要以每天吃也不會死沒看到過有人因為吃萊劑而中毒這樣的說法太輕率了\n342398\t365284\t這個凸顯了官僚的心態以外也忽視了民眾對於自我健康管理的這個差異和我選擇的自由所以每個人的身體狀況不一樣代謝功能也不一樣你吃了沒事不代表我不會不舒服或不是或者是他不會生病可是我吃了就不舒服我就沒有辦法適應或是我就是根本就不想吃嘛\n369245\t395984\t所以民眾做飲食選擇的依據食安的標準從來都不該指示會不會吃了會不會死吃了以後會不會生病或者你上次罵我們的是知識的缺乏才會擔心不是不是你上次罵我上次質詢你罵我們的會擔心的都是因為知識的缺乏而非基於科學的風險評估\n398218\t406689\t我覺得這個態度才是最重要的不然說我吃不死啊我對食安的標準不是吃了會死的也不是說吃了會中毒的不是你要安人民的心啊 沒錯你說看嘛 對不對\n414278\t436148\t報告委員,我想我們都是天下父母親,我完全了解我們吃東西要怎麼吃,那署長他也是人家的天下父母親,但是他以他過去的...對啊,他是食藥署署長啊,你不可以做一個父母說你快點吃,吃了就不會中毒,吃了就不會死,用這種標準來看待食安啊\n436448\t462706\t他的意思是說他用的專業 事實上真的希望讓大家安心好啦 署長你再看一下啦我剛剛講的 當你檢驗你邊境查驗逐年遞減 而六天查到3P有減出雖然沒有超標 但是不是應該要稍微提高一下你的邊境的抽驗原來你源頭把關好了 不要流落到後市場去嘛\n463226\t464047\t我們最討厭聽到業者自律,因為的確業者不可能自律\n486415\t513260\t從所有食品安全破功我們都是建立在業者自律結果我們發現 屢屢發現業者自律 要求業者自律這個事情是不可能存在的都必須要他律啊對 我的意思是說這次呢 業者自己跳出來說他不需要銷出去 然後暫時都沒有要我是說他這個部分 他要做這件事其實我們都尊重他們啊對啦 我的意思是說你不應該告訴人民說這吃了沒中毒 吃了沒死不是用這個標準\n515880\t539767\t報告委員我們對食安的標準不是這樣子我的意思是說對於食品安全的這個風險的評估裡面我們知道科學上的風險是什麼是是但我們要有知的權利我沒有說不定標準或是不准進來但我可以選擇不要不吃到不買對我說所以我在也非常同意委員這邊的提點但你這我責任是你必須要趕快掐牆查驗看看有沒有超標的\n545441\t572159\t你應該提高查驗的這個批次然後告訴我們超標的幾乎沒有 雖然都有檢出但澳洲的全部都有檢出 譬如說是不是這樣子讓我們有知道風險 把關風險的能力要先有資訊啊我們針對這個抽驗的部分我們會持續的去做一些積極的評估我們也待會去做一些考慮謝謝委員的支持好\n572839\t588522\t因為你的數據其實也有一點玩弄你不敢講逐年遞減這種事好沒關係我來問一下長照的事情部長這個台灣進入超高齡社會這個平均壽命是80.2男生76.9女生83.7那特別要強調這個數據是因為這個數據關係到整體長照的負荷和效能你從2.0要到3.0但是人力和財源要同時到位\n602085\t621780\t因為它影響到服務的品質還有它的可進性如果前端階段有效介入那麼延後減緩進入長照體系的速度所以資源的配置要很精準要提升照顧的品質這個是制度設計的這個關鍵也是政策精準化的重要方向好 那我現在要跟你討論的是腦中風年輕化這件事\n625622\t651233\t腦中風年輕化我們的長照體系可以接得住這一群45歲以下就中風失能的人嗎你回答我45歲以下就失能的人我們的長照有辦法接得住他們嗎那報告委員喔這個也是很重要的議題所以我們在長照3.0會把這個部分你要怎麼接進去\n652250\t668588\t那個請次長回答一下非常感謝委員我想三個重點第一個我們現在3.0我們現在會來放寬就是說如果說有這一個有這個部分的話我們之前大概都是65歲以上對等等那些嘛那我們現在如果說有這個部分的話我們會來放寬\n670350\t691091\t你是要從年齡去放寬還是要從什麼資格因為你就室內的資格我跟委員報告其實主要是從我們住院那個PAC就是那個基金後期你都青菜公共幫委員這不是青菜公共我也知道就是現在目前中風確實有年輕化的現象你知道有多嚴重中風的人裡面幾個有一個是年輕人45歲以下你知道嗎\n692686\t721769\t你知不知道以前中風的比例年輕人大概占5到6%現在到幾%你知道嗎你沒有去正視這個問題你連數據都沒有幾%你知道嗎中風的人裡面有幾%是年輕人啊45歲以下你不知道我告訴你不用叫他們給你數據了15到18%而且每七個就有一個是45歲以下而且45歲以下青壯年正值事業的巔峰啊\n722429\t738166\t在這種狀況對家庭對他個人對整個社會的衝擊何其大那我們在講是說你知道而且都以哪一種中風有兩種出血型還有阻射型嘛你知道年輕人的中風跟老年人的中風有沒有顯著的不一樣你知道嗎\n738966\t755483\t年輕人是出血型比較多年輕人是出血型比較多年老的人出血型中風只佔了兩成但年輕人的中風大概五六成都是出血性的中風而且男生佔了六七成我講男生而且都是家計負擔者\n756984\t785933\t這很重要所以在這種狀況裡面他的代謝疾病很多人都不知道自己糖尿病不曉得自己高血脂都不知道自己有三高45歲以下誰會想到自己離死神有多遠或多近那我要問你一次說你剛剛講說PAC我現在要問你喔中風的黃金復健期是多久半年半年好那你的PAC要接觸的人有辦法接觸這一群嗎\n787151\t806486\t包委我們現在目前的做法是這樣現在就是在出院準備之後我們現在目前當然就是說我們現在一方面當然是縮短嘛對不對縮短之後然後現在我們也跟健保署這邊在加強加強合作就是說整個天數上面的那個縮短還有另外一個就是說我們就是沒有啦你不是天數而已啦\n806886\t814850\t還有中介機構就是說你現在目前整個你要回到家中間呢我們現在也在輔導你們PAC從2014年開始做這個名稱叫腦中風急性後期的照護他要解決住院的天數的問題還有復健連續性的問題然後呢在急性後期的照護進入穩定期以後轉介到復健的專門醫院在這種狀況裡面我們要講的是說他為什麼\n835880\t845165\t這個東西很好 效果很好 成效很好可是很多人沒有辦法使用的原因是在他的門檻很高他的門檻有多高 你知道嗎\n846394\t870373\t要使用PAC計畫必須個案本身體力需要承受大量密集的復健運動醫療團隊判斷需要具備積極復健的潛能者第一要具備基本認知學習能力和意願第二要具備足夠的體力支撐下能於輪椅或船員至少為止一個小時的坐姿自己有辦法坐一小時的啊\n873695\t901617\t我現在要說的是說能夠進入PAC計畫的腦中風患者相對的都是失能的程度沒有那麼嚴重的啦沒有那麼嚴重的所以你這一個條件沒有改變其實年輕人一中風失能程度嚴重他沒有辦法進入PAC啊甚至他沒有任何可以接住他們因為你長照服務的四大類型適用資格是什麼\n902738\t921441\t保委我們現在主要大概就是那個65歲以上CMS2-8另外就是我們原住民55歲還有那個還有身障身障還有50歲以上失智但是如果年輕的中風者要符合哪一個條件\n922362\t937916\t只能夠等到身心障礙者的身份我們現在目前在3.0的時候我們現在目前會在整個資格上面來說來做放寬你要放寬到哪裡我現在跟你講你要先知道問題在哪裡因為你要等到他確定是殘障領到殘障所措才能進入失能的體系去\n938857\t962688\t那要經過半年觀察他不會認為醫療機構還有這個鑑定機構不會認為你一中風就是永久性的失能所以一定要失能一陣子確認你失能了才要給你證明你才有辦法進入長照體系那可是跟我們的黃金復健期剛好是衝突的我必須在黃金復健期馬上做這個復健然後呢否則的話\n966512\t990290\t可是跟黃金復健期這個年輕的中風者必須要幹什麼嗎他必須要不斷的換醫院不斷的轉換醫院雖然你們從109年開始就刪除了住院日數30天的品質指標但是每個大型醫院都會告訴腦中風的患者管你45歲以下還是45歲以上28天通通要出院\n991190\t1018805\t理由就是病情穩定了你希望後面還有很多人中風的要用這個資源所以這復健科還不到一個月28天的年輕的中風的人他就要開始找醫院然後呢他的復健之路何其漫長他的黃金復原期很重要可是呢如果一個年輕人你在做黃金復健的時候你沒有接住他你讓他變成永久失能永久躺在那裡\n1020086\t1031783\t這個國家的長照 未來的長照體系 國家的醫療資源這樣不好啊 你在黃金時期讓他趕快的復原能夠復原到相當程度 能夠生活自理 能夠照顧自己\n1034631\t1057052\t這個頭三個月這樣的一個黃金的恢復期物理治療職能治療語言治療在這種狀況裡面他才是要搶救我們第一優先資源要配置在他們身上可是我們就目前的制度沒有接觸他們沒有所以照顧者45歲以下有可能剛結婚耶他的配偶或是他的貓\n1058134\t1062157\t父母誰可以放下手邊的家庭和工作甚至小孩2歲 3歲 5歲 10歲\n1065243\t1091741\t誰可以來接住他們他光是在都市裡面尋求大型醫院的復健科要銜接黃金復健期都已經很困難了如果你在鄉下地區醫療資源相對不特別充裕的縣市其實這些年輕的中風者會出現不論是醫療體系或是健保甚至是患者家庭最不願意看的狀況他們會躺好躺滿一直躺到生命結束\n1093286\t1116615\t這是不應該的所以這是不應該的你覺得我們 部長你覺得我們要讓他們這樣子吧年輕中風七個就有一個這麼嚴重 報告委員真的很感謝齁您把這個重要的問題也是一直長期這幾年來大家心中的覺得比較需要解決的問題提出來沒有啦 說真的 說的空的我沒理由 我就跟你說啦所以你們回去要想3.0的會努力\n1121437\t1128401\t3.0要怎麼努力好好的想一下要第一優先要接觸的是年輕的中風的人中風和醫療和長照的關係是什麼\n1133957\t1153140\t跟委員報告這個從開始早先的這個症狀就要警覺啦然後呢我們健保現在有擴大那個取栓數的黃金時間最早的那段時間所以取栓數我們擴大到24小時血栓溶解劑你現在講治療醫療你現在講醫療我現在講的是長照體系要怎麼先接住他們所以我剛剛講了幾個課題嘛醫療長照\n1163363\t1163384\t哼\n1165306\t1191660\t醫療和長照和復健所以私能的部分我們現在的PAC有三種樣態啦有住院PAC有日間照護的PAC跟居家的PAC那剛剛委員講的是說要不要再把這個進PAC的條件再放寬一些因為過去呢大家討論的都是比較有potential復健的那一些才進PAC相對輕症啦不是potential啦\n1193911\t1210134\t相對輕症 因為對你們來講相對輕症這種看起來改善率很好嘛可是我要告訴你是說即使不符合住院型PAC 收案的條件但也不代表要放棄他們也不代表說他們沒有需求\n1210615\t1218262\t他也是會進入尋常的復健他還是有復健尋常的哪裡有尋常的復健過去衛福部示範過護理之交的PAC啦但是這個非醫院主導模式的role model\n1225908\t1230269\t沒有後續沒有繼續試辦你們的PAC健保給醫院你們沒有下放到地區的這種護理之家住宿型的復健照顧機構你們這個體制我不管你用什麼方法我只想要看到年輕的腦中風的這一些人我們要在黃金時期整個長照體系照護體系要接住他們\n1255619\t1275084\t對不對我想我們會把醫療跟長照結合起來如果接不住那些有需求的年輕人未來累積的醫療費用更多長照支出更多社會支援成本更多都變成個人和整個社會難以承擔的壓力一個是走壞地方跟一個不會走壞地方\n1277826\t1295483\t你要照顧的時間不一樣資源不一樣所以你一定要讓他避免越年輕師能照顧越沉重的狀況所以你PAC跟長照銜接的好你資格要放寬你的3.0就是要計畫到那這裡來如果年輕型的腦中風依然沒有辦法納入的話\n1297125\t1317034\t那這個問題就根本沒有接觸我們醫療跟長照結合一定會接觸每一個病人我現在告訴你這裡就是沒有接觸的啊我現在告訴你這裡就是沒有被接觸的我們來演繹來改善台灣人長照制度已經涵蓋了重症兒童到高齡的長者逐步來形成這個全民式的照顧的架構可是呢\n1317554\t1346127\t透過早期的復健和這個功能的促進要減少後續的醫療支出和長照的支出而年輕型的腦狀風這一類型就是最關鍵的一個族群了是我們台灣醫療水準很高不能不容許讓我們的病人不是醫療水準而已啦醫療跟長照跟長照我請問一下那個署長那個復健不是在長照也都有護嗎\n1347387\t1376094\t你們不是都有延伸到那個長照機構裡面也有回診那個附件還是有附的你去看也要擺落骨 因為都需要大附件因為前三個月前六個月大概都還需要附件床然後住在那裡然後要去附件但是大型的醫院都沒有床位啦然後這個非大型的醫院的附件人家不會認為他們的附件設施專業是到位的而年輕人需要的就是\n1376814\t1389401\t搶救他關鍵那六個月所以這個他的PAC計畫要不要放寬資格因為他很嚴格你自己我都支撐1.1億以上這中方我都自己支撐1.1億以上的中方都是相對比較輕度的再來就是說你的PAC你只有健保給付連動到大醫院沒有連動到護理之家也沒有連動到這個長照的機構沒有給沒有給付點數啦\n1404929\t1413601\t都沒有,所以這問題很嚴重,就是床也不夠可是我想講的是,45歲以下,他真的是關鍵啦要接觸他們啦\n","txt":"好 謝謝召委是不是請我們部長和署長江署長委員好 委員請多保重對 我也希望不要感冒\n這個署長曾經在2021年說過當時是教授的身份嘛那以Codex的標準每天要吃6公斤的萊豬連續吃好幾年才會超標但是這跟中毒優勢兩件事政府會把關請大家買豬肉食的時候要放輕鬆如果依照署長這個標準大概食安就是沒有食安的問題只有吃到毒物才會死的問題那我今天講說\n這六天裡面來從短短六天就有驗出三批來寄的這個豬肉產品雖然都在那個我們的標準裡面但六天就有三批其實我剛才有沒有提到有退回去的有幾批減出啦減出但沒鈔票有三批那有退關的嗎\n從租業方面沒有都沒有好因為署長部長和署長要提醒你喔這個對於食安的態度要兢兢業業尤其是我自己做一個媽媽作為一個家庭裡面會開火的\n食安的把關者其實我的標準我個人的標準不是只有吃了會中毒吃了會有落毒的方向我自己個人是我不想要吃到那我想很多媽媽跟我一樣的心情\n那我們想的說那就是透明知的權利知的權利其實就是這樣子而已你其實對抗WTO的貿易架構就是這樣子你強迫我們開了邊界我們就讓你進來但我消費者可以不買啊\n就全體的世界貿易都一直都有這種情節啊你強迫我開放那我就是我可以選擇不吃不買但是國家要扮演什麼你沒有去標籤化它但是你不可以講說這個署長你丟了一句說沒見過有人吃萊克多巴胺牛肉中毒的用這種態度來善效擔心的民眾我覺得唯一不需要的是這樣子你應該想的是\n人民真的很擔心因為我有選擇不吃的這個權利啊我自己因為每個人的健康管理風險都是每個人在負責的我不想要而我有慢性的我代謝疾病我慢性三高的所以這種狀況裡面你在講講得很得意洋洋說你們科學的方法在把關你們的這個border protection whatBPI你們在做什麼其實\n我們都希望有政府是邊境裡面源頭把關邊境如果6天就也撿到3批雖然沒有超標那有沒有可能\n在邊境裡面其實就應該要把查驗的這個強度稍微提高一下加強邊境和後市場的稽查那你在這個過程當中你一直以幾個數據來告訴我們譬如說你的新聞稿寫2021年1月1號到2025年4月30邊境報驗的豬肉和豬雜碎共計兩萬\n5466批110年到114年4月間後市場對進口及國產豬肉的產品共檢驗18501件檢驗這個萊克多巴胺結果皆合格\n你是這樣寫的嘛但是我要問你是說你是不是應該公佈的不是這五年裡面我減了多少每一年你減多少因為我們知道剛開始的那一年減的數量是最多的也就是2021年110年減的批次最多那到2024、2025年其實都遞減了\n所以邊境抽驗的比例其實是大幅遞減的在用遞減裡面六天就檢驗出三批含有萊劑雖然沒有超標但是我們說如果在那個主管機關的立場你應該告訴大家說那我來加強邊境的把關我是不是要把抽驗的批次再增加一點當你增加了檢驗出來了覺得風險沒有增加\n那這樣子對人民才有交代啊而不是在這裡說吃了要吃沒多少啦 這都合格吃不死啦我們的標準你的 如果你要講科學數據 科學分析那麼你應該把每一年減幾批公佈出來啊 每一年啊讓我們看到從2021到2025是逐年遞減的你就不要糊弄我們用一個總的數據嘛所以\n萊劑的安全容許量是一回事我們有標準也是一回事但我們也有不想吃到的權利所以不要以每天吃也不會死沒看到過有人因為吃萊劑而中毒這樣的說法太輕率了\n這個凸顯了官僚的心態以外也忽視了民眾對於自我健康管理的這個差異和我選擇的自由所以每個人的身體狀況不一樣代謝功能也不一樣你吃了沒事不代表我不會不舒服或不是或者是他不會生病可是我吃了就不舒服我就沒有辦法適應或是我就是根本就不想吃嘛\n所以民眾做飲食選擇的依據食安的標準從來都不該指示會不會吃了會不會死吃了以後會不會生病或者你上次罵我們的是知識的缺乏才會擔心不是不是你上次罵我上次質詢你罵我們的會擔心的都是因為知識的缺乏而非基於科學的風險評估\n我覺得這個態度才是最重要的不然說我吃不死啊我對食安的標準不是吃了會死的也不是說吃了會中毒的不是你要安人民的心啊 沒錯你說看嘛 對不對\n報告委員,我想我們都是天下父母親,我完全了解我們吃東西要怎麼吃,那署長他也是人家的天下父母親,但是他以他過去的...對啊,他是食藥署署長啊,你不可以做一個父母說你快點吃,吃了就不會中毒,吃了就不會死,用這種標準來看待食安啊\n他的意思是說他用的專業 事實上真的希望讓大家安心好啦 署長你再看一下啦我剛剛講的 當你檢驗你邊境查驗逐年遞減 而六天查到3P有減出雖然沒有超標 但是不是應該要稍微提高一下你的邊境的抽驗原來你源頭把關好了 不要流落到後市場去嘛\n我們最討厭聽到業者自律,因為的確業者不可能自律\n從所有食品安全破功我們都是建立在業者自律結果我們發現 屢屢發現業者自律 要求業者自律這個事情是不可能存在的都必須要他律啊對 我的意思是說這次呢 業者自己跳出來說他不需要銷出去 然後暫時都沒有要我是說他這個部分 他要做這件事其實我們都尊重他們啊對啦 我的意思是說你不應該告訴人民說這吃了沒中毒 吃了沒死不是用這個標準\n報告委員我們對食安的標準不是這樣子我的意思是說對於食品安全的這個風險的評估裡面我們知道科學上的風險是什麼是是但我們要有知的權利我沒有說不定標準或是不准進來但我可以選擇不要不吃到不買對我說所以我在也非常同意委員這邊的提點但你這我責任是你必須要趕快掐牆查驗看看有沒有超標的\n你應該提高查驗的這個批次然後告訴我們超標的幾乎沒有 雖然都有檢出但澳洲的全部都有檢出 譬如說是不是這樣子讓我們有知道風險 把關風險的能力要先有資訊啊我們針對這個抽驗的部分我們會持續的去做一些積極的評估我們也待會去做一些考慮謝謝委員的支持好\n因為你的數據其實也有一點玩弄你不敢講逐年遞減這種事好沒關係我來問一下長照的事情部長這個台灣進入超高齡社會這個平均壽命是80.2男生76.9女生83.7那特別要強調這個數據是因為這個數據關係到整體長照的負荷和效能你從2.0要到3.0但是人力和財源要同時到位\n因為它影響到服務的品質還有它的可進性如果前端階段有效介入那麼延後減緩進入長照體系的速度所以資源的配置要很精準要提升照顧的品質這個是制度設計的這個關鍵也是政策精準化的重要方向好 那我現在要跟你討論的是腦中風年輕化這件事\n腦中風年輕化我們的長照體系可以接得住這一群45歲以下就中風失能的人嗎你回答我45歲以下就失能的人我們的長照有辦法接得住他們嗎那報告委員喔這個也是很重要的議題所以我們在長照3.0會把這個部分你要怎麼接進去\n那個請次長回答一下非常感謝委員我想三個重點第一個我們現在3.0我們現在會來放寬就是說如果說有這一個有這個部分的話我們之前大概都是65歲以上對等等那些嘛那我們現在如果說有這個部分的話我們會來放寬\n你是要從年齡去放寬還是要從什麼資格因為你就室內的資格我跟委員報告其實主要是從我們住院那個PAC就是那個基金後期你都青菜公共幫委員這不是青菜公共我也知道就是現在目前中風確實有年輕化的現象你知道有多嚴重中風的人裡面幾個有一個是年輕人45歲以下你知道嗎\n你知不知道以前中風的比例年輕人大概占5到6%現在到幾%你知道嗎你沒有去正視這個問題你連數據都沒有幾%你知道嗎中風的人裡面有幾%是年輕人啊45歲以下你不知道我告訴你不用叫他們給你數據了15到18%而且每七個就有一個是45歲以下而且45歲以下青壯年正值事業的巔峰啊\n在這種狀況對家庭對他個人對整個社會的衝擊何其大那我們在講是說你知道而且都以哪一種中風有兩種出血型還有阻射型嘛你知道年輕人的中風跟老年人的中風有沒有顯著的不一樣你知道嗎\n年輕人是出血型比較多年輕人是出血型比較多年老的人出血型中風只佔了兩成但年輕人的中風大概五六成都是出血性的中風而且男生佔了六七成我講男生而且都是家計負擔者\n這很重要所以在這種狀況裡面他的代謝疾病很多人都不知道自己糖尿病不曉得自己高血脂都不知道自己有三高45歲以下誰會想到自己離死神有多遠或多近那我要問你一次說你剛剛講說PAC我現在要問你喔中風的黃金復健期是多久半年半年好那你的PAC要接觸的人有辦法接觸這一群嗎\n包委我們現在目前的做法是這樣現在就是在出院準備之後我們現在目前當然就是說我們現在一方面當然是縮短嘛對不對縮短之後然後現在我們也跟健保署這邊在加強加強合作就是說整個天數上面的那個縮短還有另外一個就是說我們就是沒有啦你不是天數而已啦\n還有中介機構就是說你現在目前整個你要回到家中間呢我們現在也在輔導你們PAC從2014年開始做這個名稱叫腦中風急性後期的照護他要解決住院的天數的問題還有復健連續性的問題然後呢在急性後期的照護進入穩定期以後轉介到復健的專門醫院在這種狀況裡面我們要講的是說他為什麼\n這個東西很好 效果很好 成效很好可是很多人沒有辦法使用的原因是在他的門檻很高他的門檻有多高 你知道嗎\n要使用PAC計畫必須個案本身體力需要承受大量密集的復健運動醫療團隊判斷需要具備積極復健的潛能者第一要具備基本認知學習能力和意願第二要具備足夠的體力支撐下能於輪椅或船員至少為止一個小時的坐姿自己有辦法坐一小時的啊\n我現在要說的是說能夠進入PAC計畫的腦中風患者相對的都是失能的程度沒有那麼嚴重的啦沒有那麼嚴重的所以你這一個條件沒有改變其實年輕人一中風失能程度嚴重他沒有辦法進入PAC啊甚至他沒有任何可以接住他們因為你長照服務的四大類型適用資格是什麼\n保委我們現在主要大概就是那個65歲以上CMS2-8另外就是我們原住民55歲還有那個還有身障身障還有50歲以上失智但是如果年輕的中風者要符合哪一個條件\n只能夠等到身心障礙者的身份我們現在目前在3.0的時候我們現在目前會在整個資格上面來說來做放寬你要放寬到哪裡我現在跟你講你要先知道問題在哪裡因為你要等到他確定是殘障領到殘障所措才能進入失能的體系去\n那要經過半年觀察他不會認為醫療機構還有這個鑑定機構不會認為你一中風就是永久性的失能所以一定要失能一陣子確認你失能了才要給你證明你才有辦法進入長照體系那可是跟我們的黃金復健期剛好是衝突的我必須在黃金復健期馬上做這個復健然後呢否則的話\n可是跟黃金復健期這個年輕的中風者必須要幹什麼嗎他必須要不斷的換醫院不斷的轉換醫院雖然你們從109年開始就刪除了住院日數30天的品質指標但是每個大型醫院都會告訴腦中風的患者管你45歲以下還是45歲以上28天通通要出院\n理由就是病情穩定了你希望後面還有很多人中風的要用這個資源所以這復健科還不到一個月28天的年輕的中風的人他就要開始找醫院然後呢他的復健之路何其漫長他的黃金復原期很重要可是呢如果一個年輕人你在做黃金復健的時候你沒有接住他你讓他變成永久失能永久躺在那裡\n這個國家的長照 未來的長照體系 國家的醫療資源這樣不好啊 你在黃金時期讓他趕快的復原能夠復原到相當程度 能夠生活自理 能夠照顧自己\n這個頭三個月這樣的一個黃金的恢復期物理治療職能治療語言治療在這種狀況裡面他才是要搶救我們第一優先資源要配置在他們身上可是我們就目前的制度沒有接觸他們沒有所以照顧者45歲以下有可能剛結婚耶他的配偶或是他的貓\n父母誰可以放下手邊的家庭和工作甚至小孩2歲 3歲 5歲 10歲\n誰可以來接住他們他光是在都市裡面尋求大型醫院的復健科要銜接黃金復健期都已經很困難了如果你在鄉下地區醫療資源相對不特別充裕的縣市其實這些年輕的中風者會出現不論是醫療體系或是健保甚至是患者家庭最不願意看的狀況他們會躺好躺滿一直躺到生命結束\n這是不應該的所以這是不應該的你覺得我們 部長你覺得我們要讓他們這樣子吧年輕中風七個就有一個這麼嚴重 報告委員真的很感謝齁您把這個重要的問題也是一直長期這幾年來大家心中的覺得比較需要解決的問題提出來沒有啦 說真的 說的空的我沒理由 我就跟你說啦所以你們回去要想3.0的會努力\n3.0要怎麼努力好好的想一下要第一優先要接觸的是年輕的中風的人中風和醫療和長照的關係是什麼\n跟委員報告這個從開始早先的這個症狀就要警覺啦然後呢我們健保現在有擴大那個取栓數的黃金時間最早的那段時間所以取栓數我們擴大到24小時血栓溶解劑你現在講治療醫療你現在講醫療我現在講的是長照體系要怎麼先接住他們所以我剛剛講了幾個課題嘛醫療長照\n哼\n醫療和長照和復健所以私能的部分我們現在的PAC有三種樣態啦有住院PAC有日間照護的PAC跟居家的PAC那剛剛委員講的是說要不要再把這個進PAC的條件再放寬一些因為過去呢大家討論的都是比較有potential復健的那一些才進PAC相對輕症啦不是potential啦\n相對輕症 因為對你們來講相對輕症這種看起來改善率很好嘛可是我要告訴你是說即使不符合住院型PAC 收案的條件但也不代表要放棄他們也不代表說他們沒有需求\n他也是會進入尋常的復健他還是有復健尋常的哪裡有尋常的復健過去衛福部示範過護理之交的PAC啦但是這個非醫院主導模式的role model\n沒有後續沒有繼續試辦你們的PAC健保給醫院你們沒有下放到地區的這種護理之家住宿型的復健照顧機構你們這個體制我不管你用什麼方法我只想要看到年輕的腦中風的這一些人我們要在黃金時期整個長照體系照護體系要接住他們\n對不對我想我們會把醫療跟長照結合起來如果接不住那些有需求的年輕人未來累積的醫療費用更多長照支出更多社會支援成本更多都變成個人和整個社會難以承擔的壓力一個是走壞地方跟一個不會走壞地方\n你要照顧的時間不一樣資源不一樣所以你一定要讓他避免越年輕師能照顧越沉重的狀況所以你PAC跟長照銜接的好你資格要放寬你的3.0就是要計畫到那這裡來如果年輕型的腦中風依然沒有辦法納入的話\n那這個問題就根本沒有接觸我們醫療跟長照結合一定會接觸每一個病人我現在告訴你這裡就是沒有接觸的啊我現在告訴你這裡就是沒有被接觸的我們來演繹來改善台灣人長照制度已經涵蓋了重症兒童到高齡的長者逐步來形成這個全民式的照顧的架構可是呢\n透過早期的復健和這個功能的促進要減少後續的醫療支出和長照的支出而年輕型的腦狀風這一類型就是最關鍵的一個族群了是我們台灣醫療水準很高不能不容許讓我們的病人不是醫療水準而已啦醫療跟長照跟長照我請問一下那個署長那個復健不是在長照也都有護嗎\n你們不是都有延伸到那個長照機構裡面也有回診那個附件還是有附的你去看也要擺落骨 因為都需要大附件因為前三個月前六個月大概都還需要附件床然後住在那裡然後要去附件但是大型的醫院都沒有床位啦然後這個非大型的醫院的附件人家不會認為他們的附件設施專業是到位的而年輕人需要的就是\n搶救他關鍵那六個月所以這個他的PAC計畫要不要放寬資格因為他很嚴格你自己我都支撐1.1億以上這中方我都自己支撐1.1億以上的中方都是相對比較輕度的再來就是說你的PAC你只有健保給付連動到大醫院沒有連動到護理之家也沒有連動到這個長照的機構沒有給沒有給付點數啦\n都沒有,所以這問題很嚴重,就是床也不夠可是我想講的是,45歲以下,他真的是關鍵啦要接觸他們啦\n","vtt":"WEBVTT\n\n00:10.034 --> 00:27.524\n好謝謝召委是不是請我們部長和署長江署長委員好委員請多保重對我也希望不要感冒\n\n00:30.242 --> 00:56.318\n這個署長曾經在2021年說過當時是教授的身份嘛那以Codex的標準每天要吃6公斤的萊豬連續吃好幾年才會超標但是這跟中毒優勢兩件事政府會把關請大家買豬肉食的時候要放輕鬆如果依照署長這個標準大概食安就是沒有食安的問題只有吃到毒物才會死的問題那我今天講說\n\n00:58.160 --> 01:20.482\n這六天裡面來從短短六天就有驗出三批來寄的這個豬肉產品雖然都在那個我們的標準裡面但六天就有三批其實我剛才有沒有提到有退回去的有幾批減出啦減出但沒鈔票有三批那有退關的嗎\n\n01:22.652 --> 01:39.953\n從租業方面沒有都沒有好因為署長部長和署長要提醒你喔這個對於食安的態度要兢兢業業尤其是我自己做一個媽媽作為一個家庭裡面會開火的\n\n01:41.252 --> 01:58.188\n食安的把關者其實我的標準我個人的標準不是只有吃了會中毒吃了會有落毒的方向我自己個人是我不想要吃到那我想很多媽媽跟我一樣的心情\n\n01:59.039 --> 02:15.412\n那我們想的說那就是透明知的權利知的權利其實就是這樣子而已你其實對抗WTO的貿易架構就是這樣子你強迫我們開了邊界我們就讓你進來但我消費者可以不買啊\n\n02:16.485 --> 02:44.605\n就全體的世界貿易都一直都有這種情節啊你強迫我開放那我就是我可以選擇不吃不買但是國家要扮演什麼你沒有去標籤化它但是你不可以講說這個署長你丟了一句說沒見過有人吃萊克多巴胺牛肉中毒的用這種態度來善效擔心的民眾我覺得唯一不需要的是這樣子你應該想的是\n\n02:45.626 --> 03:09.596\n人民真的很擔心因為我有選擇不吃的這個權利啊我自己因為每個人的健康管理風險都是每個人在負責的我不想要而我有慢性的我代謝疾病我慢性三高的所以這種狀況裡面你在講講得很得意洋洋說你們科學的方法在把關你們的這個borderprotectionwhatBPI你們在做什麼其實\n\n03:13.652 --> 03:23.414\n我們都希望有政府是邊境裡面源頭把關邊境如果6天就也撿到3批雖然沒有超標那有沒有可能\n\n03:23.959 --> 03:40.871\n在邊境裡面其實就應該要把查驗的這個強度稍微提高一下加強邊境和後市場的稽查那你在這個過程當中你一直以幾個數據來告訴我們譬如說你的新聞稿寫2021年1月1號到2025年4月30邊境報驗的豬肉和豬雜碎共計兩萬\n\n03:48.556 --> 03:51.098\n5466批110年到114年4月間後市場對進口及國產豬肉的產品共檢驗18501件檢驗這個萊克多巴胺結果皆合格\n\n04:04.103 --> 04:19.151\n你是這樣寫的嘛但是我要問你是說你是不是應該公佈的不是這五年裡面我減了多少每一年你減多少因為我們知道剛開始的那一年減的數量是最多的也就是2021年110年減的批次最多那到2024、2025年其實都遞減了\n\n04:29.167 --> 04:43.571\n所以邊境抽驗的比例其實是大幅遞減的在用遞減裡面六天就檢驗出三批含有萊劑雖然沒有超標但是我們說如果在那個主管機關的立場你應該告訴大家說那我來加強邊境的把關我是不是要把抽驗的批次再增加一點當你增加了檢驗出來了覺得風險沒有增加\n\n04:57.130 --> 05:15.956\n那這樣子對人民才有交代啊而不是在這裡說吃了要吃沒多少啦這都合格吃不死啦我們的標準你的如果你要講科學數據科學分析那麼你應該把每一年減幾批公佈出來啊每一年啊讓我們看到從2021到2025是逐年遞減的你就不要糊弄我們用一個總的數據嘛所以\n\n05:22.459 --> 05:39.075\n萊劑的安全容許量是一回事我們有標準也是一回事但我們也有不想吃到的權利所以不要以每天吃也不會死沒看到過有人因為吃萊劑而中毒這樣的說法太輕率了\n\n05:42.398 --> 06:05.284\n這個凸顯了官僚的心態以外也忽視了民眾對於自我健康管理的這個差異和我選擇的自由所以每個人的身體狀況不一樣代謝功能也不一樣你吃了沒事不代表我不會不舒服或不是或者是他不會生病可是我吃了就不舒服我就沒有辦法適應或是我就是根本就不想吃嘛\n\n06:09.245 --> 06:35.984\n所以民眾做飲食選擇的依據食安的標準從來都不該指示會不會吃了會不會死吃了以後會不會生病或者你上次罵我們的是知識的缺乏才會擔心不是不是你上次罵我上次質詢你罵我們的會擔心的都是因為知識的缺乏而非基於科學的風險評估\n\n06:38.218 --> 06:46.689\n我覺得這個態度才是最重要的不然說我吃不死啊我對食安的標準不是吃了會死的也不是說吃了會中毒的不是你要安人民的心啊沒錯你說看嘛對不對\n\n06:54.278 --> 07:16.148\n報告委員,我想我們都是天下父母親,我完全了解我們吃東西要怎麼吃,那署長他也是人家的天下父母親,但是他以他過去的...對啊,他是食藥署署長啊,你不可以做一個父母說你快點吃,吃了就不會中毒,吃了就不會死,用這種標準來看待食安啊\n\n07:16.448 --> 07:42.706\n他的意思是說他用的專業事實上真的希望讓大家安心好啦署長你再看一下啦我剛剛講的當你檢驗你邊境查驗逐年遞減而六天查到3P有減出雖然沒有超標但是不是應該要稍微提高一下你的邊境的抽驗原來你源頭把關好了不要流落到後市場去嘛\n\n07:43.226 --> 07:44.047\n我們最討厭聽到業者自律,因為的確業者不可能自律\n\n08:06.415 --> 08:33.260\n從所有食品安全破功我們都是建立在業者自律結果我們發現屢屢發現業者自律要求業者自律這個事情是不可能存在的都必須要他律啊對我的意思是說這次呢業者自己跳出來說他不需要銷出去然後暫時都沒有要我是說他這個部分他要做這件事其實我們都尊重他們啊對啦我的意思是說你不應該告訴人民說這吃了沒中毒吃了沒死不是用這個標準\n\n08:35.880 --> 08:59.767\n報告委員我們對食安的標準不是這樣子我的意思是說對於食品安全的這個風險的評估裡面我們知道科學上的風險是什麼是是但我們要有知的權利我沒有說不定標準或是不准進來但我可以選擇不要不吃到不買對我說所以我在也非常同意委員這邊的提點但你這我責任是你必須要趕快掐牆查驗看看有沒有超標的\n\n09:05.441 --> 09:32.159\n你應該提高查驗的這個批次然後告訴我們超標的幾乎沒有雖然都有檢出但澳洲的全部都有檢出譬如說是不是這樣子讓我們有知道風險把關風險的能力要先有資訊啊我們針對這個抽驗的部分我們會持續的去做一些積極的評估我們也待會去做一些考慮謝謝委員的支持好\n\n09:32.839 --> 09:48.522\n因為你的數據其實也有一點玩弄你不敢講逐年遞減這種事好沒關係我來問一下長照的事情部長這個台灣進入超高齡社會這個平均壽命是80.2男生76.9女生83.7那特別要強調這個數據是因為這個數據關係到整體長照的負荷和效能你從2.0要到3.0但是人力和財源要同時到位\n\n10:02.085 --> 10:21.780\n因為它影響到服務的品質還有它的可進性如果前端階段有效介入那麼延後減緩進入長照體系的速度所以資源的配置要很精準要提升照顧的品質這個是制度設計的這個關鍵也是政策精準化的重要方向好那我現在要跟你討論的是腦中風年輕化這件事\n\n10:25.622 --> 10:51.233\n腦中風年輕化我們的長照體系可以接得住這一群45歲以下就中風失能的人嗎你回答我45歲以下就失能的人我們的長照有辦法接得住他們嗎那報告委員喔這個也是很重要的議題所以我們在長照3.0會把這個部分你要怎麼接進去\n\n10:52.250 --> 11:08.588\n那個請次長回答一下非常感謝委員我想三個重點第一個我們現在3.0我們現在會來放寬就是說如果說有這一個有這個部分的話我們之前大概都是65歲以上對等等那些嘛那我們現在如果說有這個部分的話我們會來放寬\n\n11:10.350 --> 11:31.091\n你是要從年齡去放寬還是要從什麼資格因為你就室內的資格我跟委員報告其實主要是從我們住院那個PAC就是那個基金後期你都青菜公共幫委員這不是青菜公共我也知道就是現在目前中風確實有年輕化的現象你知道有多嚴重中風的人裡面幾個有一個是年輕人45歲以下你知道嗎\n\n11:32.686 --> 12:01.769\n你知不知道以前中風的比例年輕人大概占5到6%現在到幾%你知道嗎你沒有去正視這個問題你連數據都沒有幾%你知道嗎中風的人裡面有幾%是年輕人啊45歲以下你不知道我告訴你不用叫他們給你數據了15到18%而且每七個就有一個是45歲以下而且45歲以下青壯年正值事業的巔峰啊\n\n12:02.429 --> 12:18.166\n在這種狀況對家庭對他個人對整個社會的衝擊何其大那我們在講是說你知道而且都以哪一種中風有兩種出血型還有阻射型嘛你知道年輕人的中風跟老年人的中風有沒有顯著的不一樣你知道嗎\n\n12:18.966 --> 12:35.483\n年輕人是出血型比較多年輕人是出血型比較多年老的人出血型中風只佔了兩成但年輕人的中風大概五六成都是出血性的中風而且男生佔了六七成我講男生而且都是家計負擔者\n\n12:36.984 --> 13:05.933\n這很重要所以在這種狀況裡面他的代謝疾病很多人都不知道自己糖尿病不曉得自己高血脂都不知道自己有三高45歲以下誰會想到自己離死神有多遠或多近那我要問你一次說你剛剛講說PAC我現在要問你喔中風的黃金復健期是多久半年半年好那你的PAC要接觸的人有辦法接觸這一群嗎\n\n13:07.151 --> 13:26.486\n包委我們現在目前的做法是這樣現在就是在出院準備之後我們現在目前當然就是說我們現在一方面當然是縮短嘛對不對縮短之後然後現在我們也跟健保署這邊在加強加強合作就是說整個天數上面的那個縮短還有另外一個就是說我們就是沒有啦你不是天數而已啦\n\n13:26.886 --> 13:34.850\n還有中介機構就是說你現在目前整個你要回到家中間呢我們現在也在輔導你們PAC從2014年開始做這個名稱叫腦中風急性後期的照護他要解決住院的天數的問題還有復健連續性的問題然後呢在急性後期的照護進入穩定期以後轉介到復健的專門醫院在這種狀況裡面我們要講的是說他為什麼\n\n13:55.880 --> 14:05.165\n這個東西很好效果很好成效很好可是很多人沒有辦法使用的原因是在他的門檻很高他的門檻有多高你知道嗎\n\n14:06.394 --> 14:30.373\n要使用PAC計畫必須個案本身體力需要承受大量密集的復健運動醫療團隊判斷需要具備積極復健的潛能者第一要具備基本認知學習能力和意願第二要具備足夠的體力支撐下能於輪椅或船員至少為止一個小時的坐姿自己有辦法坐一小時的啊\n\n14:33.695 --> 15:01.617\n我現在要說的是說能夠進入PAC計畫的腦中風患者相對的都是失能的程度沒有那麼嚴重的啦沒有那麼嚴重的所以你這一個條件沒有改變其實年輕人一中風失能程度嚴重他沒有辦法進入PAC啊甚至他沒有任何可以接住他們因為你長照服務的四大類型適用資格是什麼\n\n15:02.738 --> 15:21.441\n保委我們現在主要大概就是那個65歲以上CMS2-8另外就是我們原住民55歲還有那個還有身障身障還有50歲以上失智但是如果年輕的中風者要符合哪一個條件\n\n15:22.362 --> 15:37.916\n只能夠等到身心障礙者的身份我們現在目前在3.0的時候我們現在目前會在整個資格上面來說來做放寬你要放寬到哪裡我現在跟你講你要先知道問題在哪裡因為你要等到他確定是殘障領到殘障所措才能進入失能的體系去\n\n15:38.857 --> 16:02.688\n那要經過半年觀察他不會認為醫療機構還有這個鑑定機構不會認為你一中風就是永久性的失能所以一定要失能一陣子確認你失能了才要給你證明你才有辦法進入長照體系那可是跟我們的黃金復健期剛好是衝突的我必須在黃金復健期馬上做這個復健然後呢否則的話\n\n16:06.512 --> 16:30.290\n可是跟黃金復健期這個年輕的中風者必須要幹什麼嗎他必須要不斷的換醫院不斷的轉換醫院雖然你們從109年開始就刪除了住院日數30天的品質指標但是每個大型醫院都會告訴腦中風的患者管你45歲以下還是45歲以上28天通通要出院\n\n16:31.190 --> 16:58.805\n理由就是病情穩定了你希望後面還有很多人中風的要用這個資源所以這復健科還不到一個月28天的年輕的中風的人他就要開始找醫院然後呢他的復健之路何其漫長他的黃金復原期很重要可是呢如果一個年輕人你在做黃金復健的時候你沒有接住他你讓他變成永久失能永久躺在那裡\n\n17:00.086 --> 17:11.783\n這個國家的長照未來的長照體系國家的醫療資源這樣不好啊你在黃金時期讓他趕快的復原能夠復原到相當程度能夠生活自理能夠照顧自己\n\n17:14.631 --> 17:37.052\n這個頭三個月這樣的一個黃金的恢復期物理治療職能治療語言治療在這種狀況裡面他才是要搶救我們第一優先資源要配置在他們身上可是我們就目前的制度沒有接觸他們沒有所以照顧者45歲以下有可能剛結婚耶他的配偶或是他的貓\n\n17:38.134 --> 17:42.157\n父母誰可以放下手邊的家庭和工作甚至小孩2歲3歲5歲10歲\n\n17:45.243 --> 18:11.741\n誰可以來接住他們他光是在都市裡面尋求大型醫院的復健科要銜接黃金復健期都已經很困難了如果你在鄉下地區醫療資源相對不特別充裕的縣市其實這些年輕的中風者會出現不論是醫療體系或是健保甚至是患者家庭最不願意看的狀況他們會躺好躺滿一直躺到生命結束\n\n18:13.286 --> 18:36.615\n這是不應該的所以這是不應該的你覺得我們部長你覺得我們要讓他們這樣子吧年輕中風七個就有一個這麼嚴重報告委員真的很感謝齁您把這個重要的問題也是一直長期這幾年來大家心中的覺得比較需要解決的問題提出來沒有啦說真的說的空的我沒理由我就跟你說啦所以你們回去要想3.0的會努力\n\n18:41.437 --> 18:48.401\n3.0要怎麼努力好好的想一下要第一優先要接觸的是年輕的中風的人中風和醫療和長照的關係是什麼\n\n18:53.957 --> 19:13.140\n跟委員報告這個從開始早先的這個症狀就要警覺啦然後呢我們健保現在有擴大那個取栓數的黃金時間最早的那段時間所以取栓數我們擴大到24小時血栓溶解劑你現在講治療醫療你現在講醫療我現在講的是長照體系要怎麼先接住他們所以我剛剛講了幾個課題嘛醫療長照\n\n19:23.363 --> 19:23.384\n哼\n\n19:25.306 --> 19:51.660\n醫療和長照和復健所以私能的部分我們現在的PAC有三種樣態啦有住院PAC有日間照護的PAC跟居家的PAC那剛剛委員講的是說要不要再把這個進PAC的條件再放寬一些因為過去呢大家討論的都是比較有potential復健的那一些才進PAC相對輕症啦不是potential啦\n\n19:53.911 --> 20:10.134\n相對輕症因為對你們來講相對輕症這種看起來改善率很好嘛可是我要告訴你是說即使不符合住院型PAC收案的條件但也不代表要放棄他們也不代表說他們沒有需求\n\n20:10.615 --> 20:18.262\n他也是會進入尋常的復健他還是有復健尋常的哪裡有尋常的復健過去衛福部示範過護理之交的PAC啦但是這個非醫院主導模式的rolemodel\n\n20:25.908 --> 20:30.269\n沒有後續沒有繼續試辦你們的PAC健保給醫院你們沒有下放到地區的這種護理之家住宿型的復健照顧機構你們這個體制我不管你用什麼方法我只想要看到年輕的腦中風的這一些人我們要在黃金時期整個長照體系照護體系要接住他們\n\n20:55.619 --> 21:15.084\n對不對我想我們會把醫療跟長照結合起來如果接不住那些有需求的年輕人未來累積的醫療費用更多長照支出更多社會支援成本更多都變成個人和整個社會難以承擔的壓力一個是走壞地方跟一個不會走壞地方\n\n21:17.826 --> 21:35.483\n你要照顧的時間不一樣資源不一樣所以你一定要讓他避免越年輕師能照顧越沉重的狀況所以你PAC跟長照銜接的好你資格要放寬你的3.0就是要計畫到那這裡來如果年輕型的腦中風依然沒有辦法納入的話\n\n21:37.125 --> 21:57.034\n那這個問題就根本沒有接觸我們醫療跟長照結合一定會接觸每一個病人我現在告訴你這裡就是沒有接觸的啊我現在告訴你這裡就是沒有被接觸的我們來演繹來改善台灣人長照制度已經涵蓋了重症兒童到高齡的長者逐步來形成這個全民式的照顧的架構可是呢\n\n21:57.554 --> 22:26.127\n透過早期的復健和這個功能的促進要減少後續的醫療支出和長照的支出而年輕型的腦狀風這一類型就是最關鍵的一個族群了是我們台灣醫療水準很高不能不容許讓我們的病人不是醫療水準而已啦醫療跟長照跟長照我請問一下那個署長那個復健不是在長照也都有護嗎\n\n22:27.387 --> 22:56.094\n你們不是都有延伸到那個長照機構裡面也有回診那個附件還是有附的你去看也要擺落骨因為都需要大附件因為前三個月前六個月大概都還需要附件床然後住在那裡然後要去附件但是大型的醫院都沒有床位啦然後這個非大型的醫院的附件人家不會認為他們的附件設施專業是到位的而年輕人需要的就是\n\n22:56.814 --> 23:09.401\n搶救他關鍵那六個月所以這個他的PAC計畫要不要放寬資格因為他很嚴格你自己我都支撐1.1億以上這中方我都自己支撐1.1億以上的中方都是相對比較輕度的再來就是說你的PAC你只有健保給付連動到大醫院沒有連動到護理之家也沒有連動到這個長照的機構沒有給沒有給付點數啦\n\n23:24.929 --> 23:33.601\n都沒有,所以這問題很嚴重,就是床也不夠可是我想講的是,45歲以下,他真的是關鍵啦要接觸他們啦\n\n","segments":[{"start":10.034,"end":27.524,"text":"好 謝謝召委是不是請我們部長和署長江署長委員好 委員請多保重對 我也希望不要感冒"},{"start":30.242,"end":56.318,"text":"這個署長曾經在2021年說過當時是教授的身份嘛那以Codex的標準每天要吃6公斤的萊豬連續吃好幾年才會超標但是這跟中毒優勢兩件事政府會把關請大家買豬肉食的時候要放輕鬆如果依照署長這個標準大概食安就是沒有食安的問題只有吃到毒物才會死的問題那我今天講說"},{"start":58.16,"end":80.482,"text":"這六天裡面來從短短六天就有驗出三批來寄的這個豬肉產品雖然都在那個我們的標準裡面但六天就有三批其實我剛才有沒有提到有退回去的有幾批減出啦減出但沒鈔票有三批那有退關的嗎"},{"start":82.652,"end":99.953,"text":"從租業方面沒有都沒有好因為署長部長和署長要提醒你喔這個對於食安的態度要兢兢業業尤其是我自己做一個媽媽作為一個家庭裡面會開火的"},{"start":101.252,"end":118.188,"text":"食安的把關者其實我的標準我個人的標準不是只有吃了會中毒吃了會有落毒的方向我自己個人是我不想要吃到那我想很多媽媽跟我一樣的心情"},{"start":119.039,"end":135.412,"text":"那我們想的說那就是透明知的權利知的權利其實就是這樣子而已你其實對抗WTO的貿易架構就是這樣子你強迫我們開了邊界我們就讓你進來但我消費者可以不買啊"},{"start":136.485,"end":164.605,"text":"就全體的世界貿易都一直都有這種情節啊你強迫我開放那我就是我可以選擇不吃不買但是國家要扮演什麼你沒有去標籤化它但是你不可以講說這個署長你丟了一句說沒見過有人吃萊克多巴胺牛肉中毒的用這種態度來善效擔心的民眾我覺得唯一不需要的是這樣子你應該想的是"},{"start":165.626,"end":189.596,"text":"人民真的很擔心因為我有選擇不吃的這個權利啊我自己因為每個人的健康管理風險都是每個人在負責的我不想要而我有慢性的我代謝疾病我慢性三高的所以這種狀況裡面你在講講得很得意洋洋說你們科學的方法在把關你們的這個border protection whatBPI你們在做什麼其實"},{"start":193.652,"end":203.414,"text":"我們都希望有政府是邊境裡面源頭把關邊境如果6天就也撿到3批雖然沒有超標那有沒有可能"},{"start":203.959,"end":220.871,"text":"在邊境裡面其實就應該要把查驗的這個強度稍微提高一下加強邊境和後市場的稽查那你在這個過程當中你一直以幾個數據來告訴我們譬如說你的新聞稿寫2021年1月1號到2025年4月30邊境報驗的豬肉和豬雜碎共計兩萬"},{"start":228.556,"end":231.098,"text":"5466批110年到114年4月間後市場對進口及國產豬肉的產品共檢驗18501件檢驗這個萊克多巴胺結果皆合格"},{"start":244.103,"end":259.151,"text":"你是這樣寫的嘛但是我要問你是說你是不是應該公佈的不是這五年裡面我減了多少每一年你減多少因為我們知道剛開始的那一年減的數量是最多的也就是2021年110年減的批次最多那到2024、2025年其實都遞減了"},{"start":269.167,"end":283.571,"text":"所以邊境抽驗的比例其實是大幅遞減的在用遞減裡面六天就檢驗出三批含有萊劑雖然沒有超標但是我們說如果在那個主管機關的立場你應該告訴大家說那我來加強邊境的把關我是不是要把抽驗的批次再增加一點當你增加了檢驗出來了覺得風險沒有增加"},{"start":297.13,"end":315.956,"text":"那這樣子對人民才有交代啊而不是在這裡說吃了要吃沒多少啦 這都合格吃不死啦我們的標準你的 如果你要講科學數據 科學分析那麼你應該把每一年減幾批公佈出來啊 每一年啊讓我們看到從2021到2025是逐年遞減的你就不要糊弄我們用一個總的數據嘛所以"},{"start":322.459,"end":339.075,"text":"萊劑的安全容許量是一回事我們有標準也是一回事但我們也有不想吃到的權利所以不要以每天吃也不會死沒看到過有人因為吃萊劑而中毒這樣的說法太輕率了"},{"start":342.398,"end":365.284,"text":"這個凸顯了官僚的心態以外也忽視了民眾對於自我健康管理的這個差異和我選擇的自由所以每個人的身體狀況不一樣代謝功能也不一樣你吃了沒事不代表我不會不舒服或不是或者是他不會生病可是我吃了就不舒服我就沒有辦法適應或是我就是根本就不想吃嘛"},{"start":369.245,"end":395.984,"text":"所以民眾做飲食選擇的依據食安的標準從來都不該指示會不會吃了會不會死吃了以後會不會生病或者你上次罵我們的是知識的缺乏才會擔心不是不是你上次罵我上次質詢你罵我們的會擔心的都是因為知識的缺乏而非基於科學的風險評估"},{"start":398.218,"end":406.689,"text":"我覺得這個態度才是最重要的不然說我吃不死啊我對食安的標準不是吃了會死的也不是說吃了會中毒的不是你要安人民的心啊 沒錯你說看嘛 對不對"},{"start":414.278,"end":436.148,"text":"報告委員,我想我們都是天下父母親,我完全了解我們吃東西要怎麼吃,那署長他也是人家的天下父母親,但是他以他過去的...對啊,他是食藥署署長啊,你不可以做一個父母說你快點吃,吃了就不會中毒,吃了就不會死,用這種標準來看待食安啊"},{"start":436.448,"end":462.706,"text":"他的意思是說他用的專業 事實上真的希望讓大家安心好啦 署長你再看一下啦我剛剛講的 當你檢驗你邊境查驗逐年遞減 而六天查到3P有減出雖然沒有超標 但是不是應該要稍微提高一下你的邊境的抽驗原來你源頭把關好了 不要流落到後市場去嘛"},{"start":463.226,"end":464.047,"text":"我們最討厭聽到業者自律,因為的確業者不可能自律"},{"start":486.415,"end":513.26,"text":"從所有食品安全破功我們都是建立在業者自律結果我們發現 屢屢發現業者自律 要求業者自律這個事情是不可能存在的都必須要他律啊對 我的意思是說這次呢 業者自己跳出來說他不需要銷出去 然後暫時都沒有要我是說他這個部分 他要做這件事其實我們都尊重他們啊對啦 我的意思是說你不應該告訴人民說這吃了沒中毒 吃了沒死不是用這個標準"},{"start":515.88,"end":539.767,"text":"報告委員我們對食安的標準不是這樣子我的意思是說對於食品安全的這個風險的評估裡面我們知道科學上的風險是什麼是是但我們要有知的權利我沒有說不定標準或是不准進來但我可以選擇不要不吃到不買對我說所以我在也非常同意委員這邊的提點但你這我責任是你必須要趕快掐牆查驗看看有沒有超標的"},{"start":545.441,"end":572.159,"text":"你應該提高查驗的這個批次然後告訴我們超標的幾乎沒有 雖然都有檢出但澳洲的全部都有檢出 譬如說是不是這樣子讓我們有知道風險 把關風險的能力要先有資訊啊我們針對這個抽驗的部分我們會持續的去做一些積極的評估我們也待會去做一些考慮謝謝委員的支持好"},{"start":572.839,"end":588.522,"text":"因為你的數據其實也有一點玩弄你不敢講逐年遞減這種事好沒關係我來問一下長照的事情部長這個台灣進入超高齡社會這個平均壽命是80.2男生76.9女生83.7那特別要強調這個數據是因為這個數據關係到整體長照的負荷和效能你從2.0要到3.0但是人力和財源要同時到位"},{"start":602.085,"end":621.78,"text":"因為它影響到服務的品質還有它的可進性如果前端階段有效介入那麼延後減緩進入長照體系的速度所以資源的配置要很精準要提升照顧的品質這個是制度設計的這個關鍵也是政策精準化的重要方向好 那我現在要跟你討論的是腦中風年輕化這件事"},{"start":625.622,"end":651.233,"text":"腦中風年輕化我們的長照體系可以接得住這一群45歲以下就中風失能的人嗎你回答我45歲以下就失能的人我們的長照有辦法接得住他們嗎那報告委員喔這個也是很重要的議題所以我們在長照3.0會把這個部分你要怎麼接進去"},{"start":652.25,"end":668.588,"text":"那個請次長回答一下非常感謝委員我想三個重點第一個我們現在3.0我們現在會來放寬就是說如果說有這一個有這個部分的話我們之前大概都是65歲以上對等等那些嘛那我們現在如果說有這個部分的話我們會來放寬"},{"start":670.35,"end":691.091,"text":"你是要從年齡去放寬還是要從什麼資格因為你就室內的資格我跟委員報告其實主要是從我們住院那個PAC就是那個基金後期你都青菜公共幫委員這不是青菜公共我也知道就是現在目前中風確實有年輕化的現象你知道有多嚴重中風的人裡面幾個有一個是年輕人45歲以下你知道嗎"},{"start":692.686,"end":721.769,"text":"你知不知道以前中風的比例年輕人大概占5到6%現在到幾%你知道嗎你沒有去正視這個問題你連數據都沒有幾%你知道嗎中風的人裡面有幾%是年輕人啊45歲以下你不知道我告訴你不用叫他們給你數據了15到18%而且每七個就有一個是45歲以下而且45歲以下青壯年正值事業的巔峰啊"},{"start":722.429,"end":738.166,"text":"在這種狀況對家庭對他個人對整個社會的衝擊何其大那我們在講是說你知道而且都以哪一種中風有兩種出血型還有阻射型嘛你知道年輕人的中風跟老年人的中風有沒有顯著的不一樣你知道嗎"},{"start":738.966,"end":755.483,"text":"年輕人是出血型比較多年輕人是出血型比較多年老的人出血型中風只佔了兩成但年輕人的中風大概五六成都是出血性的中風而且男生佔了六七成我講男生而且都是家計負擔者"},{"start":756.984,"end":785.933,"text":"這很重要所以在這種狀況裡面他的代謝疾病很多人都不知道自己糖尿病不曉得自己高血脂都不知道自己有三高45歲以下誰會想到自己離死神有多遠或多近那我要問你一次說你剛剛講說PAC我現在要問你喔中風的黃金復健期是多久半年半年好那你的PAC要接觸的人有辦法接觸這一群嗎"},{"start":787.151,"end":806.486,"text":"包委我們現在目前的做法是這樣現在就是在出院準備之後我們現在目前當然就是說我們現在一方面當然是縮短嘛對不對縮短之後然後現在我們也跟健保署這邊在加強加強合作就是說整個天數上面的那個縮短還有另外一個就是說我們就是沒有啦你不是天數而已啦"},{"start":806.886,"end":814.85,"text":"還有中介機構就是說你現在目前整個你要回到家中間呢我們現在也在輔導你們PAC從2014年開始做這個名稱叫腦中風急性後期的照護他要解決住院的天數的問題還有復健連續性的問題然後呢在急性後期的照護進入穩定期以後轉介到復健的專門醫院在這種狀況裡面我們要講的是說他為什麼"},{"start":835.88,"end":845.165,"text":"這個東西很好 效果很好 成效很好可是很多人沒有辦法使用的原因是在他的門檻很高他的門檻有多高 你知道嗎"},{"start":846.394,"end":870.373,"text":"要使用PAC計畫必須個案本身體力需要承受大量密集的復健運動醫療團隊判斷需要具備積極復健的潛能者第一要具備基本認知學習能力和意願第二要具備足夠的體力支撐下能於輪椅或船員至少為止一個小時的坐姿自己有辦法坐一小時的啊"},{"start":873.695,"end":901.617,"text":"我現在要說的是說能夠進入PAC計畫的腦中風患者相對的都是失能的程度沒有那麼嚴重的啦沒有那麼嚴重的所以你這一個條件沒有改變其實年輕人一中風失能程度嚴重他沒有辦法進入PAC啊甚至他沒有任何可以接住他們因為你長照服務的四大類型適用資格是什麼"},{"start":902.738,"end":921.441,"text":"保委我們現在主要大概就是那個65歲以上CMS2-8另外就是我們原住民55歲還有那個還有身障身障還有50歲以上失智但是如果年輕的中風者要符合哪一個條件"},{"start":922.362,"end":937.916,"text":"只能夠等到身心障礙者的身份我們現在目前在3.0的時候我們現在目前會在整個資格上面來說來做放寬你要放寬到哪裡我現在跟你講你要先知道問題在哪裡因為你要等到他確定是殘障領到殘障所措才能進入失能的體系去"},{"start":938.857,"end":962.688,"text":"那要經過半年觀察他不會認為醫療機構還有這個鑑定機構不會認為你一中風就是永久性的失能所以一定要失能一陣子確認你失能了才要給你證明你才有辦法進入長照體系那可是跟我們的黃金復健期剛好是衝突的我必須在黃金復健期馬上做這個復健然後呢否則的話"},{"start":966.512,"end":990.29,"text":"可是跟黃金復健期這個年輕的中風者必須要幹什麼嗎他必須要不斷的換醫院不斷的轉換醫院雖然你們從109年開始就刪除了住院日數30天的品質指標但是每個大型醫院都會告訴腦中風的患者管你45歲以下還是45歲以上28天通通要出院"},{"start":991.19,"end":1018.805,"text":"理由就是病情穩定了你希望後面還有很多人中風的要用這個資源所以這復健科還不到一個月28天的年輕的中風的人他就要開始找醫院然後呢他的復健之路何其漫長他的黃金復原期很重要可是呢如果一個年輕人你在做黃金復健的時候你沒有接住他你讓他變成永久失能永久躺在那裡"},{"start":1020.086,"end":1031.783,"text":"這個國家的長照 未來的長照體系 國家的醫療資源這樣不好啊 你在黃金時期讓他趕快的復原能夠復原到相當程度 能夠生活自理 能夠照顧自己"},{"start":1034.631,"end":1057.052,"text":"這個頭三個月這樣的一個黃金的恢復期物理治療職能治療語言治療在這種狀況裡面他才是要搶救我們第一優先資源要配置在他們身上可是我們就目前的制度沒有接觸他們沒有所以照顧者45歲以下有可能剛結婚耶他的配偶或是他的貓"},{"start":1058.134,"end":1062.157,"text":"父母誰可以放下手邊的家庭和工作甚至小孩2歲 3歲 5歲 10歲"},{"start":1065.243,"end":1091.741,"text":"誰可以來接住他們他光是在都市裡面尋求大型醫院的復健科要銜接黃金復健期都已經很困難了如果你在鄉下地區醫療資源相對不特別充裕的縣市其實這些年輕的中風者會出現不論是醫療體系或是健保甚至是患者家庭最不願意看的狀況他們會躺好躺滿一直躺到生命結束"},{"start":1093.286,"end":1116.615,"text":"這是不應該的所以這是不應該的你覺得我們 部長你覺得我們要讓他們這樣子吧年輕中風七個就有一個這麼嚴重 報告委員真的很感謝齁您把這個重要的問題也是一直長期這幾年來大家心中的覺得比較需要解決的問題提出來沒有啦 說真的 說的空的我沒理由 我就跟你說啦所以你們回去要想3.0的會努力"},{"start":1121.437,"end":1128.401,"text":"3.0要怎麼努力好好的想一下要第一優先要接觸的是年輕的中風的人中風和醫療和長照的關係是什麼"},{"start":1133.957,"end":1153.14,"text":"跟委員報告這個從開始早先的這個症狀就要警覺啦然後呢我們健保現在有擴大那個取栓數的黃金時間最早的那段時間所以取栓數我們擴大到24小時血栓溶解劑你現在講治療醫療你現在講醫療我現在講的是長照體系要怎麼先接住他們所以我剛剛講了幾個課題嘛醫療長照"},{"start":1163.363,"end":1163.384,"text":"哼"},{"start":1165.306,"end":1191.66,"text":"醫療和長照和復健所以私能的部分我們現在的PAC有三種樣態啦有住院PAC有日間照護的PAC跟居家的PAC那剛剛委員講的是說要不要再把這個進PAC的條件再放寬一些因為過去呢大家討論的都是比較有potential復健的那一些才進PAC相對輕症啦不是potential啦"},{"start":1193.911,"end":1210.134,"text":"相對輕症 因為對你們來講相對輕症這種看起來改善率很好嘛可是我要告訴你是說即使不符合住院型PAC 收案的條件但也不代表要放棄他們也不代表說他們沒有需求"},{"start":1210.615,"end":1218.262,"text":"他也是會進入尋常的復健他還是有復健尋常的哪裡有尋常的復健過去衛福部示範過護理之交的PAC啦但是這個非醫院主導模式的role model"},{"start":1225.908,"end":1230.269,"text":"沒有後續沒有繼續試辦你們的PAC健保給醫院你們沒有下放到地區的這種護理之家住宿型的復健照顧機構你們這個體制我不管你用什麼方法我只想要看到年輕的腦中風的這一些人我們要在黃金時期整個長照體系照護體系要接住他們"},{"start":1255.619,"end":1275.084,"text":"對不對我想我們會把醫療跟長照結合起來如果接不住那些有需求的年輕人未來累積的醫療費用更多長照支出更多社會支援成本更多都變成個人和整個社會難以承擔的壓力一個是走壞地方跟一個不會走壞地方"},{"start":1277.826,"end":1295.483,"text":"你要照顧的時間不一樣資源不一樣所以你一定要讓他避免越年輕師能照顧越沉重的狀況所以你PAC跟長照銜接的好你資格要放寬你的3.0就是要計畫到那這裡來如果年輕型的腦中風依然沒有辦法納入的話"},{"start":1297.125,"end":1317.034,"text":"那這個問題就根本沒有接觸我們醫療跟長照結合一定會接觸每一個病人我現在告訴你這裡就是沒有接觸的啊我現在告訴你這裡就是沒有被接觸的我們來演繹來改善台灣人長照制度已經涵蓋了重症兒童到高齡的長者逐步來形成這個全民式的照顧的架構可是呢"},{"start":1317.554,"end":1346.127,"text":"透過早期的復健和這個功能的促進要減少後續的醫療支出和長照的支出而年輕型的腦狀風這一類型就是最關鍵的一個族群了是我們台灣醫療水準很高不能不容許讓我們的病人不是醫療水準而已啦醫療跟長照跟長照我請問一下那個署長那個復健不是在長照也都有護嗎"},{"start":1347.387,"end":1376.094,"text":"你們不是都有延伸到那個長照機構裡面也有回診那個附件還是有附的你去看也要擺落骨 因為都需要大附件因為前三個月前六個月大概都還需要附件床然後住在那裡然後要去附件但是大型的醫院都沒有床位啦然後這個非大型的醫院的附件人家不會認為他們的附件設施專業是到位的而年輕人需要的就是"},{"start":1376.814,"end":1389.401,"text":"搶救他關鍵那六個月所以這個他的PAC計畫要不要放寬資格因為他很嚴格你自己我都支撐1.1億以上這中方我都自己支撐1.1億以上的中方都是相對比較輕度的再來就是說你的PAC你只有健保給付連動到大醫院沒有連動到護理之家也沒有連動到這個長照的機構沒有給沒有給付點數啦"},{"start":1404.929,"end":1413.601,"text":"都沒有,所以這問題很嚴重,就是床也不夠可是我想講的是,45歲以下,他真的是關鍵啦要接觸他們啦"}]}}},"gazette":{"lineno":462,"blocks":[["林委員淑芬：（10時24分）謝謝召委，請部長和姜署長。"],["邱部長泰源：委員好。委員請多保重，多喝開水。"],["林委員淑芬：對，我也希望不要感冒。署長曾經在2021年說過，當時是教授身分，以CODEX標準，每天吃6公斤萊豬，連續吃好幾年才會超標，但這跟中毒又是兩件事，政府會把關，請大家買豬肉時要放輕鬆。如果依照署長這個標準，大概就沒有食安問題，只有吃到毒物才會死的問題。我今天要講的是，短短6天驗出三批含有萊劑的豬肉產品，雖然都在標準裡面，但6天就有三批，剛才有沒有提到退回去的有幾批？喔！是檢出啦！檢出但沒超標的有三批，有退關的嗎？"],["邱部長泰源：豬肉方面沒有。"],["林委員淑芬：都沒有？好，我要提醒部長和署長，對於食安的態度要兢兢業業，尤其我自己作為一個媽媽、作為一個會開伙家庭的食安把關者，我個人的標準不是只有吃了會中毒、吃了會有多大風險，我自己個人是不想要吃到，我想很多媽媽跟我一樣的心情，所以我們想要的就是透明、知的權利，就是這樣子而已。","其實對抗WTO貿易架構就是這樣子，你強迫我們開了邊界，我就讓你進來，但消費者可以不買，這是整體世界貿易一直有的情節，你強迫我開放，那我可以選擇不吃、不買，但是國家要扮演什麼角色？你沒有去標籤化它，但是你不可以講說……署長，你丟出一句話：沒見過有人吃萊克多巴胺牛肉中毒的。用這種態度來訕笑擔心的民眾，我覺得唯一不需要的是這樣子，你應該想的是人民真的很擔心，因為我有選擇不吃的權利，因為每個人的健康管理風險都是每個人要負責，我不想要、我有代謝疾病、我有慢性三高等，在這種狀況之下，你講得很洋洋得意，說你們有科學方法在把關，你們的Border Prediction Intelligent、BPI在做什麼，其實我們都希望有政府在源頭、邊境把關，因為如果6天就檢出三批，雖然沒有超標，那有沒有可能邊境的查驗強度應該稍微提高，加強邊境和後市場的稽查？在這個過程當中，你一直以幾個數據告訴我們，譬如你在新聞稿寫：2021年1月1號到2025年4月30號，邊境報驗的豬肉和豬雜碎共計2萬5,466批；110年到114年4月間，後市場對進口及國產豬肉的產品共檢驗1萬8,501件，檢驗萊克多巴胺結果皆合格。你是這樣寫的，但是我覺得你應該公布的不是這五年裡檢了多少，而是每一年你檢多少？因為我們知道剛開始的那一年，檢的數量是最多的，也就是2021年、110年檢的批次最多，到2024、2025年其實都遞減了，就是邊境抽驗的比例其實是大幅遞減，在這種遞減之下，6天還檢驗出三批含有萊劑，雖然沒有超標，但站在主管機關立場，應該是告訴大家會加強邊境把關，把抽驗的批次再增加一點，當你增加了、檢驗出來了，覺得風險沒有增加，這樣對人民才有交代，而不是在這裡說沒吃那麼多、這都合格、吃不死的！如果要講科學數據、科學分析，那麼應該把每一年檢幾批公布出來，是每一年，讓我們看到從2021到2025是逐年遞減，而不是用一個總的數據唬弄我們嘛！","萊劑的安全容許量是一回事，我們有標準也是一回事，但我們也有不想吃到的權利，所以不要以每天吃也不會死、沒看過有人因為吃萊劑而中毒的說法告訴民眾，這樣的說法太輕率了，除了凸顯官僚心態外，也忽視了民眾對於自我健康管理的差異和選擇的自由，每個人的身體狀況不一樣，代謝功能也不一樣，你吃了沒事，不代表我不會不舒服或不適；或者他不會生病，可是我吃了就不舒服，我就沒有辦法適應，或是我根本就不想吃！民眾選擇飲食的依據，食安的標準從來都不該只是吃了會不會死、吃了以後會不會生病，或者你上次罵我們的：是知識的缺乏才會擔心。不是！不是！我上次質詢時，你罵我們：會擔心的，都是因為知識的缺乏，而非基於科學的風險評估。我覺得這個態度才是最重要的，不能說反正吃不死，我對食安的標準不是吃了會不會死，也不是吃了會不會中毒，都不是！你要安人民的心吶！部長，你講看看，是不是這樣？"],["邱部長泰源：報告委員，我想我們都是天下父母心，我完全瞭解我們吃東西要怎麼吃，署長也是人家的……也是天下父母心，但是他以他過去……"],["林委員淑芬：對啊！他是食藥署署長，他不能當人家父母卻說，趕快吃，反正吃了也不會中毒，吃了也不會死，不能用這種標準來看待食安。"],["邱部長泰源：他的意思是說，他會用他的專業、數十年來的經驗，希望讓大家安心，所以在用詞上面……"],["林委員淑芬：好啦，署長你說說看好了。我剛剛講了，當你邊境查驗逐年遞減，6天查到3批有檢出，雖然沒有超標，但是不是應該要稍微提高一下你的邊境抽驗？你源頭把關好了，不要流落到後市場嘛！"],["姜署長至剛：我先跟委員做個簡單的報告，因為邊境查到的3批其實是同一家製造廠，由兩家貿易商代理進來。原則上，業者的自制跟自主的……我們其實是給予高度的尊重，這是第一件事情。"],["林委員淑芬：我們最討厭聽到業者自律，因為業者的確不可能自律。所有食品安全的破功，都是建立在業者自律上，結果我們卻屢屢發現要求業者自律這個事情是不可能存在的，都必須要他律啦！"],["姜署長至剛：我的意思是說，這次業者自己跳出來說，他不會銷出去，暫時都沒有要……我是說他在這個部分要做這件事情，其實我們都會尊重他們。"],["林委員淑芬：對，但我的意思是，你不應該告訴人民，這個吃了不會中毒，吃了不會死，不是用這個標準，我們對食安的標準不是這樣子的。"],["姜署長至剛：報告委員，不是這個意思，我的意思是說，對於食品安全風險的評估……"],["林委員淑芬：我們知道科學上的風險是什麼，但我們要有知的權利，我們沒有說不定標準或是不准進來，但我可以選擇不要、不吃到、不買。"],["姜署長至剛：所以我也非常同意委員這邊的提點，就是從安全跟安心的……"],["林委員淑芬：但你政府有責任，你必須趕快加強查驗看看有沒有超標的，你應該提高查驗的批次，然後告訴我們超標的幾乎沒有，雖然都有檢出，像是澳洲的就是全部都有檢出，是不是這樣子？讓我們有知道風險、把關風險的能力，要先有資訊啊！"],["姜署長至剛：我們針對抽驗的部分會持續去做積極的評估，也會帶回去做一些考量，謝謝委員的支持。"],["林委員淑芬：因為你的數據其實也有一點玩弄，你不敢講逐年遞減這種事。","好，沒關係，我來問一下長照的事情。部長，臺灣進入超高齡社會，平均壽命是80.2歲，男生是76.9歲，女生是83.7歲，特別要強調這個數據是因為這個數據關係到整體長照的負荷和效能，你從2.0要到3.0，但是人力和財源要同時到位，因為它會影響到服務的品質，還有它的可近性。如果前端階段有效介入，就會延後減緩進入長照體系的速度，所以資源的配置要很精準。要提升照顧的品質，這個是制度設計的關鍵，也是政策精準化的重要方向。","我現在要跟你討論的是，腦中風年輕化這件事。因為腦中風年輕化，我們的長照體系可以接得住這一群45歲以下就中風失能的人嗎？你回答我。45歲以下就失能的人，我們的長照有辦法接得住他們嗎？"],["邱部長泰源：報告委員，這個也是一個很重要的議題，所以我們在長照3.0會把這個部分納進來。"],["林委員淑芬：你要怎麼接進去？"],["邱部長泰源：我請次長回答一下。"],["呂次長建德：非常感謝委員，我想有三個重點：第一個，現在的3.0會放寬，之前大概都是65歲以上的那些……"],["林委員淑芬：對。"],["呂次長建德：現在如果有這個部分的話，我們會來放寬。"],["林委員淑芬：你要從年齡去放寬，還是要從什麼資格？因為只有四類資格。"],["呂次長建德：我跟委員報告，其實主要是從……我們住院的PAC就是急性後期……"],["林委員淑芬：你都是隨便講講的。"],["呂次長建德：報告委員，這不是隨便講講的，我也知道現在中風確實有年輕化的現象……"],["林委員淑芬：你知不知有多嚴重？中風的人裡面，幾個有一個是年輕人（45歲以下），你知道嗎？你知不知道？以前中風的比例，年輕人大概占5%到6%，現在到百分之幾你知道嗎？你沒有去正視這個問題，你連數據都沒有，百分之幾你知道嗎？中風的人裡面，有百分之幾是年輕人在45歲以下啊？你不知道，我告訴你，不用叫他們給你數據了，是15%到18%。"],["呂次長建德：OK。"],["林委員淑芬：而且每7個人就有1個在45歲以下，45歲以下的是青壯年，正值事業的巔峰，這種狀況對他的家庭、對他個人、對整個社會的衝擊何其大！我要講的是，你也知道中風有兩種，分別出血性還有阻塞性嘛！"],["呂次長建德：對。"],["林委員淑芬：你知道年輕人的中風跟老年人的中風有沒有顯著的不一樣？你知道嗎？"],["邱部長泰源：年輕人是出血性比較多。"],["呂次長建德：對。"],["林委員淑芬：年輕人是出血性比較多，年老的人出血性的中風只占了兩成，但年輕人的中風大概有五、六成都是出血性的，而且男生占了六、七成。我要講的是男生，而且都是家計負擔者，這很重要，所以在這種情況裡面，他有代謝疾病，很多人都不知道自己的糖尿病、不曉得自己有高血脂，都不知道自己有三高，45歲以下誰會想到自己離死神有多遠？或多近？","你剛剛講到PAC，我現在問你，中風的黃金復健期是多久？"],["呂次長建德：半年。"],["林委員淑芬：半年？"],["呂次長建德：對。"],["林委員淑芬：好，你的PAC要接住的人，有辦法接住這一群嗎？"],["呂次長建德：報告委員，我們目前的作法是這樣，現在就是在出院準備之後，現在一方面當是縮短，縮短之後我們跟健保署也在加強合作，就是在整個天數上面的縮短，還有另外一個，我們最重要的是……"],["林委員淑芬：沒有啦！不是只有天數而已啦！"],["呂次長建德：委員，還有中介機構，就是說，你要回到家，中間我們現在也在輔導……"],["林委員淑芬：你們PAC從2014年開始做，這個名稱叫「腦中風急性後期照護」。"],["呂次長建德：對，沒錯。"],["林委員淑芬：它要解決住院天數的問題，還有復健連續性的問題。"],["呂次長建德：對。"],["林委員淑芬：然後呢？在急性後期的照護進入穩定期以後，就會轉介到復健的專門醫院。"],["呂次長建德：是的，沒錯。"],["林委員淑芬：在這種狀況裡面，我們要講的是，這個東西效果很好、成效很好，可是很多人沒有辦法使用的原因是在於它的門檻很高。它的門檻有多高，你知道嗎？要使用PAC計畫，必須個案本身的體力要能承受大量密集的復健運動，醫療團隊判斷須具備積極復健的潛能者。第一，要具備基本認知、學習能力和意願；第二，要具備足夠的體力，支撐能於輪椅或床緣至少維持1個小時的坐姿。要自己有辦法坐1個小時啊！我現在要說的是，能夠進入PAC計畫的腦中風患者，相對都是失能程度沒有那麼嚴重的啦！所以你這一個條件沒有改變，其實年輕人一中風，失能程度嚴重，他就沒有辦法進入PAC，甚至也沒有任何可以接住他們的地方，因為你長照服務的四大類型適用資格是什麼？跟你們部長說一下。"],["呂次長建德：報告委員，我們現在主要大概就是65歲以上……"],["林委員淑芬：65歲以上。"],["呂次長建德：CMS，2到8，還有另外就是……"],["林委員淑芬：原住民要55歲。"],["呂次長建德：對，還有身障。"],["林委員淑芬：還有身障，還有50歲以上的失智。"],["呂次長建德：對，沒錯，還有失智的部分。"],["林委員淑芬：但是年輕的中風者，要符合哪一個條件？只能夠等到身心障礙者的身分啦！"],["呂次長建德：報告委員，我們目前在3.0的時候，會就整個資格上面做放寬。"],["林委員淑芬：你要放寬到哪裡，我現在跟你講，你要先知道問題在哪裡。"],["呂次長建德：是。"],["林委員淑芬：因為你要等到他確定領到殘障手冊了，才能進入失能體系去，這要經過半年觀察，醫療機構還有鑑定機構不會認為你一中風就是永久性的失能，所以一定要失能一陣子，確認失能了，才要給你證明，你才有辦法進入長照體系。"],["呂次長建德：對。"],["林委員淑芬：可是這跟黃金復健期剛好是衝突的，我必須在黃金復健期馬上做這個復健，否則……在這個黃金復健期，年輕的中風者必須幹什麼？他必須不斷地換醫院、不斷地轉換醫院。雖然你們從109年開始就刪除了住院日數30天的品質指標，但是每個大型醫院都會告訴腦中風的患者，不管你是45歲以下還是45歲以上，28天就通通要出院，理由就是病情穩定了，後面還有很多中風的人要用這個資源，所以在復健科28天、還不到一個月，中風的年輕人就要開始找醫院，他的復健之路何其漫長？他的黃金復原期很重要，可是一個年輕人在做黃金復健的時候，你沒有接住他，讓他變成永久失能、永久躺在那裡，這樣對國家未來的長照體系、醫療資源沒有比較好！你讓他在黃金時期趕快復原，復原到相當程度能夠生活自理、照顧自己。從3個月的黃金恢復期進行物理治療、職能治療、語言治療，在這種狀況裡面，他們才是第一優先要搶救，資源要配置在他們身上，可是目前的制度沒有接住他們。45歲以下有可能剛結婚，所以照顧者可能是他的配偶或他的父母，誰可以放下手邊的家庭和工作？甚至小孩2歲、3歲、5歲、10歲，誰可以來接住他們？光是在都市裡面尋求大型醫院的復健科要銜接黃金復健期，都已經很困難了，如果在鄉下地區、醫療資源相對不特別充裕的縣市，其實這些年輕的中風者會出現不論是醫療體系或健保，甚至患者家庭最不願意看的狀況──他們會躺好躺滿，一直躺到生命結束，這是不應該的！部長，你覺得我們要讓他們這樣嗎？年輕中風7個就有1個，這麼嚴重！"],["邱部長泰源：真的很感謝您把這個重要的問題，也是這幾年來大家心中覺得比較需要解決的問題提出來。"],["林委員淑芬：不！說這個就是空的。我要問你，我都跟你說了，所以你們回去要想……"],["邱部長泰源：3.0會努力，現在……"],["林委員淑芬：好好想一下3.0要怎麼努力，第一優先要接住的是中風的年輕人……"],["邱部長泰源：健保署在這個部分也做很多。"],["林委員淑芬：中風和醫療、長照的關係是什麼？"],["石署長崇良：這個從開始、有早先的症狀就要警覺，健保現在有擴大取栓術的黃金時間，即最早的那段時間，所以取栓術擴大到24小時，血栓溶解劑……"],["林委員淑芬：你現在講的是醫療，我講的是長照體系要怎麼銜接住他們。"],["石署長崇良：我知道前面要強化、減少失能的機會，接著失能的……"],["林委員淑芬：我剛剛講幾個課題，醫療、長照和復健……"],["石署長崇良：對，有關失能的部分，現在PAC有三種樣態，有住院PAC、日間照護PAC跟居家PAC。剛剛委員講的是，要不要再把進PAC的條件再放寬一些，因為過去大家討論的都是比較有potential、復健的那一些才進PAC，不然的話，他可能……"],["林委員淑芬：相對輕症，不是potential。"],["石署長崇良：那就得是有辦法改善的。"],["林委員淑芬：對你們來講，相對輕症這種看起來改善率很好。"],["石署長崇良：對，要能夠改善。"],["林委員淑芬：可是我告訴你，即使不符合住院型PAC收案的條件，但不代表要放棄他們，也不代表他們沒有需求。"],["石署長崇良：他也是可以進入尋常的復健，他還是有復健……"],["林委員淑芬：哪裡有尋常的復健？過去衛福部試辦過護理之家的PAC，但是這個非醫院主導模式的role model，後續沒有繼續試辦。"],["石署長崇良：我們再找專家，大家來討論一下……"],["林委員淑芬：你們的PAC健保給付只付給醫院，沒有下放到地區的護理之家、住宿型的復健照顧機構，我不管你們這個體制用什麼方法，我只想要看到這一些腦中風的年輕人在黃金時期，整個長照體系、照護體系要接住他們，對不對？"],["邱部長泰源：我們會把醫療跟長照結合起來，接住這些年輕人。"],["林委員淑芬：如果接不住那些有需求的年輕人，未來累積的醫療費用更多、長照支出更多、社會資源成本更多，都變成個人和整個社會難以承擔的壓力。40歲中風跟80歲中風要照顧的時間不一樣、資源不一樣，所以一定要避免越年輕失能照護越沉重的狀況，所以PAC跟長照要銜接得好、資格要放寬，3.0就是要進化到這裡。如果年輕型的腦中風依然沒有辦法納入，這個問題就根本沒有解決，我們不認為……"],["邱部長泰源：醫療跟長照結合一定會接住每一個需要的病人。"],["林委員淑芬：我現在告訴你，這裡就是沒有被接住的。"],["邱部長泰源：我們來努力，我們來研議改善。"],["林委員淑芬：臺灣的長照制度已經涵蓋了重症兒童到高齡長者，逐步形成全齡式的照顧架構，透過早期的復健和功能的促進可以減少後續的醫療支出和長照支出，而年輕型的腦中風這一類型就是最關鍵的族群了。"],["邱部長泰源：是，臺灣醫療水準很高，不容許我們的病人求醫無門，我們一定要努力。"],["林委員淑芬：不是醫療水準而已，醫療跟長照、復健……"],["邱部長泰源：後續的照護……"],["主席：我請問一下署長，復健不是在長照也都有付嗎？你們不是都有延伸到？"],["石署長崇良：長照機構裡面也有回診，復健還是有付的。"],["林委員淑芬：你去看看要排多久，他們都還需要住院，因為前三個月、前六個月，大概都還需要復健床，住在那裡然後去復健，但是大型的醫院都沒有床位。人家不會認為非大型醫院的復健設施、專業是到位的，而年輕人需要的就是搶救關鍵那六個月，所以PAC計畫要不要放寬資格？因為它很嚴格，規定自己有辦法支撐1小時以上，如果有辦法自己支撐1小時以上的中風都是相對比較輕度的。再來，PAC的健保給付只有連動到大醫院，沒有連動到護理之家，也沒有連動到長照機構，都沒有給付點數，所以這個問題很嚴重，床也不夠。可是我跟你講，45歲以下真的是關鍵，要接住他們！"],["邱部長泰源：是，謝謝委員，我們努力。"],["主席：謝謝林委員的用心，謝謝部長。","接續請涂權吉委員質詢。"]],"agenda":{"page_end":256,"meet_id":"委員會-11-3-26-10","speakers":["蘇清泉","陳昭姿","林月琴","陳菁徽","王育敏","邱鎮軍","林淑芬","涂權吉","黃秀芳","王正旭","陳瑩","廖偉翔","陳培瑜","李坤城","徐富癸","楊瓊瓔","楊曜","劉書彬","劉建國","黃國昌","顏寬恒","張嘉郡","伍麗華Saidhai‧Tahovecahe","翁曉玲"],"page_start":163,"meetingDate":["2025-05-08"],"gazette_id":"1144701","agenda_lcidc_ids":["1144701_00005"],"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10次全體委員會議紀錄","content":"一、邀請衛生福利部部長就「長照2.0執行情形檢討及3.0未來規劃」進行專題報告，並備質詢；\n二、邀請衛生福利部部長就「澳洲進口豬腳驗出含萊克多巴胺，如何加強肉品食安查驗，讓民眾\n放心」進行專題報告，並備質詢","agenda_id":"1144701_00004"}}}