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\"text\": \"認為是重中之重尤其需要有更好的一個資訊整合的模式那醫療照顧整合依據部長你們今天提供的第七頁有關於醫療照顧整合的資訊的部分醫療跟照顧將透過大家醫計畫來整合在宅醫療在宅責任醫療等等來建構資訊管理平臺\", \"words\": [{\"word\": \"認\"}, {\"word\": \"為\"}, {\"word\": \"是\", \"start\": 155.614, \"end\": 155.954, \"score\": 0.999}, {\"word\": \"重\", \"start\": 155.954, \"end\": 156.175, \"score\": 0.975}, {\"word\": \"中\", \"start\": 156.175, \"end\": 156.395, \"score\": 0.954}, {\"word\": \"之\", \"start\": 156.395, \"end\": 156.575, \"score\": 0.997}, {\"word\": \"重\", \"start\": 156.575, \"end\": 157.355, \"score\": 0.958}, {\"word\": \"尤\", \"start\": 157.355, \"end\": 157.515, \"score\": 0.889}, {\"word\": \"其\", \"start\": 157.515, \"end\": 158.376, \"score\": 0.977}, {\"word\": \"需\", \"start\": 158.376, \"end\": 158.616, \"score\": 0.999}, {\"word\": \"要\", \"start\": 158.616, \"end\": 159.076, \"score\": 1.0}, {\"word\": \"有\", \"start\": 159.076, \"end\": 159.316, \"score\": 0.999}, {\"word\": \"更\", \"start\": 159.316, \"end\": 159.556, \"score\": 0.999}, {\"word\": 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{\"word\": \"的\", \"start\": 498.721, \"end\": 498.881, \"score\": 0.977}, {\"word\": \"概\", \"start\": 498.881, \"end\": 499.021, \"score\": 0.996}, {\"word\": \"念\", \"start\": 499.021, \"end\": 499.162, \"score\": 0.994}, {\"word\": \"也\", \"start\": 499.162, \"end\": 499.322, \"score\": 0.998}, {\"word\": \"不\", \"start\": 499.322, \"end\": 499.502, \"score\": 0.998}, {\"word\": \"對\"}, {\"word\": \"所\", \"start\": 499.502, \"end\": 500.083, \"score\": 0.922}, {\"word\": \"以\", \"start\": 500.083, \"end\": 500.223, \"score\": 0.849}, {\"word\": \"我\", \"start\": 500.223, \"end\": 500.484, \"score\": 0.917}, {\"word\": \"們\"}, {\"word\": \"再\", \"start\": 500.484, \"end\": 501.786, \"score\": 0.944}, {\"word\": \"來\"}, {\"word\": \"檢\"}, {\"word\": \"討\"}, {\"word\": \"看\", \"start\": 501.786, \"end\": 501.966, \"score\": 0.999}, {\"word\": \"看\", \"start\": 501.966, \"end\": 502.767, \"score\": 0.959}, {\"word\": \"適\"}, {\"word\": \"用\", \"start\": 502.767, \"end\": 503.168, 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00:00:55,757\n從那個小英總統到現任的賴總統真的做了非常多的努力不只經費大幅的增加而且這個服務的據點也大幅的擴充同時也贏得了非常好的滿意度表示說這個政策是非常的正確而且服務到該照顧的人民因為我們也知道進入到超高齡社會的確長照尤其是高齡者的協助照顧真的是非常非常的重要\n\n3\n00:00:57,109 --> 00:01:15,882\n這部分就在根據後判斷需要注意的事情跟部長這邊再來做討論我們也知道其實長照過程裡面很重要就是疾病本身帶來一些照顧上的問題包括林書文也提到中風\n\n4\n00:01:16,903 --> 00:01:41,373\n尤其是年輕人的送風如何能夠協助他們能夠穩定病情那同時得到好的復健最後能夠回歸到家庭回歸到社會持續對臺灣有所貢獻所以在極限期極限後期的照護到緩加以後呢這個都需要非常好的銜接才能把這個事情做好所以PAC就是極限後期的照護如果能夠做得好的話就能夠\n\n5\n00:01:42,713 --> 00:02:10,511\n讓後面的這個長照可以得到很好的改善對於醫療跟整個國家的這個資源的幫助一定是非常非常明顯我想部長一定會很確認這個觀點那再過來我們還是希望照顧不中斷的原則之下那如何針對於持續要努力的長照3.0醫療長照的這個照顧整合能夠做資訊整合的無縫接軌那\n\n6\n00:02:11,832 --> 00:02:33,873\n剛剛也有提到那如果我們要擴大這個照顧量能的話那上游跟乘坐醫院的負荷我們如何能夠同時來兼顧那最後就是有關於長照這個醫療這個資源的布局跟銜接這個都是為了我們要共同努力的地方其實資訊整合我相信大家都非常非常的\n\n7\n00:02:35,614 --> 00:03:00,568\n認為是重中之重尤其需要有更好的一個資訊整合的模式那醫療照顧整合依據部長你們今天提供的第七頁有關於醫療照顧整合的資訊的部分醫療跟照顧將透過大家醫計畫來整合在宅醫療在宅責任醫療等等來建構資訊管理平臺\n\n8\n00:03:02,209 --> 00:03:14,162\n那這個是希望透過大家的計畫來建置這個資訊管理平臺可是我們現在看到的就是PAC這兩個是不一樣的計畫那這樣的資訊平臺未來可以共用嗎\n\n9\n00:03:17,165 --> 00:03:39,580\n在處理上我們需要再注意哪一些的事情這個是我們很擔心如果他只偏待大家一計畫的所建置的這個資訊管理平臺那未來在針對長照PAC的銜接會不會造成資訊上的一些落差變成一個資訊孤島那如果這個落差存在的話\n\n10\n00:03:40,461 --> 00:03:57,941\n那我們的這個A個案管理如何能夠正確的落實讓他在這個服務裡面這麼關鍵的一個銜接工作能夠有效的來落實那這部分部長您的意見怎麼樣好謝謝委員提出的非常重要的關鍵的點我們在3.0方向\n\n11\n00:04:01,565 --> 00:04:30,222\n就是把醫療跟長照結合不漏接每一個需要的人甚至讓他更加的富能能夠恢復正常提高生活的品質所以資訊的整合才能夠避免剛剛您提的資訊孤島或者重複的資源的浪費那這個部分在社區過去20年來我們健保署跟衛生部跟政府在社區醫療群的一個\n\n12\n00:04:31,602 --> 00:04:56,859\n資訊的努力方面其實已經下了很大的功夫那以這樣的一個基礎我是覺得是最聰明跟最有效率的來結合後續不管是更多的預防保健長照的工作以這樣來講是最好的一個方向那至於現在實際上怎麼做是不是我們請健保署署長可以補充一下\n\n13\n00:04:57,219 --> 00:05:25,145\n好委員好現在是這樣我們先雖然叫做大嘉義計畫可是它後面有一個資訊系統叫做嘉義大平台那最主要它就是以人為中心把它的資料整合不論你在哪一個醫療院所看的資料以人為中心整合在一起那同時把預防保健包含CDC國健署的這些預防保健的資料也都整合起來所以是以人歸人歸戶的概念那我們現在先做到的是醫療這一塊\n\n14\n00:05:26,425 --> 00:05:55,785\n那接著我們就要去接長照服務那一塊所以等於是我們後面有一個平台一個資訊平台在做整合啦資訊的整合所以我們下一步現在正在跟長照系統這邊嘗試要把它也把它歸人進來以人為中心做整合因為這個人會變化嘛他本來過去可能是在家庭醫師計畫裡面有一天他中風了他就失能了所以其實他是一個連續性的所以我們才會以一個才不會\n\n15\n00:05:56,605 --> 00:06:23,558\n變成過去這樣好多個系統對其實我們很期待就是透過這樣的資訊平台當一位病患或者是當他要回到社區的時候他可以透過AI的這些媒合的模式他要到哪一個據點他應該執行哪一方面的復健或者是回家以後如何安排相關的一些就是從點對點的這種服務模式這樣的話才能夠完整至少就是\n\n16\n00:06:24,298 --> 00:06:38,474\n以人為本的服務模式這個是很期待透過這一次的這個計畫能夠把這方面可以持續的來落實那我們再看再過來就是說有關於這個成長部分因為當初的\n\n17\n00:06:40,141 --> 00:07:02,948\n成長的預估是3.85%根據這個長照的需求那PAC的部分如果我們要擴大這個不管是年齡的放寬早發現的失智或者是未滿65歲的中風那林書分委一直強調小於40歲的中風的這個族群已經占到將近15%那如何能夠讓這樣的服務量能\n\n18\n00:07:06,263 --> 00:07:22,815\n在考慮增加的同時也能夠造成因為醫院的負擔的情形之下如何能夠去改善它那人力跟復健的這個部分是不是能夠跟得上支付誘因是不是能夠平衡在這部分不知道部長或署長有沒有規劃\n\n19\n00:07:25,206 --> 00:07:46,192\n因為這個部分我們很感謝在健保方面都一直配合在做處理跟委員說明一下以目前我們參加PAC的乘坐醫院大概203家那他們的戰床率現在大概是差不多五成而已所以其實病床空間是有\n\n20\n00:07:46,812 --> 00:08:09,928\n那現在接下來當然要調整的就是說他的服務上的那些人力啦人力的標準啊那些搭配著支付標準我們再來檢討不過呢還是得要有一些條件不然就會變成住院的延長我們的PAC還是希望他是有復健的潛能的才進PAC的Program\n\n21\n00:08:10,228 --> 00:08:25,151\n不然還是應該要到長照不然就會變成我們PAC有三個月最長可以12週以後都變成延長住院的概念也不對所以我們再來檢討看看適用上條件的這個調整我們再來檢討\n\n22\n00:08:26,776 --> 00:08:53,257\n因為我們也知道203家這樣的這個PAC的團隊可是資源相對可能都會集中在人口集中的都會區所以如何能夠讓這個區域的缺口根據這個需要鼓勵不管是中銜或小銜的醫院地區醫院等等來增加這方面的服務模式還有剛剛也提到其實包括復健師或者是其他相關的這些人才的\n\n23\n00:08:53,897 --> 00:09:21,308\n留置在這個比較偏遠的地方也都是很重要需要請部裡面或者是書裡面這邊來加強處理的部分也希望在未來的規劃上也把這些都考量進來那再過來就是有關於這個積極賦能我們剛有提到其實如果這些在急性期當中能夠積極賦能的話對於未來的這些所需要的資源就可以大幅的下降\n\n24\n00:09:22,208 --> 00:09:35,061\n那飲食呢事實上就是讓積極富農裡面在營養的補充得到最好的一個支持的部分我們也知道在日本他們對這個非常非常的重視所以在2002年他們就\n\n25\n00:09:37,663 --> 00:10:01,837\n根據這個日本接戶食品協議會去提供非常多的標章的處置或者是協助社會如何能夠知道在需要比較主角能力下降或者是需要有其他方式來進食的民眾有很好的資訊來得到好的這個相關的幫忙跟支持那這部分台灣相對來講\n\n26\n00:10:03,018 --> 00:10:26,812\n是沒有那麼樣的進展那麼樣的這個順利所以未來是不是能夠麻煩我們部裡面或者相關的單位能夠針對於這個長照通用設計飲食不管是提供指引也好或者是提供各類的要求讓質地的這個分布可以更符合民眾的期待在處理上有更精進的做法那這部分\n\n27\n00:10:27,492 --> 00:10:50,900\n需要的是長照師國健署甚至是營養單位共同來努力那這部分就要麻煩部長來要求相關單位來把這個部分可以精進的做進一步讓國民尤其是需要這一類食品的老人家也好或者是針對這個口腔組結能力變得不好的民眾可以有效的得到指引\n\n28\n00:10:53,373 --> 00:11:20,199\n那個謝謝委員能夠關心到這個病人或者是長照的人的一個飲食的狀況因為如果能夠好好的指導他怎麼飲食或者是口腔的衛生把他照顧好然後選擇他想吃的食物以及他可以吃的食物其實我們可以讓我們的病人或者是我們的長者不需要去甕個鼻胃管\n\n29\n00:11:20,999 --> 00:11:34,775\n或是不必要的人工輸液營養這是非常重要的照顧的一個模式那這個都就是要有相關的人員的訓練當然以家屬的照顧來講我們也希望有指引\n\n30\n00:11:36,056 --> 00:11:59,597\n就像日本這樣子日本在這方面真的是相當先進值得我們來學習那我們國建署的確也做出了一個比較一般老者長者的一個食品的指引我們未來會把它弄成更個別化來努力那預計什麼時候會是台灣無管人生的元年無管的喔就沒有管制的人生\n\n31\n00:12:00,237 --> 00:12:19,014\n我們從30年前就立下誓言,表示只要安年緩和醫療的專業能夠更加的發揮,讓我們對長者照顧的模式能夠更加的有專業,我相信應該有更多的長者或病人\n\n32\n00:12:19,815 --> 00:12:33,609\n不太需要去用到不必要痛苦的鼻胃管這是我們台灣人性化很重要的一個里程碑感謝王委員多年來的努力\n\n","tsv":"start\tend\ttext\n6408\t28982\t謝謝主席我們請邱部長難得我們在台下有這麼多委員在同時在這個諮詢的過程當中在我們共同來努力 謝謝今天看了這個部長的報告前面的部分是針對於我們在長照的照護部分的確在過去\n29822\t55757\t從那個小英總統到現任的賴總統真的做了非常多的努力不只經費大幅的增加而且這個服務的據點也大幅的擴充同時也贏得了非常好的滿意度表示說這個政策是非常的正確而且服務到該照顧的人民因為我們也知道進入到超高齡社會的確長照尤其是高齡者的協助照顧真的是非常非常的重要\n57109\t75882\t這部分就在根據後判斷需要注意的事情跟部長這邊再來做討論我們也知道其實長照過程裡面很重要就是疾病本身帶來一些照顧上的問題包括林書文也提到中風\n76903\t101373\t尤其是年輕人的送風如何能夠協助他們能夠穩定病情那同時得到好的復健最後能夠回歸到家庭回歸到社會持續對臺灣有所貢獻所以在極限期極限後期的照護到緩加以後呢這個都需要非常好的銜接才能把這個事情做好所以PAC就是極限後期的照護如果能夠做得好的話就能夠\n102713\t130511\t讓後面的這個長照可以得到很好的改善對於醫療跟整個國家的這個資源的幫助一定是非常非常明顯我想部長一定會很確認這個觀點那再過來我們還是希望照顧不中斷的原則之下那如何針對於持續要努力的長照3.0醫療長照的這個照顧整合能夠做資訊整合的無縫接軌那\n131832\t153873\t剛剛也有提到那如果我們要擴大這個照顧量能的話那上游跟乘坐醫院的負荷我們如何能夠同時來兼顧那最後就是有關於長照這個醫療這個資源的布局跟銜接這個都是為了我們要共同努力的地方其實資訊整合我相信大家都非常非常的\n155614\t180568\t認為是重中之重尤其需要有更好的一個資訊整合的模式那醫療照顧整合依據部長你們今天提供的第七頁有關於醫療照顧整合的資訊的部分醫療跟照顧將透過大家醫計畫來整合在宅醫療在宅責任醫療等等來建構資訊管理平臺\n182209\t194162\t那這個是希望透過大家的計畫來建置這個資訊管理平臺可是我們現在看到的就是PAC這兩個是不一樣的計畫那這樣的資訊平臺未來可以共用嗎\n197165\t219580\t在處理上我們需要再注意哪一些的事情這個是我們很擔心如果他只偏待大家一計畫的所建置的這個資訊管理平臺那未來在針對長照PAC的銜接會不會造成資訊上的一些落差變成一個資訊孤島那如果這個落差存在的話\n220461\t237941\t那我們的這個A個案管理如何能夠正確的落實讓他在這個服務裡面這麼關鍵的一個銜接工作能夠有效的來落實那這部分部長您的意見怎麼樣好 謝謝委員提出的非常重要的關鍵的點我們在3.0方向\n241565\t270222\t就是把醫療跟長照結合不漏接每一個需要的人甚至讓他更加的富能能夠恢復正常提高生活的品質所以資訊的整合才能夠避免剛剛您提的資訊孤島或者重複的資源的浪費那這個部分在社區過去20年來我們健保署跟衛生部跟政府在社區醫療群的一個\n271602\t296859\t資訊的努力方面其實已經下了很大的功夫那以這樣的一個基礎我是覺得是最聰明跟最有效率的來結合後續不管是更多的預防保健長照的工作以這樣來講是最好的一個方向那至於現在實際上怎麼做是不是我們請健保署署長可以補充一下\n297219\t325145\t好 委員好現在是這樣我們先雖然叫做大嘉義計畫可是它後面有一個資訊系統叫做嘉義大平台那最主要它就是以人為中心把它的資料整合不論你在哪一個醫療院所看的資料以人為中心整合在一起那同時把預防保健包含CDC國健署的這些預防保健的資料也都整合起來所以是以人歸人歸戶的概念那我們現在先做到的是醫療這一塊\n326425\t355785\t那接著我們就要去接長照服務那一塊所以等於是我們後面有一個平台一個資訊平台在做整合啦資訊的整合所以我們下一步現在正在跟長照系統這邊嘗試要把它也把它歸人進來以人為中心做整合因為這個人會變化嘛他本來過去可能是在家庭醫師計畫裡面有一天他中風了他就失能了所以其實他是一個連續性的所以我們才會以一個才不會\n356605\t383558\t變成過去這樣好多個系統對其實我們很期待就是透過這樣的資訊平台當一位病患或者是當他要回到社區的時候他可以透過AI的這些媒合的模式他要到哪一個據點他應該執行哪一方面的復健或者是回家以後如何安排相關的一些就是從點對點的這種服務模式這樣的話才能夠完整至少就是\n384298\t398474\t以人為本的服務模式這個是很期待透過這一次的這個計畫能夠把這方面可以持續的來落實那我們再看再過來就是說有關於這個成長部分因為當初的\n400141\t422948\t成長的預估是3.85%根據這個長照的需求那PAC的部分如果我們要擴大這個不管是年齡的放寬早發現的失智或者是未滿65歲的中風那林書分委一直強調小於40歲的中風的這個族群已經占到將近15%那如何能夠讓這樣的服務量能\n426263\t442815\t在考慮增加的同時也能夠造成因為醫院的負擔的情形之下如何能夠去改善它那人力跟復健的這個部分是不是能夠跟得上支付誘因是不是能夠平衡在這部分不知道部長或署長有沒有規劃\n445206\t466192\t因為這個部分我們很感謝在健保方面都一直配合在做處理跟委員說明一下以目前我們參加PAC的乘坐醫院大概203家那他們的戰床率現在大概是差不多五成而已所以其實病床空間是有\n466812\t489928\t那現在接下來當然要調整的就是說他的服務上的那些人力啦人力的標準啊那些搭配著支付標準我們再來檢討不過呢還是得要有一些條件不然就會變成住院的延長我們的PAC還是希望他是有復健的潛能的才進PAC的Program\n490228\t505151\t不然還是應該要到長照不然就會變成我們PAC有三個月最長可以12週以後都變成延長住院的概念也不對所以我們再來檢討看看適用上條件的這個調整我們再來檢討\n506776\t533257\t因為我們也知道203家這樣的這個PAC的團隊可是資源相對可能都會集中在人口集中的都會區所以如何能夠讓這個區域的缺口根據這個需要鼓勵不管是中銜或小銜的醫院地區醫院等等來增加這方面的服務模式還有剛剛也提到其實包括復健師或者是其他相關的這些人才的\n533897\t561308\t留置在這個比較偏遠的地方也都是很重要需要請部裡面或者是書裡面這邊來加強處理的部分也希望在未來的規劃上也把這些都考量進來那再過來就是有關於這個積極賦能我們剛有提到其實如果這些在急性期當中能夠積極賦能的話對於未來的這些所需要的資源就可以大幅的下降\n562208\t575061\t那飲食呢事實上就是讓積極富農裡面在營養的補充得到最好的一個支持的部分我們也知道在日本他們對這個非常非常的重視所以在2002年他們就\n577663\t601837\t根據這個日本接戶食品協議會去提供非常多的標章的處置或者是協助社會如何能夠知道在需要比較主角能力下降或者是需要有其他方式來進食的民眾有很好的資訊來得到好的這個相關的幫忙跟支持那這部分台灣相對來講\n603018\t626812\t是沒有那麼樣的進展那麼樣的這個順利所以未來是不是能夠麻煩我們部裡面或者相關的單位能夠針對於這個長照通用設計飲食不管是提供指引也好或者是提供各類的要求讓質地的這個分布可以更符合民眾的期待在處理上有更精進的做法那這部分\n627492\t650900\t需要的是長照師國健署甚至是營養單位共同來努力那這部分就要麻煩部長來要求相關單位來把這個部分可以精進的做進一步讓國民尤其是需要這一類食品的老人家也好或者是針對這個口腔組結能力變得不好的民眾可以有效的得到指引\n653373\t680199\t那個謝謝委員能夠關心到這個病人或者是長照的人的一個飲食的狀況因為如果能夠好好的指導他怎麼飲食或者是口腔的衛生把他照顧好然後選擇他想吃的食物以及他可以吃的食物其實我們可以讓我們的病人或者是我們的長者不需要去甕個鼻胃管\n680999\t694775\t或是不必要的人工輸液營養這是非常重要的照顧的一個模式那這個都就是要有相關的人員的訓練當然以家屬的照顧來講我們也希望有指引\n696056\t719597\t就像日本這樣子 日本在這方面真的是相當先進 值得我們來學習那我們國建署的確也做出了一個比較一般老者長者的一個食品的指引我們未來會把它弄成更個別化來努力那預計什麼時候會是台灣無管人生的元年無管的喔就沒有管制的人生\n720237\t739014\t我們從30年前就立下誓言,表示只要安年緩和醫療的專業能夠更加的發揮,讓我們對長者照顧的模式能夠更加的有專業,我相信應該有更多的長者或病人\n739815\t753609\t不太需要去用到不必要痛苦的鼻胃管這是我們台灣人性化很重要的一個里程碑感謝王委員多年來的努力\n","txt":"謝謝主席我們請邱部長難得我們在台下有這麼多委員在同時在這個諮詢的過程當中在我們共同來努力 謝謝今天看了這個部長的報告前面的部分是針對於我們在長照的照護部分的確在過去\n從那個小英總統到現任的賴總統真的做了非常多的努力不只經費大幅的增加而且這個服務的據點也大幅的擴充同時也贏得了非常好的滿意度表示說這個政策是非常的正確而且服務到該照顧的人民因為我們也知道進入到超高齡社會的確長照尤其是高齡者的協助照顧真的是非常非常的重要\n這部分就在根據後判斷需要注意的事情跟部長這邊再來做討論我們也知道其實長照過程裡面很重要就是疾病本身帶來一些照顧上的問題包括林書文也提到中風\n尤其是年輕人的送風如何能夠協助他們能夠穩定病情那同時得到好的復健最後能夠回歸到家庭回歸到社會持續對臺灣有所貢獻所以在極限期極限後期的照護到緩加以後呢這個都需要非常好的銜接才能把這個事情做好所以PAC就是極限後期的照護如果能夠做得好的話就能夠\n讓後面的這個長照可以得到很好的改善對於醫療跟整個國家的這個資源的幫助一定是非常非常明顯我想部長一定會很確認這個觀點那再過來我們還是希望照顧不中斷的原則之下那如何針對於持續要努力的長照3.0醫療長照的這個照顧整合能夠做資訊整合的無縫接軌那\n剛剛也有提到那如果我們要擴大這個照顧量能的話那上游跟乘坐醫院的負荷我們如何能夠同時來兼顧那最後就是有關於長照這個醫療這個資源的布局跟銜接這個都是為了我們要共同努力的地方其實資訊整合我相信大家都非常非常的\n認為是重中之重尤其需要有更好的一個資訊整合的模式那醫療照顧整合依據部長你們今天提供的第七頁有關於醫療照顧整合的資訊的部分醫療跟照顧將透過大家醫計畫來整合在宅醫療在宅責任醫療等等來建構資訊管理平臺\n那這個是希望透過大家的計畫來建置這個資訊管理平臺可是我們現在看到的就是PAC這兩個是不一樣的計畫那這樣的資訊平臺未來可以共用嗎\n在處理上我們需要再注意哪一些的事情這個是我們很擔心如果他只偏待大家一計畫的所建置的這個資訊管理平臺那未來在針對長照PAC的銜接會不會造成資訊上的一些落差變成一個資訊孤島那如果這個落差存在的話\n那我們的這個A個案管理如何能夠正確的落實讓他在這個服務裡面這麼關鍵的一個銜接工作能夠有效的來落實那這部分部長您的意見怎麼樣好 謝謝委員提出的非常重要的關鍵的點我們在3.0方向\n就是把醫療跟長照結合不漏接每一個需要的人甚至讓他更加的富能能夠恢復正常提高生活的品質所以資訊的整合才能夠避免剛剛您提的資訊孤島或者重複的資源的浪費那這個部分在社區過去20年來我們健保署跟衛生部跟政府在社區醫療群的一個\n資訊的努力方面其實已經下了很大的功夫那以這樣的一個基礎我是覺得是最聰明跟最有效率的來結合後續不管是更多的預防保健長照的工作以這樣來講是最好的一個方向那至於現在實際上怎麼做是不是我們請健保署署長可以補充一下\n好 委員好現在是這樣我們先雖然叫做大嘉義計畫可是它後面有一個資訊系統叫做嘉義大平台那最主要它就是以人為中心把它的資料整合不論你在哪一個醫療院所看的資料以人為中心整合在一起那同時把預防保健包含CDC國健署的這些預防保健的資料也都整合起來所以是以人歸人歸戶的概念那我們現在先做到的是醫療這一塊\n那接著我們就要去接長照服務那一塊所以等於是我們後面有一個平台一個資訊平台在做整合啦資訊的整合所以我們下一步現在正在跟長照系統這邊嘗試要把它也把它歸人進來以人為中心做整合因為這個人會變化嘛他本來過去可能是在家庭醫師計畫裡面有一天他中風了他就失能了所以其實他是一個連續性的所以我們才會以一個才不會\n變成過去這樣好多個系統對其實我們很期待就是透過這樣的資訊平台當一位病患或者是當他要回到社區的時候他可以透過AI的這些媒合的模式他要到哪一個據點他應該執行哪一方面的復健或者是回家以後如何安排相關的一些就是從點對點的這種服務模式這樣的話才能夠完整至少就是\n以人為本的服務模式這個是很期待透過這一次的這個計畫能夠把這方面可以持續的來落實那我們再看再過來就是說有關於這個成長部分因為當初的\n成長的預估是3.85%根據這個長照的需求那PAC的部分如果我們要擴大這個不管是年齡的放寬早發現的失智或者是未滿65歲的中風那林書分委一直強調小於40歲的中風的這個族群已經占到將近15%那如何能夠讓這樣的服務量能\n在考慮增加的同時也能夠造成因為醫院的負擔的情形之下如何能夠去改善它那人力跟復健的這個部分是不是能夠跟得上支付誘因是不是能夠平衡在這部分不知道部長或署長有沒有規劃\n因為這個部分我們很感謝在健保方面都一直配合在做處理跟委員說明一下以目前我們參加PAC的乘坐醫院大概203家那他們的戰床率現在大概是差不多五成而已所以其實病床空間是有\n那現在接下來當然要調整的就是說他的服務上的那些人力啦人力的標準啊那些搭配著支付標準我們再來檢討不過呢還是得要有一些條件不然就會變成住院的延長我們的PAC還是希望他是有復健的潛能的才進PAC的Program\n不然還是應該要到長照不然就會變成我們PAC有三個月最長可以12週以後都變成延長住院的概念也不對所以我們再來檢討看看適用上條件的這個調整我們再來檢討\n因為我們也知道203家這樣的這個PAC的團隊可是資源相對可能都會集中在人口集中的都會區所以如何能夠讓這個區域的缺口根據這個需要鼓勵不管是中銜或小銜的醫院地區醫院等等來增加這方面的服務模式還有剛剛也提到其實包括復健師或者是其他相關的這些人才的\n留置在這個比較偏遠的地方也都是很重要需要請部裡面或者是書裡面這邊來加強處理的部分也希望在未來的規劃上也把這些都考量進來那再過來就是有關於這個積極賦能我們剛有提到其實如果這些在急性期當中能夠積極賦能的話對於未來的這些所需要的資源就可以大幅的下降\n那飲食呢事實上就是讓積極富農裡面在營養的補充得到最好的一個支持的部分我們也知道在日本他們對這個非常非常的重視所以在2002年他們就\n根據這個日本接戶食品協議會去提供非常多的標章的處置或者是協助社會如何能夠知道在需要比較主角能力下降或者是需要有其他方式來進食的民眾有很好的資訊來得到好的這個相關的幫忙跟支持那這部分台灣相對來講\n是沒有那麼樣的進展那麼樣的這個順利所以未來是不是能夠麻煩我們部裡面或者相關的單位能夠針對於這個長照通用設計飲食不管是提供指引也好或者是提供各類的要求讓質地的這個分布可以更符合民眾的期待在處理上有更精進的做法那這部分\n需要的是長照師國健署甚至是營養單位共同來努力那這部分就要麻煩部長來要求相關單位來把這個部分可以精進的做進一步讓國民尤其是需要這一類食品的老人家也好或者是針對這個口腔組結能力變得不好的民眾可以有效的得到指引\n那個謝謝委員能夠關心到這個病人或者是長照的人的一個飲食的狀況因為如果能夠好好的指導他怎麼飲食或者是口腔的衛生把他照顧好然後選擇他想吃的食物以及他可以吃的食物其實我們可以讓我們的病人或者是我們的長者不需要去甕個鼻胃管\n或是不必要的人工輸液營養這是非常重要的照顧的一個模式那這個都就是要有相關的人員的訓練當然以家屬的照顧來講我們也希望有指引\n就像日本這樣子 日本在這方面真的是相當先進 值得我們來學習那我們國建署的確也做出了一個比較一般老者長者的一個食品的指引我們未來會把它弄成更個別化來努力那預計什麼時候會是台灣無管人生的元年無管的喔就沒有管制的人生\n我們從30年前就立下誓言,表示只要安年緩和醫療的專業能夠更加的發揮,讓我們對長者照顧的模式能夠更加的有專業,我相信應該有更多的長者或病人\n不太需要去用到不必要痛苦的鼻胃管這是我們台灣人性化很重要的一個里程碑感謝王委員多年來的努力\n","vtt":"WEBVTT\n\n00:06.408 --> 00:28.982\n謝謝主席我們請邱部長難得我們在台下有這麼多委員在同時在這個諮詢的過程當中在我們共同來努力謝謝今天看了這個部長的報告前面的部分是針對於我們在長照的照護部分的確在過去\n\n00:29.822 --> 00:55.757\n從那個小英總統到現任的賴總統真的做了非常多的努力不只經費大幅的增加而且這個服務的據點也大幅的擴充同時也贏得了非常好的滿意度表示說這個政策是非常的正確而且服務到該照顧的人民因為我們也知道進入到超高齡社會的確長照尤其是高齡者的協助照顧真的是非常非常的重要\n\n00:57.109 --> 01:15.882\n這部分就在根據後判斷需要注意的事情跟部長這邊再來做討論我們也知道其實長照過程裡面很重要就是疾病本身帶來一些照顧上的問題包括林書文也提到中風\n\n01:16.903 --> 01:41.373\n尤其是年輕人的送風如何能夠協助他們能夠穩定病情那同時得到好的復健最後能夠回歸到家庭回歸到社會持續對臺灣有所貢獻所以在極限期極限後期的照護到緩加以後呢這個都需要非常好的銜接才能把這個事情做好所以PAC就是極限後期的照護如果能夠做得好的話就能夠\n\n01:42.713 --> 02:10.511\n讓後面的這個長照可以得到很好的改善對於醫療跟整個國家的這個資源的幫助一定是非常非常明顯我想部長一定會很確認這個觀點那再過來我們還是希望照顧不中斷的原則之下那如何針對於持續要努力的長照3.0醫療長照的這個照顧整合能夠做資訊整合的無縫接軌那\n\n02:11.832 --> 02:33.873\n剛剛也有提到那如果我們要擴大這個照顧量能的話那上游跟乘坐醫院的負荷我們如何能夠同時來兼顧那最後就是有關於長照這個醫療這個資源的布局跟銜接這個都是為了我們要共同努力的地方其實資訊整合我相信大家都非常非常的\n\n02:35.614 --> 03:00.568\n認為是重中之重尤其需要有更好的一個資訊整合的模式那醫療照顧整合依據部長你們今天提供的第七頁有關於醫療照顧整合的資訊的部分醫療跟照顧將透過大家醫計畫來整合在宅醫療在宅責任醫療等等來建構資訊管理平臺\n\n03:02.209 --> 03:14.162\n那這個是希望透過大家的計畫來建置這個資訊管理平臺可是我們現在看到的就是PAC這兩個是不一樣的計畫那這樣的資訊平臺未來可以共用嗎\n\n03:17.165 --> 03:39.580\n在處理上我們需要再注意哪一些的事情這個是我們很擔心如果他只偏待大家一計畫的所建置的這個資訊管理平臺那未來在針對長照PAC的銜接會不會造成資訊上的一些落差變成一個資訊孤島那如果這個落差存在的話\n\n03:40.461 --> 03:57.941\n那我們的這個A個案管理如何能夠正確的落實讓他在這個服務裡面這麼關鍵的一個銜接工作能夠有效的來落實那這部分部長您的意見怎麼樣好謝謝委員提出的非常重要的關鍵的點我們在3.0方向\n\n04:01.565 --> 04:30.222\n就是把醫療跟長照結合不漏接每一個需要的人甚至讓他更加的富能能夠恢復正常提高生活的品質所以資訊的整合才能夠避免剛剛您提的資訊孤島或者重複的資源的浪費那這個部分在社區過去20年來我們健保署跟衛生部跟政府在社區醫療群的一個\n\n04:31.602 --> 04:56.859\n資訊的努力方面其實已經下了很大的功夫那以這樣的一個基礎我是覺得是最聰明跟最有效率的來結合後續不管是更多的預防保健長照的工作以這樣來講是最好的一個方向那至於現在實際上怎麼做是不是我們請健保署署長可以補充一下\n\n04:57.219 --> 05:25.145\n好委員好現在是這樣我們先雖然叫做大嘉義計畫可是它後面有一個資訊系統叫做嘉義大平台那最主要它就是以人為中心把它的資料整合不論你在哪一個醫療院所看的資料以人為中心整合在一起那同時把預防保健包含CDC國健署的這些預防保健的資料也都整合起來所以是以人歸人歸戶的概念那我們現在先做到的是醫療這一塊\n\n05:26.425 --> 05:55.785\n那接著我們就要去接長照服務那一塊所以等於是我們後面有一個平台一個資訊平台在做整合啦資訊的整合所以我們下一步現在正在跟長照系統這邊嘗試要把它也把它歸人進來以人為中心做整合因為這個人會變化嘛他本來過去可能是在家庭醫師計畫裡面有一天他中風了他就失能了所以其實他是一個連續性的所以我們才會以一個才不會\n\n05:56.605 --> 06:23.558\n變成過去這樣好多個系統對其實我們很期待就是透過這樣的資訊平台當一位病患或者是當他要回到社區的時候他可以透過AI的這些媒合的模式他要到哪一個據點他應該執行哪一方面的復健或者是回家以後如何安排相關的一些就是從點對點的這種服務模式這樣的話才能夠完整至少就是\n\n06:24.298 --> 06:38.474\n以人為本的服務模式這個是很期待透過這一次的這個計畫能夠把這方面可以持續的來落實那我們再看再過來就是說有關於這個成長部分因為當初的\n\n06:40.141 --> 07:02.948\n成長的預估是3.85%根據這個長照的需求那PAC的部分如果我們要擴大這個不管是年齡的放寬早發現的失智或者是未滿65歲的中風那林書分委一直強調小於40歲的中風的這個族群已經占到將近15%那如何能夠讓這樣的服務量能\n\n07:06.263 --> 07:22.815\n在考慮增加的同時也能夠造成因為醫院的負擔的情形之下如何能夠去改善它那人力跟復健的這個部分是不是能夠跟得上支付誘因是不是能夠平衡在這部分不知道部長或署長有沒有規劃\n\n07:25.206 --> 07:46.192\n因為這個部分我們很感謝在健保方面都一直配合在做處理跟委員說明一下以目前我們參加PAC的乘坐醫院大概203家那他們的戰床率現在大概是差不多五成而已所以其實病床空間是有\n\n07:46.812 --> 08:09.928\n那現在接下來當然要調整的就是說他的服務上的那些人力啦人力的標準啊那些搭配著支付標準我們再來檢討不過呢還是得要有一些條件不然就會變成住院的延長我們的PAC還是希望他是有復健的潛能的才進PAC的Program\n\n08:10.228 --> 08:25.151\n不然還是應該要到長照不然就會變成我們PAC有三個月最長可以12週以後都變成延長住院的概念也不對所以我們再來檢討看看適用上條件的這個調整我們再來檢討\n\n08:26.776 --> 08:53.257\n因為我們也知道203家這樣的這個PAC的團隊可是資源相對可能都會集中在人口集中的都會區所以如何能夠讓這個區域的缺口根據這個需要鼓勵不管是中銜或小銜的醫院地區醫院等等來增加這方面的服務模式還有剛剛也提到其實包括復健師或者是其他相關的這些人才的\n\n08:53.897 --> 09:21.308\n留置在這個比較偏遠的地方也都是很重要需要請部裡面或者是書裡面這邊來加強處理的部分也希望在未來的規劃上也把這些都考量進來那再過來就是有關於這個積極賦能我們剛有提到其實如果這些在急性期當中能夠積極賦能的話對於未來的這些所需要的資源就可以大幅的下降\n\n09:22.208 --> 09:35.061\n那飲食呢事實上就是讓積極富農裡面在營養的補充得到最好的一個支持的部分我們也知道在日本他們對這個非常非常的重視所以在2002年他們就\n\n09:37.663 --> 10:01.837\n根據這個日本接戶食品協議會去提供非常多的標章的處置或者是協助社會如何能夠知道在需要比較主角能力下降或者是需要有其他方式來進食的民眾有很好的資訊來得到好的這個相關的幫忙跟支持那這部分台灣相對來講\n\n10:03.018 --> 10:26.812\n是沒有那麼樣的進展那麼樣的這個順利所以未來是不是能夠麻煩我們部裡面或者相關的單位能夠針對於這個長照通用設計飲食不管是提供指引也好或者是提供各類的要求讓質地的這個分布可以更符合民眾的期待在處理上有更精進的做法那這部分\n\n10:27.492 --> 10:50.900\n需要的是長照師國健署甚至是營養單位共同來努力那這部分就要麻煩部長來要求相關單位來把這個部分可以精進的做進一步讓國民尤其是需要這一類食品的老人家也好或者是針對這個口腔組結能力變得不好的民眾可以有效的得到指引\n\n10:53.373 --> 11:20.199\n那個謝謝委員能夠關心到這個病人或者是長照的人的一個飲食的狀況因為如果能夠好好的指導他怎麼飲食或者是口腔的衛生把他照顧好然後選擇他想吃的食物以及他可以吃的食物其實我們可以讓我們的病人或者是我們的長者不需要去甕個鼻胃管\n\n11:20.999 --> 11:34.775\n或是不必要的人工輸液營養這是非常重要的照顧的一個模式那這個都就是要有相關的人員的訓練當然以家屬的照顧來講我們也希望有指引\n\n11:36.056 --> 11:59.597\n就像日本這樣子日本在這方面真的是相當先進值得我們來學習那我們國建署的確也做出了一個比較一般老者長者的一個食品的指引我們未來會把它弄成更個別化來努力那預計什麼時候會是台灣無管人生的元年無管的喔就沒有管制的人生\n\n12:00.237 --> 12:19.014\n我們從30年前就立下誓言,表示只要安年緩和醫療的專業能夠更加的發揮,讓我們對長者照顧的模式能夠更加的有專業,我相信應該有更多的長者或病人\n\n12:19.815 --> 12:33.609\n不太需要去用到不必要痛苦的鼻胃管這是我們台灣人性化很重要的一個里程碑感謝王委員多年來的努力\n\n","segments":[{"start":6.408,"end":28.982,"text":"謝謝主席我們請邱部長難得我們在台下有這麼多委員在同時在這個諮詢的過程當中在我們共同來努力 謝謝今天看了這個部長的報告前面的部分是針對於我們在長照的照護部分的確在過去"},{"start":29.822,"end":55.757,"text":"從那個小英總統到現任的賴總統真的做了非常多的努力不只經費大幅的增加而且這個服務的據點也大幅的擴充同時也贏得了非常好的滿意度表示說這個政策是非常的正確而且服務到該照顧的人民因為我們也知道進入到超高齡社會的確長照尤其是高齡者的協助照顧真的是非常非常的重要"},{"start":57.109,"end":75.882,"text":"這部分就在根據後判斷需要注意的事情跟部長這邊再來做討論我們也知道其實長照過程裡面很重要就是疾病本身帶來一些照顧上的問題包括林書文也提到中風"},{"start":76.903,"end":101.373,"text":"尤其是年輕人的送風如何能夠協助他們能夠穩定病情那同時得到好的復健最後能夠回歸到家庭回歸到社會持續對臺灣有所貢獻所以在極限期極限後期的照護到緩加以後呢這個都需要非常好的銜接才能把這個事情做好所以PAC就是極限後期的照護如果能夠做得好的話就能夠"},{"start":102.713,"end":130.511,"text":"讓後面的這個長照可以得到很好的改善對於醫療跟整個國家的這個資源的幫助一定是非常非常明顯我想部長一定會很確認這個觀點那再過來我們還是希望照顧不中斷的原則之下那如何針對於持續要努力的長照3.0醫療長照的這個照顧整合能夠做資訊整合的無縫接軌那"},{"start":131.832,"end":153.873,"text":"剛剛也有提到那如果我們要擴大這個照顧量能的話那上游跟乘坐醫院的負荷我們如何能夠同時來兼顧那最後就是有關於長照這個醫療這個資源的布局跟銜接這個都是為了我們要共同努力的地方其實資訊整合我相信大家都非常非常的"},{"start":155.614,"end":180.568,"text":"認為是重中之重尤其需要有更好的一個資訊整合的模式那醫療照顧整合依據部長你們今天提供的第七頁有關於醫療照顧整合的資訊的部分醫療跟照顧將透過大家醫計畫來整合在宅醫療在宅責任醫療等等來建構資訊管理平臺"},{"start":182.209,"end":194.162,"text":"那這個是希望透過大家的計畫來建置這個資訊管理平臺可是我們現在看到的就是PAC這兩個是不一樣的計畫那這樣的資訊平臺未來可以共用嗎"},{"start":197.165,"end":219.58,"text":"在處理上我們需要再注意哪一些的事情這個是我們很擔心如果他只偏待大家一計畫的所建置的這個資訊管理平臺那未來在針對長照PAC的銜接會不會造成資訊上的一些落差變成一個資訊孤島那如果這個落差存在的話"},{"start":220.461,"end":237.941,"text":"那我們的這個A個案管理如何能夠正確的落實讓他在這個服務裡面這麼關鍵的一個銜接工作能夠有效的來落實那這部分部長您的意見怎麼樣好 謝謝委員提出的非常重要的關鍵的點我們在3.0方向"},{"start":241.565,"end":270.222,"text":"就是把醫療跟長照結合不漏接每一個需要的人甚至讓他更加的富能能夠恢復正常提高生活的品質所以資訊的整合才能夠避免剛剛您提的資訊孤島或者重複的資源的浪費那這個部分在社區過去20年來我們健保署跟衛生部跟政府在社區醫療群的一個"},{"start":271.602,"end":296.859,"text":"資訊的努力方面其實已經下了很大的功夫那以這樣的一個基礎我是覺得是最聰明跟最有效率的來結合後續不管是更多的預防保健長照的工作以這樣來講是最好的一個方向那至於現在實際上怎麼做是不是我們請健保署署長可以補充一下"},{"start":297.219,"end":325.145,"text":"好 委員好現在是這樣我們先雖然叫做大嘉義計畫可是它後面有一個資訊系統叫做嘉義大平台那最主要它就是以人為中心把它的資料整合不論你在哪一個醫療院所看的資料以人為中心整合在一起那同時把預防保健包含CDC國健署的這些預防保健的資料也都整合起來所以是以人歸人歸戶的概念那我們現在先做到的是醫療這一塊"},{"start":326.425,"end":355.785,"text":"那接著我們就要去接長照服務那一塊所以等於是我們後面有一個平台一個資訊平台在做整合啦資訊的整合所以我們下一步現在正在跟長照系統這邊嘗試要把它也把它歸人進來以人為中心做整合因為這個人會變化嘛他本來過去可能是在家庭醫師計畫裡面有一天他中風了他就失能了所以其實他是一個連續性的所以我們才會以一個才不會"},{"start":356.605,"end":383.558,"text":"變成過去這樣好多個系統對其實我們很期待就是透過這樣的資訊平台當一位病患或者是當他要回到社區的時候他可以透過AI的這些媒合的模式他要到哪一個據點他應該執行哪一方面的復健或者是回家以後如何安排相關的一些就是從點對點的這種服務模式這樣的話才能夠完整至少就是"},{"start":384.298,"end":398.474,"text":"以人為本的服務模式這個是很期待透過這一次的這個計畫能夠把這方面可以持續的來落實那我們再看再過來就是說有關於這個成長部分因為當初的"},{"start":400.141,"end":422.948,"text":"成長的預估是3.85%根據這個長照的需求那PAC的部分如果我們要擴大這個不管是年齡的放寬早發現的失智或者是未滿65歲的中風那林書分委一直強調小於40歲的中風的這個族群已經占到將近15%那如何能夠讓這樣的服務量能"},{"start":426.263,"end":442.815,"text":"在考慮增加的同時也能夠造成因為醫院的負擔的情形之下如何能夠去改善它那人力跟復健的這個部分是不是能夠跟得上支付誘因是不是能夠平衡在這部分不知道部長或署長有沒有規劃"},{"start":445.206,"end":466.192,"text":"因為這個部分我們很感謝在健保方面都一直配合在做處理跟委員說明一下以目前我們參加PAC的乘坐醫院大概203家那他們的戰床率現在大概是差不多五成而已所以其實病床空間是有"},{"start":466.812,"end":489.928,"text":"那現在接下來當然要調整的就是說他的服務上的那些人力啦人力的標準啊那些搭配著支付標準我們再來檢討不過呢還是得要有一些條件不然就會變成住院的延長我們的PAC還是希望他是有復健的潛能的才進PAC的Program"},{"start":490.228,"end":505.151,"text":"不然還是應該要到長照不然就會變成我們PAC有三個月最長可以12週以後都變成延長住院的概念也不對所以我們再來檢討看看適用上條件的這個調整我們再來檢討"},{"start":506.776,"end":533.257,"text":"因為我們也知道203家這樣的這個PAC的團隊可是資源相對可能都會集中在人口集中的都會區所以如何能夠讓這個區域的缺口根據這個需要鼓勵不管是中銜或小銜的醫院地區醫院等等來增加這方面的服務模式還有剛剛也提到其實包括復健師或者是其他相關的這些人才的"},{"start":533.897,"end":561.308,"text":"留置在這個比較偏遠的地方也都是很重要需要請部裡面或者是書裡面這邊來加強處理的部分也希望在未來的規劃上也把這些都考量進來那再過來就是有關於這個積極賦能我們剛有提到其實如果這些在急性期當中能夠積極賦能的話對於未來的這些所需要的資源就可以大幅的下降"},{"start":562.208,"end":575.061,"text":"那飲食呢事實上就是讓積極富農裡面在營養的補充得到最好的一個支持的部分我們也知道在日本他們對這個非常非常的重視所以在2002年他們就"},{"start":577.663,"end":601.837,"text":"根據這個日本接戶食品協議會去提供非常多的標章的處置或者是協助社會如何能夠知道在需要比較主角能力下降或者是需要有其他方式來進食的民眾有很好的資訊來得到好的這個相關的幫忙跟支持那這部分台灣相對來講"},{"start":603.018,"end":626.812,"text":"是沒有那麼樣的進展那麼樣的這個順利所以未來是不是能夠麻煩我們部裡面或者相關的單位能夠針對於這個長照通用設計飲食不管是提供指引也好或者是提供各類的要求讓質地的這個分布可以更符合民眾的期待在處理上有更精進的做法那這部分"},{"start":627.492,"end":650.9,"text":"需要的是長照師國健署甚至是營養單位共同來努力那這部分就要麻煩部長來要求相關單位來把這個部分可以精進的做進一步讓國民尤其是需要這一類食品的老人家也好或者是針對這個口腔組結能力變得不好的民眾可以有效的得到指引"},{"start":653.373,"end":680.199,"text":"那個謝謝委員能夠關心到這個病人或者是長照的人的一個飲食的狀況因為如果能夠好好的指導他怎麼飲食或者是口腔的衛生把他照顧好然後選擇他想吃的食物以及他可以吃的食物其實我們可以讓我們的病人或者是我們的長者不需要去甕個鼻胃管"},{"start":680.999,"end":694.775,"text":"或是不必要的人工輸液營養這是非常重要的照顧的一個模式那這個都就是要有相關的人員的訓練當然以家屬的照顧來講我們也希望有指引"},{"start":696.056,"end":719.597,"text":"就像日本這樣子 日本在這方面真的是相當先進 值得我們來學習那我們國建署的確也做出了一個比較一般老者長者的一個食品的指引我們未來會把它弄成更個別化來努力那預計什麼時候會是台灣無管人生的元年無管的喔就沒有管制的人生"},{"start":720.237,"end":739.014,"text":"我們從30年前就立下誓言,表示只要安年緩和醫療的專業能夠更加的發揮,讓我們對長者照顧的模式能夠更加的有專業,我相信應該有更多的長者或病人"},{"start":739.815,"end":753.609,"text":"不太需要去用到不必要痛苦的鼻胃管這是我們台灣人性化很重要的一個里程碑感謝王委員多年來的努力"}]}}},"gazette":{"lineno":676,"blocks":[["王委員正旭：（11時32分）謝謝主席，請邱部長。"],["主席：部長，請。"],["王委員正旭：難得臺下有這麼多委員同時在場，在這個質詢的過程當中，我們共同來努力。謝謝。"],["邱部長泰源：委員好。"],["王委員正旭：今天看了部長的報告，銜接前面的部分是針對於我們在長照的照護部分，的確過去從小英總統到現任的賴總統真的做了非常多的努力，不只經費大幅的增加，而且服務據點也大幅的擴充，同時也贏得非常好的滿意度，表示這個政策非常的正確，而且也服務到該照顧的人民。因為我們也知道，進入到超高齡社會後，的確長照、尤其是高齡者的協助照顧，真的是非常非常的重要，這部分我就根據後半段需要注意的事情跟部長來做討論。"],["邱部長泰源：好，請指教。"],["王委員正旭：我們也知道，其實長照過程裡面很重要的就是疾病本身帶來的一些照護上的問題，包括林淑芬委員提到的中風，尤其是年輕人的中風，如何協助他們能夠穩定病情，同時得到好的復健，最後能夠回歸到家庭、回歸到社會，持續對臺灣有所貢獻。所以在急性期、急性後期照護到返家以後都需要非常好的銜接，才能把這個事情做好，所以PAC（急性後期之醫療整合照護）如果能夠做得好的話，就能夠讓後面的長照可以得到很好的改善，對於醫療跟整個國家資源的幫助一定是非常非常明顯，我想部長也一定會確認這個觀點。"],["邱部長泰源：是。"],["王委員正旭：再過來，我們還是希望在照顧不中斷的原則之下，如何持續努力於長照3.0醫療照顧整合的資訊整合無縫接軌，剛剛也有提到，如果我們要擴大照顧的量能，上游跟承作醫院的負荷如何能夠同時兼顧，最後就是有關於長照醫療整體資源的布局跟銜接，這個都是未來我們要共同努力的地方。"],["邱部長泰源：是。"],["王委員正旭：其實資訊整合，我相信大家都非常非常認同這是重中之重，尤其需要有更好的資訊整合模式。在醫療照護整合的部分，依據部長今天提供的報告第7頁「醫療照顧整合」的資訊部分提到，醫療與照顧將透過「大家醫計畫」整合在宅醫療、在宅責任醫療等等，並建構資訊管理平臺，你們是希望透過大家醫計畫來建置資訊管理平臺，可是我們現在看到的就是PAC，這兩個是不一樣的計畫，這樣的資訊平臺未來可以共用嗎？在處理上，我們需要再去注意哪一些事情？我們很擔心如果他只偏賴大家醫計畫所建置的資訊管理平臺，未來在針對長照PAC的銜接會不會造成資訊上的落差，變成一個資訊孤島？如果這個落差存在的話，我們的這個A個案管理如何能夠正確地落實？如何在這個服務裡面讓這麼關鍵的一個銜接工作能夠有效地來落實？對於這個部分，部長，您的意見怎麼樣？"],["邱部長泰源：謝謝委員提出非常重要的關鍵點，我們在3.0的方向就是把醫療跟長照結合，不漏接每一個需要的人，甚至讓他更加的復能，能夠恢復正常，提高生活的品質，所以資訊的整合才能夠避免剛剛您提的資訊孤島或者重複的資源浪費。關於這個部分，過去二十年來，健保署、衛福部及政府在社區醫療群的資訊的努力方面，其實已經下了很大的功夫，以這樣的一個基礎，我覺得是最聰明跟最有效率的來結合。後續不管是更多的預防保健以及長照的工作，以這樣來講是最好的一個方向。至於現在實際上怎麼做，是不是請健保署署長補充一下？"],["石署長崇良：委員好，現在是這樣，我們雖然叫做大家醫計畫，可是後面有一個資訊系統叫做家醫大平臺，最主要就是以人為中心，把他的資料整合，不論你在哪一個醫療院所看的資料，以人為中心整合在一起，那同時把預防保健，包含CDC、國健署的這些預防保健資料也都整合起來，所以是歸人歸戶的概念。我們現在先做到的是醫療這一塊，接著我們就要去接長照服務那一塊，所以等於是我們後面有一個資訊平臺在做資訊的整合，我們下一步正在跟長照系統這邊嘗試也把它歸人進來，以人為中心去做整合，因為這個人會變化嘛，他過去可能是在家庭醫師計畫裡面，有一天他中風了，就失能了，所以其實這是連續性的，所以我們這樣做才不會像過去那樣好多個系統。"],["王委員正旭：對，其實我們很期待透過這樣的資訊平臺，當一位病患要回到社區的時候，他可以透過AI的媒合模式，他要到哪一個據點、他應該執行哪一方面的復健，或者是回家以後如何安排相關的一些點對點的服務模式，這樣才能夠完整，至少是以人為本的服務模式，我很期待透過這次的計畫能夠把這方面持續的來落實。","再過來就是有關於成長部分，因為當初的成長預估是3.85%，根據這個長照的需求，那PAC的部分，如果我們要擴大長照年齡的放寬，納入早發性的失智或者是未滿65歲的中風，林淑芬委員一直強調小於40歲的中風族群已經占到將近15%，如何能夠讓這樣的服務量能，在考慮增加的同時，也能夠去改善醫院的負擔，人力跟復健的部分是不是能夠跟得上？支付誘因是不是能夠平衡？這部分不知道部長或署長有沒有規劃？"],["邱部長泰源：這個部分我們很感謝健保方面都一直配合在做處理，是不是請石署長報告一下？"],["石署長崇良：跟委員說明一下，目前參加PAC的承作醫院大概203家，他們的占床率現在差不多五成而已，所以其實病床空間是有的。現在接下來要調整的是服務上的人力標準、搭配的支付標準，這部分我們再來檢討，不過還是得要有一些條件，不然就會變成住院的延長，我們還是希望是有復健潛能的才進入PAC的program，不然還是應該要到長照。否則我們的PAC有3個月，最長可以12週，以後都變成延長住院的概念也不對，我們再來檢討看看，適用上條件的調整我們再來做檢討。"],["王委員正旭：好，我們也知道有203家的PAC團隊，可是資源相對可能都集中在人口集中的都會區，所以如何能夠讓區域的缺口根據需要，鼓勵不管是中型或小型醫院、地區醫院等等來增加這方面的服務模式。還有剛剛也提到的，包括復健師或者是其他相關人才留置在比較偏遠的地方也都是很重要的，需要請部裡面或者署裡面來加強處理，也希望在未來的規劃上把這些都考量進來。","再過來就是有關於積極復能的部分，我們剛剛有提到，如果在急性期當中能夠積極復能的話，對於未來所需要的資源就可以大幅下降，飲食事實上就是讓積極復能裡面在營養的補充上得到最好的一個支持。我們也知道，日本對這個部分非常非常的重視，所以在2002年日本食品產業界就成立了日本介護食品協議會，去提供非常多的標章處置，或者是協助社會如何能夠知道，咀嚼能力下降或者是需要透過其他方式來進食的民眾有很好的資訊來得到相關的幫忙跟支持；相對來講，臺灣這部分的進展沒有那麼的順利，所以未來是不是麻煩部裡面或者相關的單位能夠針對長照設計通用飲食，不管是提供指引也好，或者是提供各類的要求，讓食物質地的分布可以更符合民眾的期待，在處理上有更精進的作法，這部分需要的是長照司、國健署、甚至是營養單位共同來努力，麻煩部長要求相關單位精進這個部分並進一步提供，讓國民，尤其是需要這類食品的老人家也好，或者是針對口腔咀嚼能力變得不好的民眾可以有效地得到指引。"],["邱部長泰源：謝謝委員關心到病人或者是長照者的飲食狀況，因為如果能夠好好的指導他怎麼飲食或者是口腔的衛生，把他照顧好，選擇他想吃的食物以及他可以吃的食物，其實就可以讓我們的病人或者長者不需要去插鼻胃管，或是不必要的人工輸液營養，這是非常重要的照顧模式，這個就是要有相關人員的訓練。當然，以家屬的照顧來講，我們也希望有指引，就像日本這樣子，日本在這方面真的是相當先進，值得我們來學習，我們國健署的確也做出了一般長者的食品指引，我們未來會來努力把它弄得更個別化。"],["王委員正旭：預計什麼時候會是臺灣無管人生的元年？"],["邱部長泰源：無管喔？"],["王委員正旭：就是沒有管子的人生。"],["邱部長泰源：我們從30年前就立下誓言，表示只要安寧緩和醫療的專業能夠更加發揮，我們對長者照顧的模式能夠更加專業，我相信應該有更多長者或病人不太需要去用到不必要、痛苦的鼻胃管，這是我們臺灣人性化很重要的一個里程碑，這個部分也感謝王委員多年來的努力。"],["王委員正旭：好，部長加油，謝謝。"],["邱部長泰源：謝謝。"],["主席：謝謝王委員，謝謝部長。","現在處理臨時提案，只有1案而已，請宣讀。（參閱附錄）","4月29日、5月6日衛福部食藥署於邊境抽批驗出高達70.24公噸含有「萊克多巴胺」之冷凍澳洲豬腳，經查，食藥署竟未事先赴澳洲查廠就同意肉品進口，並放行於後市場端，完全違反行政院109年11月26日所公布的「進口豬肉之全方位管理措施」。且事發後仍維持2至10%一般抽批檢驗率，未將強度提高至100%逐批查驗，亦未擴大稽查已流入後市場端之肉品，並於清查完畢前要求該業者暫停輸入肉品，使民眾陷於食安風暴之恐慌中。","有鑑於豬肉食品使用範圍廣泛，於市場擴散速度遠較其他食品更為快速，消費者吃下肚後亦難以追蹤，爰要求衛福部食藥署應全面落實行政院109年11月26日公布之「進口豬肉之全方位管理措施」，以維護國人食安健康及消費選擇權：","一、未查廠不給進口：未曾進口來臺的肉品廠，需經我派員查廠後方得進口。","二、逐批查驗：進口豬肉必須逐批查驗。","三、產地標示跟著肉品走：肉品自大到小，從進口商、肉品廠，隨著販售通路，一路下到店頭、攤商，會讓消費者一目瞭然，自由選擇，同時也可清楚溯源追蹤。","四、政府嚴格稽查：不符標準必重罰：對於未依規定標示、標示不實或檢驗不符規定的業者，一律嚴懲重罰。","提案人：王育敏　　陳菁徽　　陳昭姿"],["主席：王委員要不要說明？"],["王委員育敏：好，謝謝召委、各位委員還有衛福部官員。我想我提出來的臨時提案，其實只是回到行政院在109年11月26號自己所公布的進口豬肉之全方位管理措施，所有的文字完全都是當時行政院對外公告的四大措施，現在因為從澳洲進口的豬肉含有萊劑，我覺得從109年到現在，我們的確有些作法已經放掉了、太鬆散，因為現在又發現有萊劑的豬肉，所以更應該要全面落實回到109年11月26號行政院自己所公布的全方位管理措施，保障國人的食安。我提案所列的一、二、三、四點都不是我個人意見，完全都是當時行政院所訂下的規範，我相信在執行上面如果政府是一致的，應該在執行上不會有窒礙難行之處，以上，謝謝。"],["主席：行政單位有沒有意見？"],["姜署長至剛：謝謝委員的提案，針對提案，我們這邊有做一些研擬，4月29日、5月6日衛福部食藥署於邊境抽批驗出高達70.24公噸含有萊克多巴胺之冷凍澳洲豬腳，且事發後仍維持2至10%一般抽批檢驗率，未將強度提高至100%逐批查驗，亦未擴大稽查已流入後市場端之肉品，並於清查完畢前要求該業者暫停輸入肉品，使民眾陷於食安風暴之恐慌中。鑑於豬肉食品使用範圍廣泛等等，特別在國人食品安全、健康消費的選擇權，我們會做以下四點，第一、加強查廠：針對進口來臺的肉品廠，加強派員查廠；第二、加強查驗：進口豬肉提升查驗率；第三、落實產地標示：肉品自大到小，從進口商、肉品廠，隨著販售通路一路下到店頭、攤商，會讓消費者一目瞭然，自由選擇，同時也可清楚標示產地；第四、政府嚴格稽查：不符標準必重罰，對於未依規定標示、標示不實或查驗不符規定的業者，一律嚴懲重罰。以上。"],["王委員育敏：有的委員需要修正的文字對不對？"],["陳委員瑩：你們修正的沒有給各委員看。"],["邱部長泰源：修正的要不要copy給大家？"],["王委員育敏：你們修正的文字可以給其他的委員看。"],["姜署長至剛：趕快給各位委員，謝謝。"],["王委員育敏：第一個就是查廠的部分，你們會去查廠嗎？"],["姜署長至剛：我們加強查廠，一定會！"],["王委員育敏：所以澳洲的部分會去嗎？"],["姜署長至剛：我們會積極的規劃。"],["王委員育敏：好。"],["主席：所以第二點逐批查驗不做，變成加強查驗這樣嗎？"],["姜署長至剛：我們一定會加強查驗。"],["邱部長泰源：這有一定的程序，就是說人工智慧，你如果查越多比例就越多，你如果到達某個程度就是百分之百了。但他是逐步用人工智慧，叫做精準查驗，不是說風吹草動就逐批。"],["王委員育敏：那一定要提高啊、一定要提高！這次其實已經查出萊克多巴胺了嘛，所以食藥署一定要提高查驗比例啊，這個可以做嘛？對不對？"],["姜署長至剛：進口豬肉會提升查驗率，這邊有提到。"],["王委員育敏：好，這個提高的部分，我也要求一定要做。然後你剛剛唸的第三點，「溯源追蹤」為什麼要刪除？"],["姜署長至剛：我們會做可以清楚的標示產地，其實意義是一樣的。"],["王委員育敏：那你就保留，有什麼問題嗎？意思一樣，我覺得保留讓大家看起來比較安心吧？就是可以清楚標示產地，溯源追蹤，這樣可以嗎？"],["姜署長至剛：我們標示的產地，就會標示是澳洲進口的，因為是豬肉之原產地，就是會標原料之原產地是來自於澳洲、來自於美國、來自於哪個國家、來自於巴拉圭等等，所以會有……"],["王委員育敏：我知道，就保留「溯源追蹤」四個字有什麼問題嗎？"],["邱部長泰源：這兩個有時候不一樣的意思。"],["王委員育敏：對，就是保留，就是「同時也可清楚標示產地，溯源追蹤」，這有什麼問題嗎？為什麼溯源追蹤一定要刪除？我不太懂。如果意思是一樣的，我是建議保留，可以嗎？"],["姜署長至剛：我想就按照委員的建議，我們可以保留「溯源追蹤」四個字。"],["王委員育敏：對啊，好不好？越清晰越好嘛。"],["姜署長至剛：好。"],["廖委員偉翔：所以我想要釐清一下，你只標示產地叫做溯源追蹤嗎？"],["姜署長至剛：報告委員，因為溯源追蹤是食安法第二十五條授權下來的，所以我們根據那樣子的溯源追蹤是已經有對於豬肉的原產地……"],["廖委員偉翔：就是有編號嘛，對不對？它不是原產地……"],["姜署長至剛：有溯源追蹤是從哪邊來的。"],["廖委員偉翔：對、對、對，所以就是它雖然美國是產地，但有不同的廠出來，每一批來的不一樣嘛，所以這是有溯源追蹤？"],["姜署長至剛：有溯源追蹤。"],["廖委員偉翔：OK，好。"],["主席：好，陳昭姿委員。"],["陳委員昭姿：我今天早上第一個質詢，有提出很多的資料，加強是形容詞，加強不是數字，因為2020年行政院講這麼清楚，那幾個國家：加拿大、紐西蘭、美國、澳洲，他們都說沒有，只准美國的萊豬進口，因為我們立了法案，一直到目前為止，他們都說是零檢出，他的這些承諾還在嗎？然後蘇院長說不查廠不准進口，而且當時他說要先逐批查廠，但是我查到當時對於美豬的查廠，事實上都沒有把報告放出來，我催了很久之後，食藥署才把它公告上網；但是非常特別，他查了六家廠，有五家根本不用「萊」的，他去查那個做什麼？只有一家用「萊」的，所以後來我沒有繼續去追蹤這件事，就是說逼著他們把查廠報告放上去。今天我們回到原點，我早上質詢講得很清楚，今天不是法案的問題，法是規定0.01，食藥署說是低於法規的0.01，所以是OK的，但是民眾不要，因為所有民進黨立委，我可以幫你找出至少20個，從老柯算起，當初說零檢出、零檢出、零檢出，因為民眾不要吃萊豬，所以我們確實訂得比國際還要嚴格，但是突然間不知道為什麼國際的標準就悄悄地更動了，讓沒有查廠過的澳洲豬肉也進來，所以我只是要他們兌現當年的承諾，第一點的未查廠不給進口，藥品也是這樣啊！你沒有查過廠，不管你用什麼方式去查廠，不管是書面查廠還是臨場查廠，沒有查廠的東西怎麼可以進口啊？去年的生理食鹽水就是這樣，管理不佳，整個斷貨啊！結果買進來都是沒查廠、沒有許可證的東西，這件事情不能再重演。沒有查廠怎麼准進口？這是什麼時候改變的要先講清楚，現在先講清楚，不然政府就道歉，現在我們就先用，儘量在後端才查。","第二個，逐批檢驗也是蘇貞昌答應的啊！逐批檢驗成效還可以，才慢慢減少，我們不知道為什麼它突然間變成只剩下2%到10%，可是一檢出來量就這麼大。另外，產地標示我一直在講，產地標示是邱部長你們這邊要準備的，產地標示「萊」的含量，這個是被列為……雖然我們要保護我們的食安，你一直在講，但是你們也講不出來到底對川普的談判如何，因為美國要我們買美豬、美牛啊，他不要我們標示原產地，原產地已經被認為說是一個障礙、標標準準的貿易障礙，就不准標示，好，那你現在繼續標示，你要有能耐、有這個本事，去談判的時候你要堅守這個立場。所以我覺得這一次的回復都是形容詞，我個人沒有辦法接受，都是形容詞，什麼叫加強？這個標示的東西，然後加強查驗，加強什麼……現在在規劃，可是那個豬肉都進來了，王委員雖然這樣提，可是我還是堅持第一個，不然你就要道歉，你當初承諾的東西，2020年是行政院的圖卡，而且那時候他是為了很多他們認為是網路上的謠言，還自己做了圖卡，我現在沒有帶在身上，我早上有show給大家看，還特別這樣講。"],["主席：我們現在的查驗差不多幾percent？"],["姜署長至剛：按照我們過去的邊境查察狀況，其實會調整，目前是2%到10%，在10%以下，我們會按照委員的意見做一些提升，以上。"],["主席：那如果要做，要逐批查驗，那量很大。"],["姜署長至剛：對，的確是，邊境的人力目前其實是相當吃緊，一直以來都是這樣的狀況，所以跟委員說明一下，因為行政端訂了一個標準之後，真的是按照那樣子來精準的抽驗，這是我們現在持續能夠努力的，委員有特別提到要提升，我們一定會答應可以提升，以上。"],["主席：那你現在要加強查驗，是差不多要提高到幾percent？差不多大約啦！"],["姜署長至剛：我們其實是希望能夠再往上提升，在下一個階級其實……"],["邱部長泰源：它有一個人工智慧的機制，你如果太多沒過、成績比較差的，我就給你加強功課，成績如果差到一個程度，你就連晚上都要來上課了，就是百分之百了，這個叫做精準查驗。"],["姜署長至剛：報告召委，原來是2%到10%，雖然理論上沒有不及格一樣是2%到10%，因為委員特別提到我們可以到下一個階層即20%到50%，針對澳洲來的牛肉做這樣子的查察，不曉得這樣子的回復是否合宜？"],["邱部長泰源：可能還是要有科學的制度啦！"],["姜署長至剛：對。"],["邱部長泰源：就是你查得怎麼樣，幾percent，如果他的成績比較不好就提升，甚至會提升到100%都有可能，這個就是精準查驗。"],["王委員育敏：因為現在別的國家都沒有查出，就是澳洲的豬肉查出含有萊克多巴胺，當然在你們的行政權裡面，你們自己可以針對高風險、國人疑慮高的，可以優先提高比例，過去向來行政權……我今天才跟你們講過，在你們的施行辦法裡面，食藥署握有非常大的權力，你說要提高就提高，或是你說要百分之百，完全都是你們在決定，那你們就應該要根據今天國會委員的關心、國人的疑慮，針對比較高風險的、有疑慮的去提高，這個就是你們的權限，好不好？"],["姜署長至剛：好，謝謝委員。"],["陳委員培瑜：我有問題，可以請問一下嗎？"],["主席：好，請陳委員。"],["陳委員培瑜：謝謝主席。我想要請食藥署說明一下，因為剛剛陳昭姿委員堅持說零查廠零進口，當時蘇院長的承諾，如果沒有記錯的話，應該是針對美國進口的肉品新設的廠場，對不對？但是這部分你沒有說明，你可不可以說明一下，到底我當時的理解跟剛剛陳委員的說法……好不好？我覺得都還是要給我們一個說明，關於查廠這件事情。"],["陳委員昭姿：這個圖檔有沒有辦法弄出來？2020年行政院自己的圖卡說，事實是只有美國萊豬會進口，因為他是在反那個謠言，事實是只有美國萊豬會進口，我可以傳給大家，我看現在有什麼方式可以show出來。"],["陳委員培瑜：陳委員，可不可以讓他們說明一下？"],["王委員育敏：恐怕署長也不知道。"],["姜署長至剛：有，我知道。"],["陳委員昭姿：部長，你早上有認真聽嗎？"],["陳委員培瑜：不是啦，委員，你現在讓他講，現在是我要問問題，我不是問你，我是問食藥署，謝謝。"],["王委員育敏：好，讓署長講。"],["姜署長至剛：謝謝委員。我們對於這個部分的了解是在109年11月26號提到的赴美查廠，是針對美國有查廠過後才會進來，這個確實我們有看到。","至於澳洲這部分，容我解釋，就是澳洲豬肉其實很久以前，在行政院農委會防檢局的時候就承諾系統性開放，同意澳洲豬肉輸臺，那時候是基於信賴保護原則，在輸入食品系統新的查驗辦法實施之前它就已經進來了，我們其實是選擇相信就是因為信賴保護，實施之後，我們沒有針對豬，但是整體在澳洲系統是牛、豬、羊、鹿肉採認完整的系統性查驗，考量到對於澳洲牛、豬、羊、鹿肉的產品是依同一個主管機關管理，管理的系統相同，我們有在106年執行過系統性的實地查核，也採認了它的系統性查核，所以112年1月13號簽奉核可之後，這是為什麼澳洲豬肉是可以進口的，進口進來之後出現有萊克多巴胺的，對於貿易廠商裡面哪一家去進口的，我們沒有特別……因為整個系統性查核，所以他們會對接到要進口什麼，我們都尊重。而在後市場端跟邊境，尤其在邊境的時候，同仁很努力的按照標準在抽，有抽到就跟國人公告，也讓委員能夠了解，這是我們現在的作法。以上的說明，謝謝。"],["王委員育敏：好。容我補充一下，我想這個議題從第8屆開始，在座如果有第8屆的立法委員可能就會知道，當時是美牛都沒有進口，所以美豬當然也是禁止，所以臺灣過去其實就是禁止萊克多巴胺，我們自己的豬農不能使用，美牛也不可以進來，美豬當然也不能進來，所以在第8屆那時候是全面禁止的情況。","到後來美牛開放，但是牛、豬分離，美豬不能開放，但是到了民進黨執政的時候，美豬要開放，所以當時109年蘇貞昌院長才訂了這個管制措施，要讓大家安心，就是含有萊劑也不能進來。大家如果回過頭去看，剛剛陳昭姿委員講的是對的，陳吉仲主委對外講的時候，他說只有美國的美豬含有萊劑，所以當時的查廠就會特別針對美國，各位，但是現在連澳洲的也含有萊劑，當時農委會告訴大家的是說美國含有萊劑，所以當然是美國查廠，但現在澳洲已經有萊劑，澳洲不查廠嗎？","食安的標準應該是一致的，如果我們回到當時109年行政院所公告的這幾項措施，不會說只有針對美國的美豬要查廠，是因為當時要進口含有萊劑的美豬，所以才特別講美國，因為農委會告訴大家說其他國家都沒有，也不會進來，這樣子大家懂了嗎？所以我們的食安標準應該是一致，當時行政院的管制措施為什麼說沒有查廠的就不進口？他是要給大家安心，就是經過了食藥署的查廠，確定這整個肉品廠是符合安全衛生的，才要放行讓他進來。所以剛剛署長提到的那個脈絡，在更之前，那個跟這個其實是沒有關係，就在109年之後，如果當時蘇貞昌院長、整個行政院做的這個管理措施是對的，我覺得不應該因為時間的推移就放鬆，而是回到109年的管制措施。"],["姜署長至剛：謝謝召委。我稍微簡單說明一下，剛才講的第一點加強查廠，為什麼講加強查廠這件事情？因為我剛才問了同仁，我說有經費，不出門嗎？他說：報告署長，你要來籌錢。但是我想我們會把加強查廠排為優先順序，好不好？我想我們會加強……"],["主席：我請問一下，澳洲的豬肉以前有沒有在查驗？"],["姜署長至剛：你說邊境的查驗嗎？"],["主席：對。"],["姜署長至剛：邊境是一體適用，我們都是抽查的，一直都是抽的。"],["主席：所以你說一開始是農委會同意他們進來？"],["姜署長至剛：對，這個幾乎是在100年之前就有。"],["主席：你今天講信賴保護講了差不多十次了，那農委會准他，你就從來沒有去查過他們的廠？"],["姜署長至剛：我們查他的是查……"],["主席：農委會沒有去查他的廠？"],["姜署長至剛：我們是查牛肉、羊肉，在106年有去。"],["主席：你們是食藥署去？"],["姜署長至剛：對，我們會跟他們一起去，查完之後，因為他們那邊是牛、豬、羊、鹿肉是一起的，所以我們就會變系統性地同意它。"],["主席：那這一次3批超量，那3批是退還是銷毀？"],["姜署長至剛：原則上他沒有超過標準，他是沒有違規的行為，所以我們是會按照管制標準，其實是會放行，交由廠商在處理。"],["主席：所以牛肉做肉包、貢丸，都跑掉了。早上林淑芬講的我覺得很有道理，他說他有資格不吃，所以標示產地是很起碼的要求，那個做得到吧？"],["姜署長至剛：對，就是後市場端，我們對於散裝的及有包裝的牛肉原料原產地會標示，假如是在臺灣製造的，但是牛肉的原料原產地在澳洲，我們就標示在澳洲生產。"],["主席：豬肉、牛肉都一樣？"],["姜署長至剛：豬肉、牛肉都有，我們有這樣子的標示。以上說明。"],["主席：還有問題嗎？"],["陳委員昭姿：主席，請允許我要求秀證據。"],["主席：這個問題太敏感了，已經經過三屆立委了。"],["陳委員昭姿：行政院的2020年圖卡告訴我們，因為很多人在謠傳，他們認為事實是什麼？只有美國萊豬會進口到臺灣，其他的產地沒有，他們說加拿大出口的豬肉不含萊劑，紐西蘭豬肉從未進來，又說澳洲國內生產幾乎不用萊劑，可是這次一查就查這麼多，圖卡上說澳洲進口總量是微乎其微，所以只有美國萊豬會進來，所以不要用這一張說到美國查廠只適用美國，不適用澳洲，只有美國萊豬會進口，這是2020年的圖卡，我剛剛說請不要翻頁，這個還是你們的黨，同一個黨在執政，這個才是行政院的圖卡。好，謝謝。"],["姜署長至剛：召委，我可以簡單說明。剛才提到的澳洲的部分，其實在右下角那裡特別有一個叫做未曾進口來臺的豬肉品廠，因為澳洲已經進來很久了，所以在這種前提之下，才沒有去，可是這次委員特別提醒我們，我們剛才有提到我們會加強。"],["陳委員昭姿：我們沒有開放啊！署長，我們沒有開放，第一個，我們沒有開放，我們只開放美國萊豬進口。第二個，已經查出這麼多批了，那這個2%到10%的部分怎麼沒有立刻矯正呢？你查到這麼多量，現在才讓委員說你們要不要提高查驗率。但現在就是不行，還是回到圖卡左邊的部分，行政院為最高指導原則，對吧？你們不能否認吧？行政院是最高的，雖然行政院出來認錯、修改，說當初答應人民的他們現在都做不到，偷偷地、悄悄地就讓其他國家的萊豬進來，就這樣，就這麼簡單，行政院是為了闢謠才做那張卡的耶！"],["姜署長至剛：謝謝委員，那我們這邊……"],["陳委員培瑜：主席，我可以再提問一下嗎？根據這張圖卡，左邊跟右邊應該是在講不同的事情吧？右邊就是剛剛食藥署說的，是針對美國的部分，未查廠不可以進口，是嗎？署長。"],["姜署長至剛：是所有沒有進口過的。"],["陳委員培瑜：是所有沒有進口的，可是左邊列出來的資料是，在那之前，就是你剛剛說的信賴保護原則，其實就已經有開始進口澳洲的豬肉。"],["姜署長至剛：其實一路以來都有進口澳洲豬肉。"],["陳委員培瑜：好。所以我覺得要理解這個資訊，左邊跟右邊的邏輯，應該是剛剛說的那樣。謝謝。"],["陳委員瑩：我想是這樣，當年是不是只有美國有萊豬，其他國家沒有？我想或許在當年有當年的時空背景跟狀態，那現在因為進口商確實進了澳洲的豬肉，他們進口的時候覺得是沒有萊劑的，但是現在查驗卻發現有了，我覺得是這樣子，如果大家認為其他國家可能會陸續有加萊劑的狀況，那沒關係，我們也很贊成食藥署可以到國外去，加強查緝的強度，這個都是可以，那我也不曉得今年署長有沒有時間做這樣的安排，但是我想旅費統刪這件事情已經發生了，所以我也不知道食藥署你們到底有沒有錢可以出去國外查廠，這個你們也要講清楚。不能一邊說希望人家去國外查廠，結果又把人家旅費全部刪光光，要人家做事，又不給人家錢，這是很奇怪的事情，所以我就提出我的看法。"],["主席：好。陳昭姿委員，你有堅持要……"],["陳委員昭姿：當初他們答應的是美國萊豬可以進來，那如果是澳洲豬肉，澳洲豬肉可以進口，但是裡面是不能含萊劑的，因為只有美國萊豬可以進來，什麼時候悄悄地萊豬就進來了？所以沒有查廠嘛，一定要查廠，要查廠，然後進來，進來之後，你可以看它的狀況，再把檢驗率等等的規範慢慢放鬆，這是可以的。但我現在就是要求，當初這麼清楚的政治承諾，你不可以當作沒有嘛！不可以直接髮夾彎嘛！不可以當作沒這件事嘛！不然行政院要出來道歉啊！趕快查廠，趕快去澳洲查廠，然後只要標示清楚，再看大家要吃不吃，說不定很好吃，說不定大家很願意吃，但那不是問題，那不是問題，就是說源頭你答應的事，源頭行政院答應的事，你告訴人民是這樣，結果不知道這幾年來悄悄地都進來了，連澳洲的萊豬都進來，本來不能進來，說只有美國萊豬可以進來，我的重點就是在這個地方。"],["陳委員培瑜：你自己放的圖卡左邊就已經有了嘛。"],["陳委員昭姿：我的重點就在這個地方，認識字的都看得懂。"],["陳委員培瑜：有邏輯的應該都看得懂啦。來，主席，我可以再確認一次嗎？"],["主席：好。"],["陳委員培瑜：好，謝謝主席。剛剛陳瑩委員說的國外旅費通刪六成這件事情，且不得流用，確實是呼應了剛剛署長突然說要去籌錢，那如果要去籌錢，但是我要提的是國外旅費的部分，我們還有哪些重要的事情，不能今天藍白的委員關心這個事情，我們就把國外旅費放在這裡，所以也許也可以請署長告訴我們，你們現在僅剩而且不得流用的國外旅費預算到底還可能用在什麼地方？而且是事關國人的食安健康，會不會後續又有其他的事情出來？國人對你們有所期待，我們如何回應國人的期待？畢竟所有的公務機關都是要為人民服務。","接下來，我剛剛講，你剛剛一直強調，在過去信賴保護原則下，在農委會時代我們跟澳洲的合作關係，如果你剛剛講的那個部分是回應這個圖卡的左半邊，我還是要拜託署長再清楚說明一次，讓更多在場所有關心這個議題的人，不管是所有的公務人員，或者是委員們，理解這件事情，然後一路回溯下來，應該這樣才比較合理。謝謝。"],["姜署長至剛：謝謝委員讓我有機會進一步說明。其實細部的旅費部分，我沒有辦法馬上counting，我可以做書面的完整說明，原則上最重要的是，其實在這一次WHA的會議裡，我有跟部內長官們一起去WHA重要的會議裡面進行宣導、宣揚。第二部分特別提到澳洲的這個部分，我們在做食安的時候，特別會提到，澳洲這部分其實是約定俗成，已經是傳統上都接受的，所以我們沒有特別再針對這個去查。舉個例子，因為澳洲已經可以用萊克多巴胺，所以我去查的時候，澳洲就是被歸類在可以用萊克多巴胺的國家裡面，所以我查澳洲的廠，它還是可以用萊克多巴胺，它的豬肉也還是會有這種東西，所以就會變成說，我去查的目的是要查這個廠的關鍵點是要看它有沒有萊克多巴胺，但不用查它就已經告訴我，它是有的，邏輯上面會是這樣，因為它就允許嘛；假如是對於它衛生管理的部分，衛生管理的部分，因為是約定俗成，這麼多年以來，相對於其他國家，澳洲來的豬肉在國內，其實更有所謂的reputation，其實大家的信任度是更高的，所以在這樣的前提之下，一直以來是這樣，所以我們就是用過去的經驗，還有剛才講的信賴保護的前提之下，才會沿用，然後沒有特別去查廠。"],["主席：我們是要處理臨時提案，不要失焦了。","休息2分鐘。跟他們兩個人說一說。發便當，吃便當，吃一吃比較不會吵。","休息（12時14分）","繼續開會（12時23分）"],["主席：來，你再把這些有爭議的再唸一次。"],["姜署長至剛：好，針對國人食安健康及消費選擇權：一、加強查廠：針對進口來臺的肉品廠，加強派員查廠。二、加強查驗：進口豬肉提升查驗比率。三、落實產地標示。最後4個字的部分回復到「溯源追蹤」。第四項沒有改變。以上。","我們沒有特別針對一個國家，但是我們心裡會有一個數，這邊跟委員特別做這樣的報告。"],["主席：王育敏委員的臨時提案，我們就修正通過，有沒有意見？（無）好，通過。","臨時提案全部處理完畢。","接下來我們請李坤城委員發言。"]],"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"}}}