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\"都\", \"start\": 422.027, \"end\": 422.167, \"score\": 0.761}, {\"word\": \"有\", \"start\": 422.167, \"end\": 422.268, \"score\": 0.888}, {\"word\": \"不\", \"start\": 422.268, \"end\": 422.368, \"score\": 0.948}, {\"word\": \"同\", \"start\": 422.368, \"end\": 422.488, \"score\": 0.819}, {\"word\": \"的\", \"start\": 422.488, \"end\": 422.788, \"score\": 0.765}, {\"word\": \"點\"}, {\"word\": \"值\", \"start\": 422.788, \"end\": 423.148, \"score\": 0.787}, {\"word\": \"計\"}, {\"word\": \"算\", \"start\": 423.148, \"end\": 423.689, \"score\": 0.932}, {\"word\": \"好\", \"start\": 423.689, \"end\": 423.809, \"score\": 0.714}, {\"word\": \"那\", \"start\": 423.809, \"end\": 424.249, \"score\": 0.68}, {\"word\": \"這\"}, {\"word\": \"個\"}, {\"word\": \"東\"}, {\"word\": \"西\", \"start\": 424.249, \"end\": 424.669, \"score\": 0.931}, {\"word\": \"來\"}, {\"word\": \"自\", \"start\": 424.669, \"end\": 424.789, \"score\": 0.822}, {\"word\": \"於\", \"start\": 424.789, \"end\": 424.869, \"score\": 0.743}, {\"word\": \"原\", \"start\": 424.869, \"end\": 425.17, \"score\": 0.749}, {\"word\": \"來\"}, {\"word\": \"的\", \"start\": 425.17, \"end\": 425.53, \"score\": 0.926}, {\"word\": \"點\"}, {\"word\": \"應\"}, {\"word\": \"該\"}, {\"word\": \"是\", \"start\": 425.53, \"end\": 425.69, \"score\": 0.691}, {\"word\": \"說\"}, {\"word\": \"最\", \"start\": 425.69, \"end\": 425.89, \"score\": 0.826}, {\"word\": \"低\", \"start\": 425.89, \"end\": 426.07, \"score\": 0.752}, {\"word\": \"1\"}, {\"word\": \".\"}, {\"word\": \"9\"}, {\"word\": \"5\"}, {\"word\": \"啦\", \"start\": 426.07, \"end\": 426.09, \"score\": 0.0}]}, {\"start\": 427.251, \"end\": 450.843, \"text\": \"對那所以這個部分跟委員報告應該是之後我們會再跟委員會做報告那我們其實健保署本來就固定每一季甚至每個每一季都會有各區域還有各層級醫療院所拿的點子我現在不是講之後啦我現在是說6月底以後是不是就可以不管是哪一區或哪一級我們是一直以來我們都在針對點子的部分做進口1.0.95元啦\", \"words\": [{\"word\": \"對\"}, {\"word\": \"那\", \"start\": 427.251, \"end\": 427.431, \"score\": 0.933}, {\"word\": \"所\", \"start\": 427.431, \"end\": 427.751, \"score\": 0.831}, {\"word\": 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0.961}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"葉\"}, {\"word\": \"委\", \"start\": 488.7, \"end\": 488.721, \"score\": 0.0}, {\"word\": \"員\"}], \"language\": \"zh\"}","srt":"1\n00:00:07,974 --> 00:00:09,067\n麻煩請那個衛福部次長\n\n2\n00:00:16,074 --> 00:00:39,355\n最近很多那個醫生朋友在反映就是說那個健保署把很多醫材都納入健保然後但是因為那個開會定的健保點數極負都過低導致於有一些廠商不想做要退出我想問一下通常健保署就是每一年要列入那麼多醫材或藥本來他們都自費嘛後來要列入他主要原因是什麼\n\n3\n00:00:40,755 --> 00:01:04,903\n健保署收载这一个几副项目的部分有几个评估的方向一个事情就是他可能在这个医学会会来向健保署提出对于他们常用或者是希望能够收载到健保内部的医材来提出审查那另外的话当然有的时候是厂商因为对厂商来讲台湾因为我们健保cover99.9%的民众所以对厂商来说如果他持续在自费的品项来讲他可能\n\n4\n00:01:05,663 --> 00:01:35,458\n它能够这个被使用的量比较少所以有些厂商也会来跟我们要求希望能够收载到健保里面所以包含了专业医学会包含了这些医材的厂商或药品的厂商那当然有的时候可能是长期我们发现说某一些比较已经有某些医材或者是药品它已经是越来越是主要的被使用的情况那这个时候我们可能也会来跟医学会或者是这个需求端这边来讨论说是不是愿意让我们收载到健保里面\n\n5\n00:01:35,878 --> 00:02:04,696\n我是覺得這個部分以後因為我最近聽很多醫生在講就有的他們的譬如說外科醫師他打骨釘什麼之類他說有的骨釘是自費市場有的是健保市場其實都已經行之有年好好的忽然間他們民眾喜歡的自費的骨釘忽然被納入到健保那被納入健保之後那個廠商有的就不想做然後反而就打亂他們本來的一些醫療的行為那這部分是不是可以請健保署就在\n\n6\n00:02:05,416 --> 00:02:30,567\n做類似工作或開會的時候可以加強溝通謝謝委員因為譬如說我舉一個例子像這個之前大家新聞上面也都有看過就是一個手術的封合劑那有一個廠商叫做泰爾茂那這家廠商一開始的時候就是因為他被給的點數太低了所以他們就決定就不賣了那後來好像健保署又不救所以後來又重新找廠商來談把他的點數增加所以他又願意繼續留下來\n\n7\n00:02:32,168 --> 00:02:56,513\n我有看到非常多藍衣生有的跟政治都無關有的藍的有的綠的都有跳出來罵這個事情可見說他在開會的過程當中的處理真的是有一點粗糙這個合價的部分在健保署這邊的相關合價事實上他是有些參考的公式那再來的話就是說其實當時在這一個醫材的部分事實上是好幾家廠商都來跟我們要求收載到健保裡面\n\n8\n00:02:57,413 --> 00:03:12,126\n是廠商來跟我們要求收窄那他要求收窄然後他自己又覺得點數太低然後退出其實是廠商來跟我們要求收窄那所以你們不是說大家先談就是說如果你要進來的話我給你多少點數你願意接受你再進來\n\n9\n00:03:14,108 --> 00:03:36,118\n是說他談了你直接給了給了你要或不要一句話健保收窄裡面他如果是同類型的他當然會有一個收窄的價格幾付價格那這個價格其實不是健保署自己這邊訂的第一個事情就是剛剛跟委員報告他需要有一些公式第二個部分他必須經過我們的共擬會共同擬定會議那共同擬定會議裡面不單純只有健保署我們就拿這個太陽帽當作例子\n\n10\n00:03:38,979 --> 00:03:53,175\n你看像當時因為因為這個已經議題在被大家關注了所以他後來健保署開一個記者會他把類似的藥全部都秀出來就是有百特醫療有泰爾茂還有埃莫高\n\n11\n00:03:54,156 --> 00:04:12,752\n然後就拿出來可是大家發現說你合給的健保點數11831的的百特跟奧特利這兩種實際上它的容量計算方式是不一樣而且它的用途也不一樣等於是你把不同的容量的東西跟不同用途的東西都合給一樣的點數\n\n12\n00:04:14,173 --> 00:04:26,027\n所以這樣的比較基礎就會有一個落差再跟你補充一下我一直講完再請你一定回答好了還有就是他也沒有當時在開會的時候也沒有列出國際價格還有一個問題就是\n\n13\n00:04:30,191 --> 00:04:45,669\n這個建議支付點數你們有一個報告裡面有提到像這個封合劑在臨床上臨床上申報使用是用4L為大宗可是我們剛列出來的表格你們比較基礎是拿2克來做比較\n\n14\n00:04:46,877 --> 00:05:14,987\n所以這個然後再加上這個藥特別是有非常多的醫生有很多不同意見其實我只是提出來就是說既然健保署基於需要因為剛剛市長一開始講了很多原因嘛要把那些藥納入既然有這麼多的需要把它納入那在核架以及開會的過程當中他那個資料的詳實性然後還有就是擴大醫界的意見的參與我覺得這一塊是不是可以多做一點啊不然的話真的\n\n15\n00:05:16,168 --> 00:05:30,899\n其實聽到蠻多醫生在對於核價這件事情他們是有很多意見的我們當然希望說這個核的價格能夠讓大家在整個使用上面或者是在醫材韌性上面能夠更好不過也報告委員就是說因為健保畢竟它是總額的\n\n16\n00:05:32,220 --> 00:05:54,572\n所以常常我們比如說A醫學會來希望我們收載了某一項給付B醫學會就會說你會影響到我們的點值這也是我們常遇到的狀況所以說當然在健保這邊它的核價不是由健保署自己來決定就像剛剛跟您報告的第一它有一些公式第二它在我們的購你會議裡面包含了我們的健保的委員以及購你會的委員還有醫界跟藥界還有相關的醫學會\n\n17\n00:05:56,693 --> 00:06:19,807\n在共理會議上面會來針對健保署這邊必須考慮在收窄這些藥品裡面去進行評估那這裡面當然我們會尊重專家的意見當然各自的我們也必須承認台灣事實上各自的醫院或者是醫師有比較習慣用的品牌那我們盡量滿足有的時候可能就會有對雖然因為剛剛你也提到那個健保點子因為我們去年有一個組決議就是健保1.0.95元\n\n18\n00:06:21,348 --> 00:06:48,558\n那本來好像是說六月底的時候要實施那目前衛福部這方面的規劃是怎樣我們固定在每個每一季我們都有點值上面的這個計算好那所以就像委員您現在所看到我們的困境我們收窄的越多給付的越高那是不是點值上面就收到一點沒有沒有這個細節不講啦我是說因為我們那時候是講說1.0.95元嘛那時候部長邱太元也說他認為有信心可以達到那因為現在已經五月快五月底了\n\n19\n00:06:49,458 --> 00:07:06,090\n再一個月所以真的6月底是可以實施1.0.95元各位有報告其實應該是說因為我們固定的這個應該說健保因為總額的關係我們還有每一季還有區域還有醫院各區域以及各層級醫院他都有不同的點值計算好那這個東西來自於原來的點應該是說最低1.95啦\n\n20\n00:07:07,251 --> 00:07:30,843\n對那所以這個部分跟委員報告應該是之後我們會再跟委員會做報告那我們其實健保署本來就固定每一季甚至每個每一季都會有各區域還有各層級醫療院所拿的點子我現在不是講之後啦我現在是說6月底以後是不是就可以不管是哪一區或哪一級我們是一直以來我們都在針對點子的部分做進口1.0.95元啦\n\n21\n00:07:31,863 --> 00:08:00,382\n我們一直都在針對這個方向做監控跟方向的討論會做得到嗎會做得到我們一直在努力那當然現在的那個是主決議啦報告委員應該是說我們現在手上當然還有各分區不一樣的現象有的區它的健保耗用沒有那麼高它甚至可以到1.1塊錢有些區它的健保耗用比較高它點值可能就比較低這個我們都知道啦這個其實去年在討論這個案子的時候大家都討論過啦現在就是說因為有一個承諾嘛6月底的時候要最少0.95元到底是有沒有做不做得到啦\n\n22\n00:08:01,303 --> 00:08:08,721\n一直都在往這個方向走所以還是有信心就對了報告委員我們是六月底當月我們是一劑一劑好謝謝好謝謝葉委員\n\n","tsv":"start\tend\ttext\n7974\t9067\t麻煩請那個衛福部次長\n16074\t39355\t最近很多那個醫生朋友在反映就是說那個健保署把很多醫材都納入健保然後但是因為那個開會定的健保點數極負都過低導致於有一些廠商不想做要退出我想問一下通常健保署就是每一年要列入那麼多醫材或藥本來他們都自費嘛後來要列入他主要原因是什麼\n40755\t64903\t健保署收载这一个几副项目的部分有几个评估的方向一个事情就是他可能在这个医学会会来向健保署提出对于他们常用或者是希望能够收载到健保内部的医材来提出审查那另外的话当然有的时候是厂商因为对厂商来讲台湾因为我们健保cover 99.9%的民众所以对厂商来说如果他持续在自费的品项来讲他可能\n65663\t95458\t它能够这个被使用的量比较少所以有些厂商也会来跟我们要求希望能够收载到健保里面所以包含了专业医学会包含了这些医材的厂商或药品的厂商那当然有的时候可能是长期我们发现说某一些比较已经有某些医材或者是药品它已经是越来越是主要的被使用的情况那这个时候我们可能也会来跟医学会或者是这个需求端这边来讨论说是不是愿意让我们收载到健保里面\n95878\t124696\t我是覺得這個部分以後因為我最近聽很多醫生在講就有的他們的譬如說外科醫師他打骨釘什麼之類他說有的骨釘是自費市場有的是健保市場其實都已經行之有年好好的忽然間他們民眾喜歡的自費的骨釘忽然被納入到健保那被納入健保之後那個廠商有的就不想做然後反而就打亂他們本來的一些醫療的行為那這部分是不是可以請健保署就在\n125416\t150567\t做類似工作或開會的時候可以加強溝通謝謝委員因為譬如說我舉一個例子像這個之前大家新聞上面也都有看過就是一個手術的封合劑那有一個廠商叫做泰爾茂那這家廠商一開始的時候就是因為他被給的點數太低了所以他們就決定就不賣了那後來好像健保署又不救所以後來又重新找廠商來談把他的點數增加所以他又願意繼續留下來\n152168\t176513\t我有看到非常多藍衣生 有的跟政治都無關 有的藍的 有的綠的都有跳出來罵這個事情 可見說他在開會的過程當中的處理真的是有一點粗糙這個合價的部分在健保署這邊的相關合價事實上他是有些參考的公式那再來的話就是說 其實當時在這一個醫材的部分事實上是好幾家廠商都來跟我們要求收載到健保裡面\n177413\t192126\t是廠商來跟我們要求收窄那他要求收窄然後他自己又覺得點數太低然後退出其實是廠商來跟我們要求收窄那所以你們不是說大家先談就是說如果你要進來的話我給你多少點數你願意接受你再進來\n194108\t216118\t是說他談了你直接給了給了你要或不要一句話健保收窄裡面他如果是同類型的他當然會有一個收窄的價格幾付價格那這個價格其實不是健保署自己這邊訂的第一個事情就是剛剛跟委員報告他需要有一些公式第二個部分他必須經過我們的共擬會共同擬定會議那共同擬定會議裡面不單純只有健保署我們就拿這個太陽帽當作例子\n218979\t233175\t你看像當時因為因為這個已經議題在被大家關注了所以他後來健保署開一個記者會他把類似的藥全部都秀出來就是有百特醫療有泰爾茂還有埃莫高\n234156\t252752\t然後就拿出來可是大家發現說你合給的健保點數11831的的百特跟奧特利這兩種實際上它的容量計算方式是不一樣而且它的用途也不一樣等於是你把不同的容量的東西跟不同用途的東西都合給一樣的點數\n254173\t266027\t所以這樣的比較基礎就會有一個落差再跟你補充一下我一直講完再請你一定回答好了還有就是他也沒有當時在開會的時候也沒有列出國際價格還有一個問題就是\n270191\t285669\t這個建議支付點數你們有一個報告裡面有提到像這個封合劑在臨床上臨床上申報使用是用4L為大宗可是我們剛列出來的表格你們比較基礎是拿2克來做比較\n286877\t314987\t所以這個然後再加上這個藥特別是有非常多的醫生有很多不同意見其實我只是提出來就是說既然健保署基於需要因為剛剛市長一開始講了很多原因嘛要把那些藥納入既然有這麼多的需要把它納入那在核架以及開會的過程當中他那個資料的詳實性然後還有就是擴大醫界的意見的參與我覺得這一塊是不是可以多做一點啊不然的話真的\n316168\t330899\t其實聽到蠻多醫生在對於核價這件事情他們是有很多意見的我們當然希望說這個核的價格能夠讓大家在整個使用上面或者是在醫材韌性上面能夠更好不過也報告委員就是說因為健保畢竟它是總額的\n332220\t354572\t所以常常我們比如說A醫學會來希望我們收載了某一項給付B醫學會就會說你會影響到我們的點值這也是我們常遇到的狀況所以說當然在健保這邊它的核價不是由健保署自己來決定就像剛剛跟您報告的第一它有一些公式第二它在我們的購你會議裡面包含了我們的健保的委員以及購你會的委員還有醫界跟藥界還有相關的醫學會\n356693\t379807\t在共理會議上面會來針對健保署這邊必須考慮在收窄這些藥品裡面去進行評估那這裡面當然我們會尊重專家的意見當然各自的我們也必須承認台灣事實上各自的醫院或者是醫師有比較習慣用的品牌那我們盡量滿足有的時候可能就會有對 雖然因為剛剛你也提到那個健保點子因為我們去年有一個組決議就是健保1.0.95元\n381348\t408558\t那本來好像是說六月底的時候要實施那目前衛福部這方面的規劃是怎樣我們固定在每個每一季我們都有點值上面的這個計算好那所以就像委員您現在所看到我們的困境我們收窄的越多給付的越高那是不是點值上面就收到一點沒有沒有這個細節不講啦我是說因為我們那時候是講說1.0.95元嘛那時候部長邱太元也說他認為有信心可以達到那因為現在已經五月快五月底了\n409458\t426090\t再一個月所以真的6月底是可以實施1.0.95元各位有報告其實應該是說因為我們固定的這個應該說健保因為總額的關係我們還有每一季還有區域還有醫院各區域以及各層級醫院他都有不同的點值計算好那這個東西來自於原來的點應該是說最低1.95啦\n427251\t450843\t對那所以這個部分跟委員報告應該是之後我們會再跟委員會做報告那我們其實健保署本來就固定每一季甚至每個每一季都會有各區域還有各層級醫療院所拿的點子我現在不是講之後啦我現在是說6月底以後是不是就可以不管是哪一區或哪一級我們是一直以來我們都在針對點子的部分做進口1.0.95元啦\n451863\t480382\t我們一直都在針對這個方向做監控跟方向的討論會做得到嗎會做得到我們一直在努力那當然現在的那個是主決議啦報告委員應該是說我們現在手上當然還有各分區不一樣的現象有的區它的健保耗用沒有那麼高它甚至可以到1.1塊錢有些區它的健保耗用比較高它點值可能就比較低這個我們都知道啦這個其實去年在討論這個案子的時候大家都討論過啦現在就是說因為有一個承諾嘛6月底的時候要最少0.95元到底是有沒有做不做得到啦\n481303\t488721\t一直都在往這個方向走所以還是有信心就對了報告委員我們是六月底當月我們是一劑一劑好謝謝好謝謝葉委員\n","txt":"麻煩請那個衛福部次長\n最近很多那個醫生朋友在反映就是說那個健保署把很多醫材都納入健保然後但是因為那個開會定的健保點數極負都過低導致於有一些廠商不想做要退出我想問一下通常健保署就是每一年要列入那麼多醫材或藥本來他們都自費嘛後來要列入他主要原因是什麼\n健保署收载这一个几副项目的部分有几个评估的方向一个事情就是他可能在这个医学会会来向健保署提出对于他们常用或者是希望能够收载到健保内部的医材来提出审查那另外的话当然有的时候是厂商因为对厂商来讲台湾因为我们健保cover 99.9%的民众所以对厂商来说如果他持续在自费的品项来讲他可能\n它能够这个被使用的量比较少所以有些厂商也会来跟我们要求希望能够收载到健保里面所以包含了专业医学会包含了这些医材的厂商或药品的厂商那当然有的时候可能是长期我们发现说某一些比较已经有某些医材或者是药品它已经是越来越是主要的被使用的情况那这个时候我们可能也会来跟医学会或者是这个需求端这边来讨论说是不是愿意让我们收载到健保里面\n我是覺得這個部分以後因為我最近聽很多醫生在講就有的他們的譬如說外科醫師他打骨釘什麼之類他說有的骨釘是自費市場有的是健保市場其實都已經行之有年好好的忽然間他們民眾喜歡的自費的骨釘忽然被納入到健保那被納入健保之後那個廠商有的就不想做然後反而就打亂他們本來的一些醫療的行為那這部分是不是可以請健保署就在\n做類似工作或開會的時候可以加強溝通謝謝委員因為譬如說我舉一個例子像這個之前大家新聞上面也都有看過就是一個手術的封合劑那有一個廠商叫做泰爾茂那這家廠商一開始的時候就是因為他被給的點數太低了所以他們就決定就不賣了那後來好像健保署又不救所以後來又重新找廠商來談把他的點數增加所以他又願意繼續留下來\n我有看到非常多藍衣生 有的跟政治都無關 有的藍的 有的綠的都有跳出來罵這個事情 可見說他在開會的過程當中的處理真的是有一點粗糙這個合價的部分在健保署這邊的相關合價事實上他是有些參考的公式那再來的話就是說 其實當時在這一個醫材的部分事實上是好幾家廠商都來跟我們要求收載到健保裡面\n是廠商來跟我們要求收窄那他要求收窄然後他自己又覺得點數太低然後退出其實是廠商來跟我們要求收窄那所以你們不是說大家先談就是說如果你要進來的話我給你多少點數你願意接受你再進來\n是說他談了你直接給了給了你要或不要一句話健保收窄裡面他如果是同類型的他當然會有一個收窄的價格幾付價格那這個價格其實不是健保署自己這邊訂的第一個事情就是剛剛跟委員報告他需要有一些公式第二個部分他必須經過我們的共擬會共同擬定會議那共同擬定會議裡面不單純只有健保署我們就拿這個太陽帽當作例子\n你看像當時因為因為這個已經議題在被大家關注了所以他後來健保署開一個記者會他把類似的藥全部都秀出來就是有百特醫療有泰爾茂還有埃莫高\n然後就拿出來可是大家發現說你合給的健保點數11831的的百特跟奧特利這兩種實際上它的容量計算方式是不一樣而且它的用途也不一樣等於是你把不同的容量的東西跟不同用途的東西都合給一樣的點數\n所以這樣的比較基礎就會有一個落差再跟你補充一下我一直講完再請你一定回答好了還有就是他也沒有當時在開會的時候也沒有列出國際價格還有一個問題就是\n這個建議支付點數你們有一個報告裡面有提到像這個封合劑在臨床上臨床上申報使用是用4L為大宗可是我們剛列出來的表格你們比較基礎是拿2克來做比較\n所以這個然後再加上這個藥特別是有非常多的醫生有很多不同意見其實我只是提出來就是說既然健保署基於需要因為剛剛市長一開始講了很多原因嘛要把那些藥納入既然有這麼多的需要把它納入那在核架以及開會的過程當中他那個資料的詳實性然後還有就是擴大醫界的意見的參與我覺得這一塊是不是可以多做一點啊不然的話真的\n其實聽到蠻多醫生在對於核價這件事情他們是有很多意見的我們當然希望說這個核的價格能夠讓大家在整個使用上面或者是在醫材韌性上面能夠更好不過也報告委員就是說因為健保畢竟它是總額的\n所以常常我們比如說A醫學會來希望我們收載了某一項給付B醫學會就會說你會影響到我們的點值這也是我們常遇到的狀況所以說當然在健保這邊它的核價不是由健保署自己來決定就像剛剛跟您報告的第一它有一些公式第二它在我們的購你會議裡面包含了我們的健保的委員以及購你會的委員還有醫界跟藥界還有相關的醫學會\n在共理會議上面會來針對健保署這邊必須考慮在收窄這些藥品裡面去進行評估那這裡面當然我們會尊重專家的意見當然各自的我們也必須承認台灣事實上各自的醫院或者是醫師有比較習慣用的品牌那我們盡量滿足有的時候可能就會有對 雖然因為剛剛你也提到那個健保點子因為我們去年有一個組決議就是健保1.0.95元\n那本來好像是說六月底的時候要實施那目前衛福部這方面的規劃是怎樣我們固定在每個每一季我們都有點值上面的這個計算好那所以就像委員您現在所看到我們的困境我們收窄的越多給付的越高那是不是點值上面就收到一點沒有沒有這個細節不講啦我是說因為我們那時候是講說1.0.95元嘛那時候部長邱太元也說他認為有信心可以達到那因為現在已經五月快五月底了\n再一個月所以真的6月底是可以實施1.0.95元各位有報告其實應該是說因為我們固定的這個應該說健保因為總額的關係我們還有每一季還有區域還有醫院各區域以及各層級醫院他都有不同的點值計算好那這個東西來自於原來的點應該是說最低1.95啦\n對那所以這個部分跟委員報告應該是之後我們會再跟委員會做報告那我們其實健保署本來就固定每一季甚至每個每一季都會有各區域還有各層級醫療院所拿的點子我現在不是講之後啦我現在是說6月底以後是不是就可以不管是哪一區或哪一級我們是一直以來我們都在針對點子的部分做進口1.0.95元啦\n我們一直都在針對這個方向做監控跟方向的討論會做得到嗎會做得到我們一直在努力那當然現在的那個是主決議啦報告委員應該是說我們現在手上當然還有各分區不一樣的現象有的區它的健保耗用沒有那麼高它甚至可以到1.1塊錢有些區它的健保耗用比較高它點值可能就比較低這個我們都知道啦這個其實去年在討論這個案子的時候大家都討論過啦現在就是說因為有一個承諾嘛6月底的時候要最少0.95元到底是有沒有做不做得到啦\n一直都在往這個方向走所以還是有信心就對了報告委員我們是六月底當月我們是一劑一劑好謝謝好謝謝葉委員\n","vtt":"WEBVTT\n\n00:07.974 --> 00:09.067\n麻煩請那個衛福部次長\n\n00:16.074 --> 00:39.355\n最近很多那個醫生朋友在反映就是說那個健保署把很多醫材都納入健保然後但是因為那個開會定的健保點數極負都過低導致於有一些廠商不想做要退出我想問一下通常健保署就是每一年要列入那麼多醫材或藥本來他們都自費嘛後來要列入他主要原因是什麼\n\n00:40.755 --> 01:04.903\n健保署收载这一个几副项目的部分有几个评估的方向一个事情就是他可能在这个医学会会来向健保署提出对于他们常用或者是希望能够收载到健保内部的医材来提出审查那另外的话当然有的时候是厂商因为对厂商来讲台湾因为我们健保cover99.9%的民众所以对厂商来说如果他持续在自费的品项来讲他可能\n\n01:05.663 --> 01:35.458\n它能够这个被使用的量比较少所以有些厂商也会来跟我们要求希望能够收载到健保里面所以包含了专业医学会包含了这些医材的厂商或药品的厂商那当然有的时候可能是长期我们发现说某一些比较已经有某些医材或者是药品它已经是越来越是主要的被使用的情况那这个时候我们可能也会来跟医学会或者是这个需求端这边来讨论说是不是愿意让我们收载到健保里面\n\n01:35.878 --> 02:04.696\n我是覺得這個部分以後因為我最近聽很多醫生在講就有的他們的譬如說外科醫師他打骨釘什麼之類他說有的骨釘是自費市場有的是健保市場其實都已經行之有年好好的忽然間他們民眾喜歡的自費的骨釘忽然被納入到健保那被納入健保之後那個廠商有的就不想做然後反而就打亂他們本來的一些醫療的行為那這部分是不是可以請健保署就在\n\n02:05.416 --> 02:30.567\n做類似工作或開會的時候可以加強溝通謝謝委員因為譬如說我舉一個例子像這個之前大家新聞上面也都有看過就是一個手術的封合劑那有一個廠商叫做泰爾茂那這家廠商一開始的時候就是因為他被給的點數太低了所以他們就決定就不賣了那後來好像健保署又不救所以後來又重新找廠商來談把他的點數增加所以他又願意繼續留下來\n\n02:32.168 --> 02:56.513\n我有看到非常多藍衣生有的跟政治都無關有的藍的有的綠的都有跳出來罵這個事情可見說他在開會的過程當中的處理真的是有一點粗糙這個合價的部分在健保署這邊的相關合價事實上他是有些參考的公式那再來的話就是說其實當時在這一個醫材的部分事實上是好幾家廠商都來跟我們要求收載到健保裡面\n\n02:57.413 --> 03:12.126\n是廠商來跟我們要求收窄那他要求收窄然後他自己又覺得點數太低然後退出其實是廠商來跟我們要求收窄那所以你們不是說大家先談就是說如果你要進來的話我給你多少點數你願意接受你再進來\n\n03:14.108 --> 03:36.118\n是說他談了你直接給了給了你要或不要一句話健保收窄裡面他如果是同類型的他當然會有一個收窄的價格幾付價格那這個價格其實不是健保署自己這邊訂的第一個事情就是剛剛跟委員報告他需要有一些公式第二個部分他必須經過我們的共擬會共同擬定會議那共同擬定會議裡面不單純只有健保署我們就拿這個太陽帽當作例子\n\n03:38.979 --> 03:53.175\n你看像當時因為因為這個已經議題在被大家關注了所以他後來健保署開一個記者會他把類似的藥全部都秀出來就是有百特醫療有泰爾茂還有埃莫高\n\n03:54.156 --> 04:12.752\n然後就拿出來可是大家發現說你合給的健保點數11831的的百特跟奧特利這兩種實際上它的容量計算方式是不一樣而且它的用途也不一樣等於是你把不同的容量的東西跟不同用途的東西都合給一樣的點數\n\n04:14.173 --> 04:26.027\n所以這樣的比較基礎就會有一個落差再跟你補充一下我一直講完再請你一定回答好了還有就是他也沒有當時在開會的時候也沒有列出國際價格還有一個問題就是\n\n04:30.191 --> 04:45.669\n這個建議支付點數你們有一個報告裡面有提到像這個封合劑在臨床上臨床上申報使用是用4L為大宗可是我們剛列出來的表格你們比較基礎是拿2克來做比較\n\n04:46.877 --> 05:14.987\n所以這個然後再加上這個藥特別是有非常多的醫生有很多不同意見其實我只是提出來就是說既然健保署基於需要因為剛剛市長一開始講了很多原因嘛要把那些藥納入既然有這麼多的需要把它納入那在核架以及開會的過程當中他那個資料的詳實性然後還有就是擴大醫界的意見的參與我覺得這一塊是不是可以多做一點啊不然的話真的\n\n05:16.168 --> 05:30.899\n其實聽到蠻多醫生在對於核價這件事情他們是有很多意見的我們當然希望說這個核的價格能夠讓大家在整個使用上面或者是在醫材韌性上面能夠更好不過也報告委員就是說因為健保畢竟它是總額的\n\n05:32.220 --> 05:54.572\n所以常常我們比如說A醫學會來希望我們收載了某一項給付B醫學會就會說你會影響到我們的點值這也是我們常遇到的狀況所以說當然在健保這邊它的核價不是由健保署自己來決定就像剛剛跟您報告的第一它有一些公式第二它在我們的購你會議裡面包含了我們的健保的委員以及購你會的委員還有醫界跟藥界還有相關的醫學會\n\n05:56.693 --> 06:19.807\n在共理會議上面會來針對健保署這邊必須考慮在收窄這些藥品裡面去進行評估那這裡面當然我們會尊重專家的意見當然各自的我們也必須承認台灣事實上各自的醫院或者是醫師有比較習慣用的品牌那我們盡量滿足有的時候可能就會有對雖然因為剛剛你也提到那個健保點子因為我們去年有一個組決議就是健保1.0.95元\n\n06:21.348 --> 06:48.558\n那本來好像是說六月底的時候要實施那目前衛福部這方面的規劃是怎樣我們固定在每個每一季我們都有點值上面的這個計算好那所以就像委員您現在所看到我們的困境我們收窄的越多給付的越高那是不是點值上面就收到一點沒有沒有這個細節不講啦我是說因為我們那時候是講說1.0.95元嘛那時候部長邱太元也說他認為有信心可以達到那因為現在已經五月快五月底了\n\n06:49.458 --> 07:06.090\n再一個月所以真的6月底是可以實施1.0.95元各位有報告其實應該是說因為我們固定的這個應該說健保因為總額的關係我們還有每一季還有區域還有醫院各區域以及各層級醫院他都有不同的點值計算好那這個東西來自於原來的點應該是說最低1.95啦\n\n07:07.251 --> 07:30.843\n對那所以這個部分跟委員報告應該是之後我們會再跟委員會做報告那我們其實健保署本來就固定每一季甚至每個每一季都會有各區域還有各層級醫療院所拿的點子我現在不是講之後啦我現在是說6月底以後是不是就可以不管是哪一區或哪一級我們是一直以來我們都在針對點子的部分做進口1.0.95元啦\n\n07:31.863 --> 08:00.382\n我們一直都在針對這個方向做監控跟方向的討論會做得到嗎會做得到我們一直在努力那當然現在的那個是主決議啦報告委員應該是說我們現在手上當然還有各分區不一樣的現象有的區它的健保耗用沒有那麼高它甚至可以到1.1塊錢有些區它的健保耗用比較高它點值可能就比較低這個我們都知道啦這個其實去年在討論這個案子的時候大家都討論過啦現在就是說因為有一個承諾嘛6月底的時候要最少0.95元到底是有沒有做不做得到啦\n\n08:01.303 --> 08:08.721\n一直都在往這個方向走所以還是有信心就對了報告委員我們是六月底當月我們是一劑一劑好謝謝好謝謝葉委員\n\n","segments":[{"start":7.974,"end":9.067,"text":"麻煩請那個衛福部次長"},{"start":16.074,"end":39.355,"text":"最近很多那個醫生朋友在反映就是說那個健保署把很多醫材都納入健保然後但是因為那個開會定的健保點數極負都過低導致於有一些廠商不想做要退出我想問一下通常健保署就是每一年要列入那麼多醫材或藥本來他們都自費嘛後來要列入他主要原因是什麼"},{"start":40.755,"end":64.903,"text":"健保署收载这一个几副项目的部分有几个评估的方向一个事情就是他可能在这个医学会会来向健保署提出对于他们常用或者是希望能够收载到健保内部的医材来提出审查那另外的话当然有的时候是厂商因为对厂商来讲台湾因为我们健保cover 99.9%的民众所以对厂商来说如果他持续在自费的品项来讲他可能"},{"start":65.663,"end":95.458,"text":"它能够这个被使用的量比较少所以有些厂商也会来跟我们要求希望能够收载到健保里面所以包含了专业医学会包含了这些医材的厂商或药品的厂商那当然有的时候可能是长期我们发现说某一些比较已经有某些医材或者是药品它已经是越来越是主要的被使用的情况那这个时候我们可能也会来跟医学会或者是这个需求端这边来讨论说是不是愿意让我们收载到健保里面"},{"start":95.878,"end":124.696,"text":"我是覺得這個部分以後因為我最近聽很多醫生在講就有的他們的譬如說外科醫師他打骨釘什麼之類他說有的骨釘是自費市場有的是健保市場其實都已經行之有年好好的忽然間他們民眾喜歡的自費的骨釘忽然被納入到健保那被納入健保之後那個廠商有的就不想做然後反而就打亂他們本來的一些醫療的行為那這部分是不是可以請健保署就在"},{"start":125.416,"end":150.567,"text":"做類似工作或開會的時候可以加強溝通謝謝委員因為譬如說我舉一個例子像這個之前大家新聞上面也都有看過就是一個手術的封合劑那有一個廠商叫做泰爾茂那這家廠商一開始的時候就是因為他被給的點數太低了所以他們就決定就不賣了那後來好像健保署又不救所以後來又重新找廠商來談把他的點數增加所以他又願意繼續留下來"},{"start":152.168,"end":176.513,"text":"我有看到非常多藍衣生 有的跟政治都無關 有的藍的 有的綠的都有跳出來罵這個事情 可見說他在開會的過程當中的處理真的是有一點粗糙這個合價的部分在健保署這邊的相關合價事實上他是有些參考的公式那再來的話就是說 其實當時在這一個醫材的部分事實上是好幾家廠商都來跟我們要求收載到健保裡面"},{"start":177.413,"end":192.126,"text":"是廠商來跟我們要求收窄那他要求收窄然後他自己又覺得點數太低然後退出其實是廠商來跟我們要求收窄那所以你們不是說大家先談就是說如果你要進來的話我給你多少點數你願意接受你再進來"},{"start":194.108,"end":216.118,"text":"是說他談了你直接給了給了你要或不要一句話健保收窄裡面他如果是同類型的他當然會有一個收窄的價格幾付價格那這個價格其實不是健保署自己這邊訂的第一個事情就是剛剛跟委員報告他需要有一些公式第二個部分他必須經過我們的共擬會共同擬定會議那共同擬定會議裡面不單純只有健保署我們就拿這個太陽帽當作例子"},{"start":218.979,"end":233.175,"text":"你看像當時因為因為這個已經議題在被大家關注了所以他後來健保署開一個記者會他把類似的藥全部都秀出來就是有百特醫療有泰爾茂還有埃莫高"},{"start":234.156,"end":252.752,"text":"然後就拿出來可是大家發現說你合給的健保點數11831的的百特跟奧特利這兩種實際上它的容量計算方式是不一樣而且它的用途也不一樣等於是你把不同的容量的東西跟不同用途的東西都合給一樣的點數"},{"start":254.173,"end":266.027,"text":"所以這樣的比較基礎就會有一個落差再跟你補充一下我一直講完再請你一定回答好了還有就是他也沒有當時在開會的時候也沒有列出國際價格還有一個問題就是"},{"start":270.191,"end":285.669,"text":"這個建議支付點數你們有一個報告裡面有提到像這個封合劑在臨床上臨床上申報使用是用4L為大宗可是我們剛列出來的表格你們比較基礎是拿2克來做比較"},{"start":286.877,"end":314.987,"text":"所以這個然後再加上這個藥特別是有非常多的醫生有很多不同意見其實我只是提出來就是說既然健保署基於需要因為剛剛市長一開始講了很多原因嘛要把那些藥納入既然有這麼多的需要把它納入那在核架以及開會的過程當中他那個資料的詳實性然後還有就是擴大醫界的意見的參與我覺得這一塊是不是可以多做一點啊不然的話真的"},{"start":316.168,"end":330.899,"text":"其實聽到蠻多醫生在對於核價這件事情他們是有很多意見的我們當然希望說這個核的價格能夠讓大家在整個使用上面或者是在醫材韌性上面能夠更好不過也報告委員就是說因為健保畢竟它是總額的"},{"start":332.22,"end":354.572,"text":"所以常常我們比如說A醫學會來希望我們收載了某一項給付B醫學會就會說你會影響到我們的點值這也是我們常遇到的狀況所以說當然在健保這邊它的核價不是由健保署自己來決定就像剛剛跟您報告的第一它有一些公式第二它在我們的購你會議裡面包含了我們的健保的委員以及購你會的委員還有醫界跟藥界還有相關的醫學會"},{"start":356.693,"end":379.807,"text":"在共理會議上面會來針對健保署這邊必須考慮在收窄這些藥品裡面去進行評估那這裡面當然我們會尊重專家的意見當然各自的我們也必須承認台灣事實上各自的醫院或者是醫師有比較習慣用的品牌那我們盡量滿足有的時候可能就會有對 雖然因為剛剛你也提到那個健保點子因為我們去年有一個組決議就是健保1.0.95元"},{"start":381.348,"end":408.558,"text":"那本來好像是說六月底的時候要實施那目前衛福部這方面的規劃是怎樣我們固定在每個每一季我們都有點值上面的這個計算好那所以就像委員您現在所看到我們的困境我們收窄的越多給付的越高那是不是點值上面就收到一點沒有沒有這個細節不講啦我是說因為我們那時候是講說1.0.95元嘛那時候部長邱太元也說他認為有信心可以達到那因為現在已經五月快五月底了"},{"start":409.458,"end":426.09,"text":"再一個月所以真的6月底是可以實施1.0.95元各位有報告其實應該是說因為我們固定的這個應該說健保因為總額的關係我們還有每一季還有區域還有醫院各區域以及各層級醫院他都有不同的點值計算好那這個東西來自於原來的點應該是說最低1.95啦"},{"start":427.251,"end":450.843,"text":"對那所以這個部分跟委員報告應該是之後我們會再跟委員會做報告那我們其實健保署本來就固定每一季甚至每個每一季都會有各區域還有各層級醫療院所拿的點子我現在不是講之後啦我現在是說6月底以後是不是就可以不管是哪一區或哪一級我們是一直以來我們都在針對點子的部分做進口1.0.95元啦"},{"start":451.863,"end":480.382,"text":"我們一直都在針對這個方向做監控跟方向的討論會做得到嗎會做得到我們一直在努力那當然現在的那個是主決議啦報告委員應該是說我們現在手上當然還有各分區不一樣的現象有的區它的健保耗用沒有那麼高它甚至可以到1.1塊錢有些區它的健保耗用比較高它點值可能就比較低這個我們都知道啦這個其實去年在討論這個案子的時候大家都討論過啦現在就是說因為有一個承諾嘛6月底的時候要最少0.95元到底是有沒有做不做得到啦"},{"start":481.303,"end":488.721,"text":"一直都在往這個方向走所以還是有信心就對了報告委員我們是六月底當月我們是一劑一劑好謝謝好謝謝葉委員"}]}}},"gazette":{"lineno":1451,"blocks":[["葉委員元之：（13時56分）麻煩請衛福部次長。"],["林次長靜儀：委員好。"],["葉委員元之：次長好。最近很多醫生朋友在反映健保署把很多醫材都納入健保，但是因為開會訂的健保點數給付都過低，導致有些廠商不想做，要退出。我想問一下，通常健保署每一年要列入那麼多醫材或藥，本來都是自費，但後來要列入的主要的原因是什麼？"],["林次長靜儀：健保署收載給付項目的部分有幾個評估的方向，一個就是可能醫學會會向健保署提出，對於他們常用或者是希望能夠收載到健保內部的醫材來提出審查。另外當然有的時候是廠商，對廠商來講，臺灣因為健保cover百分之九十九點九的民眾，所以對廠商來說，如果持續在自費的品項來講，能夠被使用的量比較少，所以有些廠商也會來跟我們要求，希望能夠收載到健保裡面，所以包含了專業醫學會、包含了這些醫材廠商或藥品廠商，當然有的時候可能是長期我們發現已經有某些醫材或者是藥品越來越是主要被使用的情況，這個時候我們可能也會跟醫學會或者需求端這邊討論是不是願意讓我們收載到健保裡面。"],["葉委員元之：對於這個部分，因為我最近真的聽到很多醫生在講，譬如說外科醫師打骨釘，他們說有的骨釘是自費市場、有的是健保市場，其實都已經行之有年，都好好的，但忽然間民眾喜歡的自費骨釘被納入到健保，被納入健保之後，廠商有的就不想做了，反而打亂他們本來的一些醫療行為，這部分是不是可以請健保署在做類似工作或開會的時候可以加強溝通？"],["林次長靜儀：謝謝委員……"],["葉委員元之：譬如我舉一個例子，像這個大家之前在新聞上都有看過，這是一個手術的封合劑，有一個廠商叫做泰爾茂，這家廠商一開始就是因為它被給的點數太低了，所以它們就決定不賣了，後來好像健保署有補救，是不是後來又重新找廠商來談，把點數增加，所以它又願意繼續留下來？這跟政治都無關，我看到非常多醫生，有的藍的、有的綠的，都有跳出來罵這個事情。"],["林次長靜儀：跟委員報告……"],["葉委員元之：可見在開會過程當中的處理真的是有點粗糙。"],["林次長靜儀：在健保署這邊相關的核價，事實上是有一些參考的公式，再來就是當時在醫材的部分，是有好幾家廠商都來跟我們要求收載到健保裡面，是廠商來跟我們要求收載的。"],["葉委員元之：他們要求收載，然後自己又覺得點數太低，然後退出？"],["林次長靜儀：是，其實是廠商來跟我們要求收載的。"],["葉委員元之：所以你們不是大家先談，如果要進來的話給多少點數，願意接受再進來？不是這樣？是他談了，你直接給了，給了，你要或不要，一句話！"],["林次長靜儀：收載到健保裡面，如果是同類型的，當然會有一個收載的價格、給付價格，但這個價格其實不是健保署這邊自己訂的，第一個就是剛剛跟委員報告的，它必須要有一些公式。第二個部分，它必須經過我們的共擬會（共同擬定會議），共同擬定會議裡面不單純只有健保署。"],["葉委員元之：我們就拿泰爾茂當作例子，當時因為這個議題已經被大家關注了，所以後來健保署有開一個記者會，它把類似的藥全部都秀出來，有百特醫療、有泰爾茂，還有埃默高，都拿出來，可是大家發現核給的健保點數11,831的百特跟奧特利這兩種，實際上它的容量計算方式不一樣，而且它的用途也不一樣，等於是把不同容量的東西跟不同用途的東西都核給一樣的點數，所以這樣的比較基礎就會有點落差。"],["林次長靜儀：再跟委員補充一下……"],["葉委員元之：我一次講完再請你一併回答好了。"],["林次長靜儀：好。"],["葉委員元之：還有當時在開會的時候也沒有列出國際價格。另外還有一個問題，關於建議支付點數，你們有一個報告裡面有提到，像封合劑在臨床上申報使用是用4ml為大宗，可是我們剛剛列出來的表格，你們的比較基礎是拿2克來做比較，再加上這個藥特別是有非常多醫生有很多不同意見，今天我只是提出來，既然健保署基於需要，因為剛剛次長一開始講了很多原因，要把那些納入，既然有這麼多需要把它納入，在核價以及開會的過程當中，那個資料的詳實性，還有擴大醫界意見的參與，我覺得這一塊是不是可以多做一點？不然的話，我其實聽到滿多醫生對於核價這件事情是有很多意見的。"],["林次長靜儀：是，我們當然希望核的價格能夠讓大家在整個使用上面，或者是在醫材韌性上面能夠更好，不過也報告委員，健保畢竟是總額的，比方說A醫學會希望我們收載某一項給付，B醫學會就會說這會影響到我們的點值，這也是我們常遇到的狀況。當然在健保這邊的核價不是由健保署自己來決定，就像剛剛跟您報告的，第一、它有一些公式；第二、它在我們的共擬會議裡面，包含健保的委員，以及共擬會的委員，還有醫界跟藥界，以及相關的醫學會，在共擬會議上會針對健保署這邊必須考慮收載這些藥品裡面進行評估，當然我們會尊重專家的意見。而我們也必須承認臺灣各自的醫院或者是醫師有比較習慣用的品牌，我們儘量滿足，有的時候可能就會有……"],["葉委員元之：對，剛剛你提到健保點值，因為我們去年有一個主決議，就是健保1點0.95元，本來好像是6月底要實施，目前衛福部這方面的規劃是怎樣？"],["林次長靜儀：我們固定在每一季都有點值上面的計算，所以就像委員現在所看到我們的困境，我們收載的越多、給付的越高，是不是點值上面就受到影響？"],["葉委員元之：沒有，這個細節不講，因為我們那時候是說1點0.95元。"],["林次長靜儀：是。"],["葉委員元之：那時候部長邱泰源也說他認為有信心可以達到。"],["林次長靜儀：是，我們朝向這個方向正在努力。"],["葉委員元之：因為現在已經5月底了，再1個月，所以6月底是真的可以實施1點0.95元？"],["林次長靜儀：跟委員報告，其實應該是說健保因為總額的關係，我們還有每一季、還有區域、還有醫院，各區域以及各層級醫院都有不同的點值計算，這個東西來自於原來的點值……"],["葉委員元之：應該是說最低1點0.95。"],["林次長靜儀：對，這個部分跟委員報告，應該是之後我們會再跟委員會報告，健保署本來就固定每一季都會有各區域，還有各層級醫療院所的點值。"],["葉委員元之：我現在不是講之後啦！"],["林次長靜儀：我是說一直以來我們是這麼做的。"],["葉委員元之：我現在是說6月底，6月底以後不管是哪一區或哪一級，是不是就可以……"],["林次長靜儀：委員，我們不是6月底之後，我們是一直以來都在針對點值的部分做監控。"],["葉委員元之：1點0.95元。"],["林次長靜儀：我們一直都在針對這個方向做監控跟方向的……"],["葉委員元之：會做得到嗎？"],["林次長靜儀：我們一直在努力。當然現在的……"],["葉委員元之：那個是主決議。"],["林次長靜儀：報告委員，應該是說我們現在手上……當然還有各分區不一樣的現象，有的區健保耗用沒有那麼高，它甚至可以到1點1塊錢，有些區的健保耗用比較高，它的點值可能就比較低。"],["葉委員元之：這個我們都知道，去年在討論這個案子的時候，大家都討論過，現在是因為有一個承諾，6月底的時候要最少0.95元，到底是做不做得到？"],["林次長靜儀：一直都在做。"],["葉委員元之：因為差一個月。"],["林次長靜儀：一直都在往這個方向做。"],["葉委員元之：所以還是有信心就對了？"],["林次長靜儀：報告委員，我們不是6月底當月，我們是一季一季。"],["葉委員元之：好，謝謝。"],["主席：謝謝葉委員，謝謝次長。"],["林次長靜儀：謝謝。"],["主席：陳冠廷委員改成書面質詢。","林楚茵、林楚茵、林楚茵委員不在。","黃捷改書面質詢。","本日會議詢答全部結束，委員王育敏、陳冠廷、邱鎮軍、廖偉翔、黃捷所提書面質詢列入紀錄，刊登公報。"],["委員王育敏書面質詢：","【一、居服中心與訪視員是否存在前端業務失職？】","1.劉彩萱、劉若琳兩位保母遭爆出不僅虐待剴剴，更早之前亦涉及對另外兩位幼童施虐。文山區居家托育服務中心（以下簡稱文山居托）作為保母的管理單位，按規定必須定期至各保母家訪視，訪視重點包含「兒虐辨識」及「居托人員社會及心理風險疑慮」。而文山居托訪視員在此期間共訪視了五次，卻都沒有發現異狀。請問衛福部，文山居托訪視員是否存在職務疏失？","2.兒虐在實務上很難發現，因此要仰賴各單位皆克盡職責。但據本席了解，剴剴案事發當時通報的單位是萬芳醫院，而非文山居托。請問衛福部身為中央主管機關，是否掌握文山居托中心當時通報情形？若無即時通報，衛福部已採取何作為改善問題？","【二、衛福部將社安網職責全部丟包給地方，中央主責在何方？】","1.衛福部在「社會工作督導支持及培力計畫」中提到，希望透過督導制度厚植在地社工人員的專業能力，提升服務品質。請問衛福部透過這個計畫，期望外聘督導應盡到何種義務和職責？","2.請問衛福部作為「社會安全網」中央主管機關，是否曾調查、掌握全國各縣市居托中心聘請外部督導的績效？","3.衛福部5月19日針對本席索資回覆，「依兒少權法第26條第3項規定：『直轄市、縣（市）主管機關為辦理居家式托育服務提供者之登記、管理、輔導、監督及檢查等事項，應自行或委託相關專業機構、團體辦理。』因居家托育服務中心係由直轄市、縣（市）主管機關委託辦理，中央主管機關並未介入處理」；並提及「中央主管機關尊重地方政府有關外聘督導的規範及管考機制。」請問衛福部身為社會安全網政策之中央主管機關，督導責任為何？","4.若兒虐事件發生，衛福部態度盡說「未介入」地方政府對居托中心之管理，試圖掩蓋自己應督導地方政府之責任，社會安全網何時才能獲得實質修補？","【三、督導的實質業務與作為，是否可以真的補足安全網漏洞？】","1.「外聘督導」之制度設計，係透過資深、有豐富經驗的社工師前輩定期指導居服中心，其扮演了居托中心訪視計畫中的關鍵角色，亦是兒虐事件中的一道重要防線。然而剴剴案事發至今，外部督導用一句「自己只是被動諮詢」來限縮自己之職責，將責任歸咎於經驗不足的居托中心本身。請問衛福部認為現行實務如此運作，符合社會安全網設置精神嗎？","2.目前衛福部對於外聘督導的資格，除了學經歷要求之外，並沒有更詳細的資格審查，當外部督導本身身兼多職，又在各縣市政府都有督導責任時，要如何確保每一個個案都能被確實關注？","3.劉彩萱、劉若琳兩位保母手中，遭受虐待的幼童就多達3位，可見居服中心與督導對於每一個個案的掌握的程度都不夠高。若外聘督導領鐘點費卻僅檢視該個案訪視報告的「形式完整性」，而未主動追蹤個案處理情形，便形成了「有權無責」的社安網問題。請問衛福部是否將具體研議將外聘督導績效納入機構評鑑？（例如同一人不得超過幾家機構的督導上限、外聘督導也須繳交督導紀錄資料）","本席認為，外聘督導有領取中央或地方政府的鐘點費，並不應該「有權無責」，並要求衛福部身為中央主管機關，應回頭檢視居托中心外聘督導之督導過程，是否僅檢視該個案訪視報告的「形式完整性」，而未主動追蹤個案處理情形。","本席亦具體建議衛福部應就外聘督導訂定相關職責指引，並要求其針對特殊個案（早療、脆弱家庭、兒少保護等托育兒童處遇；狀況保母）定期做個案檢視與討論。","【三、改隸衛福部管轄業務，是否真的有助於監督機構？】","1.衛福部去年9月曾表示，人民團體可依據自身業務與任務導向，選擇所屬主管機關，目前也沒有規定要求文教基金會不得從事社福業務。請問衛福部對於「所有」文教基金會更改主管機關的意見，是否已有更明確的態度與做法？","2.在現行社福相關業務中，仍有部分文教基金會同樣有經手屬於社政的親子館、托嬰中心、兒童臨時托育服務等業務，是否都應同樣更改主管機關，從教育部改為衛福部？","3.呈上，文教基金會若更改主管機關為衛福部後，在管理作為上可以達成何種成效？且依照衛福部現今的編制，將如何提高量能去管理眾多社福機構？"],["委員陳冠廷書面質詢：","主旨：關於性騷擾防治及外聘督導制度精進作為之質詢","一、「剴剴案」後，社福「外聘督導制度」失靈檢討與改革藍圖","1.「剴剴案」震驚社會，暴露出現行社福「外聘督導制度」嚴重失靈。作為兒少保護安全網重要環節，該制度理應及早發現並預防潛在風險，請說明：","(1)根據衛福部調查，目前全國社福機構外聘督導制度「失靈」的主要原因為何？是督導選任機制不當、督導專業性不足、還是督導意見缺乏約束力與追蹤機制？","(2)衛福部是否已全面檢視各縣市社福機構外聘督導執行現況？有多少比例的機構在督導執行頻率、方式或品質上不符合標準？請提供具體數據。","2.關於外聘督導制度改革，請說明：","(1)衛福部預計於何時提出外聘督導制度全面改革方案？其核心改革方向為何？","(2)針對督導人員的專業度與獨立性，衛福部是否考慮建立中央層級的「外聘督導人才資料庫」，並訂定嚴格的遴選標準與退場機制？","(3)針對督導意見的執行力，衛福部是否規劃修訂相關法規或行政規則，賦予督導意見更強的法律約束力，並建立未落實督導意見的課責機制？","3.地方政府在外聘督導制度中扮演重要角色，請說明：","(1)衛福部如何確保各地方政府對外聘督導制度的重視與落實？是否有具體的考核與獎懲機制？","(2)針對地方政府社會局處人力不足問題，衛福部是否有計畫增加相關預算與人力配置，以強化地方政府對外聘督導制度的監督能力？","二、提升《性騷擾防治法》運用成效與被害人信任度","1.《性騷擾防治法》修法後，延長了申訴時效並暢通外部申訴管道，請說明：","(1)修法前後，各地方政府受理性騷擾申訴案件數量變化為何？被害人對申訴處理結果的滿意度是否有所提升？請提供具體數據。","(2)民眾對《性騷擾防治法》的認知程度為何？衛福部是否進行過相關調查？若有，請提供調查結果；若無，衛福部是否計畫進行相關調查？","2.針對被害人支持服務，請說明：","(1)目前各縣市提供性騷擾被害人的支持服務內容、品質與可及性是否有差異？衛福部如何確保全國服務品質一致？","(2)衛福部是否考慮建立或補助地方政府設置「一站式性騷擾被害人支持中心」，提供被害人即時的情緒支持、法律諮詢、醫療協助等整合性服務？若有，請說明具體規劃與時程；若無，主要考量因素為何？","3.關於《性騷擾防治法》之宣導策略，請說明：","(1)衛福部針對不同群體（如青少年、職場人士、弱勢族群等）是否有差異化的宣導策略？請具體說明各族群的宣導計畫、預算與執行成效。","(2)針對高風險場域（如大眾運輸、娛樂場所、教育機構等），衛福部與相關部會是否有跨部會合作宣導計畫？請說明具體內容與執行進度。","請貴部就上述問題提供詳細說明，並提出具體可行的改革方案，以健全社福外聘督導制度並提升《性騷擾防治法》的實施成效。請於一個月內回覆。"],["委員邱鎮軍書面質詢：","邀請衛生福利部、教育部就「性騷擾防治及外聘督導制度精進作為」進行專題報告，並備質詢。","剴剴案外聘督導制度精進作為","「剴剴受虐案」引發台灣社會各界質疑，要求政府徹查責任、並進行全面制度改革，此案暴露出台灣出養制系統欠缺督導、社工監督失靈、通報流程延宕等結構性問題。","本案發生後政府沒有為此召開「重大兒虐會議」，原因是當時衛福部認為重大兒虐事件的定義僅限「家內或監護人施虐」，保母因此被排除在外。","Q1：剴剴案暴露出我國出養制系統欠缺督導、社工監督失靈、通報流程延宕等結構性問題，也凸顯居家托育服務品質堪虞，請衛福部針對上開缺失提出檢討結果及因應改善作為為何？並說明如何確保並提升保母品質？如何發現、淘汰不適任保母？並請說明目前「重大兒虐會議」定義、對象為何？","Q2：根據檢方調查發現，本案負責訪視的陳姓社工曾於9月、10月與11月探視三次，皆回報「無異狀」，被控涉嫌造假訪談紀錄，於2024年8月遭檢方依偽造文書、過失致死等罪嫌起訴。請衛福部提供本案訪視員未確實訪視之檢討結果及未來如何改善？","Q3：根據媒體報導，剴剴案的劉姓保母是登記在文山居家托育服務中心，而該居托中心由台北市社會局長期委由大愛關懷協會經營關理，按規定文山居托服務中心必須定期到各保母家去訪視居家兒童照顧環境，而大愛關懷協會內部督導及聘請的外部督導，在本案過程中完全沒有發揮作用，請衛福部說明設置外聘督導之功能、目的為何？協助居托服務中心內容為何？又本案外聘督導之角色扮演與應負責任為何？","Q4：請衛福部說明外聘督導聘期、擔任外聘督導所需資格及每年領取之相關費用為何？","Q5：根據報導剴剴案所屬文山居托中心經營者大愛關懷協會聘請之外聘督導，在台北市12個行政區中同時身兼多區的外聘督導，並且可能還同時擔任其他直轄市、縣（市）的外聘督導，請衛福部查明本案外聘督導同時兼任多少外聘督導角色？並說明外聘督導兼任規定？","Q6：針對剴剴受虐案引發社會關注，在公共政策網路參與平台中，有13萬人連署要求調高虐童者刑責，法務部長鄭銘謙近日表示，虐童行為是人神共憤、天理難容，法務部正研議更周延的法律保護措施，請問衛福部立場為何？","台大醫師性騷擾案檢討及精進作為","針對台大醫院婦產部接連爆出性騷、性侵爭議，引發社會關注，外界質疑院方通報不全，北市衛生局在案發後並未接獲通報，僅有社會局獲報，導致涉案醫師離開台大後仍能在診所執業，未受到懲戒。","Q7：針對本案凸顯醫師懲戒委員會啟動時機，沒有明確法律規範，外界建議應修正醫師法、醫師懲戒辦法，明訂醫院通知衛生局啟動懲戒程序，請衛福部說明檢討結果，如何改善？","Q8：針對專家表示，性侵害案件平均審理時間從一年至五年不等，判決出爐前，須有糾正補救措施及簡化內部相關行政程序，以防止涉案醫師離開原醫院後，仍能到其他醫療機構職業，而無法預防繼續有潛在被害人受害，請衛福部說明如何改善？","Q9：針對醫院內部性平事件預防，除了事前教育、事後送性評委員會、懲戒委員會，衛福部有無內部稽核及預防作為之規定，如何加強預防發生〔醫對病〕、〔醫對護〕或病人對護理人員性騷擾的發生？","醫療暴力零容忍具體改善作為","Q10：針對修法加重醫療機構暴力零容忍後，醫療機構持續發生病患攻擊醫護人員事件，請衛福部說明提出具體改善作為為何？"],["委員廖偉翔書面質詢：","案由：","台北市文山區居托中心虐童事件顯示，居家托育服務中心訪視輔導員未依不預約訪視與不同時段訪視原則完成家庭訪視，導致有失職之處。同時外部督導與訪視員間缺乏有效協作，以便即時發現危險訊號，有改進之必要，爰向衛福部提出書面質詢。","說明：","1.外聘督導之一般性職責為何？外聘督導於兒虐案件中負何種責任？","2.衛福部及各直轄市、縣市政府將如何強化查核機制，確保不預約、不定時訪視原則落實，並完善訪視輔導員之績效考核？","3.針對去（113）年台北市文山區保母虐童案，訪視員曾3次進行家訪卻未察覺幼童持續受虐，而最後仍由醫院通報。根據《居家托育訪視工作指引》明訂訪視員需「親見收托兒童並與之互動」，並針對傷勢有拍照存證義務，但該案訪視員未發現異常，形同制度破口。請問衛福部，是否已啟動調查訪視紀錄與流程？若有可否提供相關訪視紀錄資料？","4.文山區該托育中心每季聘請外聘督導，其職責僅協助團督與流程建議，未實際參與個案審核與兒虐風險評估。惟據《社會工作督導支持及培力計畫》，外聘督導應具備個案管理、風險辨識、情緒支持等能力，且衛福部有編列相關預算，提供每案最高20萬元補助。請問衛福部是否會增修督導職責指引？是否應強制要求外督每月參與一線個案檢討、並定期回顧訪視紀錄？"],["委員黃捷書面質詢：","台大醫院數年前曾發生婦產部住院醫師於病房內性侵女病患，雖然台大醫院內部性平會已認定構成性騷擾，但由於院方未即時通報衛生局，導致該名住院醫師仍能持續接受訓練並診治病患，時間長達三年半，引發社會譁然，亦對病患安全造成重大疑慮。","針對此事，台大醫院主張其無須通報衛生局，理由為性騷擾防治法之主管機關為社會局；另因尚未判決確定，亦無法依醫師法第25條第2款「利用業務機會犯罪經判刑確定」規定移付懲戒。","然而，此等說法顯屬規避責任。根據醫師法第25條規定，醫師若有違背醫學倫理或業務上不正當行為，即可移付懲戒，並不必須等到刑事判決確定。因此，本案中既已由性平會認定性騷擾成立，應已符合「違背醫學倫理」之標準。","以下幾點敬請貴部於一個月內提供本辦書面回覆：","1.醫師若於診間或病房內對病患實施性騷擾，雖尚未判刑確定，但只要性平機制認定性騷擾成立，即可構成醫師法所定之「違背醫學倫理」或「業務上不正當行為」，足以啟動懲戒程序？","2.本案中台大醫院未將性騷擾成立之事實通報主管機關，未依醫師法第25條程序啟動懲戒，是否構成失職？衛福部是否將針對此類案件，明確通令各級醫療機構：凡經內部性平會認定醫師、護理師、藥師等醫事人員有違反《醫師法》25條第四款行為者、應於一定時限內通報主管機關進行懲戒調查？","3.針對醫療院所內性騷及性侵事件，檢討社會局及衛生局橫向聯繫及各自權責。","4.敬請說明狼醫查詢平台建置進度及規劃。建請衛福部釐清該名醫師於三年半執業期間內，調查是否仍有其他受害病患。"],["主席：現在作以下決定：報告及詢答完畢。委員質詢未及答復或請補充資料者，請相關機關於兩週內以書面答復，委員另要求期限者，從其所定。","本日會議到此結束，現在散會，謝謝大家。","散會（14時5分）"]],"agenda":{"page_end":138,"meet_id":"委員會-11-3-26-12","speakers":["蘇清泉","林月琴","陳昭姿","徐巧芯","盧縣一","黃國昌","劉建國","涂權吉","林淑芬","陳菁徽","陳培瑜","郭昱晴","黃秀芳","洪孟楷","張啓楷","范雲","楊瓊瓔","陳瑩","楊曜","賴惠員","葉元之","王育敏","陳冠廷","邱鎮軍","廖偉翔","黃捷"],"page_start":43,"meetingDate":["2025-05-21"],"gazette_id":"1145201","agenda_lcidc_ids":["1145201_00003"],"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12次全體委員會議紀錄","content":"邀請衛生福利部、教育部就「性騷擾防治及外聘督導制度精進作為」進行專題報告，並備質詢","agenda_id":"1145201_00002"}}}