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818.339, \"end\": 818.359, \"score\": 0.0}, {\"word\": \"應\"}, {\"word\": \"委\", \"start\": 818.359, \"end\": 818.419, \"score\": 0.631}, {\"word\": \"員\"}, {\"word\": \"的\", \"start\": 818.419, \"end\": 818.439, \"score\": 0.017}, {\"word\": \"詢\"}, {\"word\": \"問\"}, {\"word\": \"好\", \"start\": 818.439, \"end\": 818.459, \"score\": 0.0}, {\"word\": \"謝\"}, {\"word\": \"謝\"}], \"language\": \"zh\"}","srt":"1\n00:00:01,090 --> 00:00:04,751\n謝謝主席還有各位委員我請邱部長來請部長委員長部長好\n\n2\n00:00:11,479 --> 00:00:39,506\n去年7月你還記得我們有一個朝野協商當時你說今年6月30以前要達成平均點值1.95元可是您在今年1月的時候受訪有一點沒信心那當然今天已經6月9號了所以大家都很關心你6月30號以前有沒有辦法達到平均點值1.0.95元我想我們第一季的成果已經出來了那可不可以請署長跟委員報告一下\n\n3\n00:00:42,330 --> 00:00:55,942\n總額裡面主要有五個總額分別是醫院總額、西醫基層總額、牙醫、中醫以及透析總額目前看起來是在西醫基層的部分平均點子是0.946其餘的話都達到0.95以上\n\n4\n00:01:00,826 --> 00:01:05,527\n這邊我幫你做出來了也是要幫你鼓勵一下因為除了台北區0.936南區跟東區每一點都超過一元有一些事情做對了比如說開源你們增加了712億實質成長率突破8%加大投資另外把一些醫療項目移出健保總額積極爭取有一些用公務預算來挹注所以本席很關心的是你們今年\n\n5\n00:01:28,352 --> 00:01:45,532\n還是一樣要用8%這個成長率來規劃嗎還是更多這個是醫護人員期待的因為最終我們還是希望點只是1點1元我們現在衛福部建議的最高推估是跟去年跟今年是一樣的明年是5.5%\n\n6\n00:01:48,055 --> 00:02:13,600\n那其他為什麼要到成長,獅子成長8%是因為我們把一些項目移出來那這個部分我們會再繼續來溝通來看看哪些項目可以再陸續來移出來那政府應該還會在一些計畫裡面,就像我們補治今年補治寒病原來在健保總會也有保障,再多了另外多了二十億那所以這個政府還會有\n\n7\n00:02:16,943 --> 00:02:32,754\n還要基金也會再增加,所以我想增加從公務預算以及我們增加的量應該跟今年一樣那公務預算或移出來的這個部分補起來我想規模也會\n\n8\n00:02:34,855 --> 00:02:45,792\n那其中你還有一個政策是比較關乎於節流是穩定點植有幫助您認為個別醫院總額目前你有沒有遇到什麼瓶頸\n\n9\n00:02:46,903 --> 00:03:14,102\n好我想個別醫院走合是希望能夠以區域來講個別當然是我們希望有分級醫療能夠落實那也希望醫院能夠財務自己管理那我們也不是說只有醫院管理我們應該有區域的我們很希望只六個分區能夠所有的醫院自行來管理以病人的健康為中心因為就是那些錢\n\n10\n00:03:15,205 --> 00:03:25,620\n那你怎麼樣讓病人更健康那我先給你看現在遇到什麼問題上禮拜大家這邊非常多委員啊官員都一起去觀摩這個中榮做得非常好的AI智能醫院那但是他卻被斷頭三億\n\n11\n00:03:31,648 --> 00:03:59,034\n所以現在我們用這個三階段折付制度逐漸的去打折一旦報大量超過三階段就完全不予給付那你把大家一起承受這個系統性的風險轉到個別醫院去承擔就是說你們醫院服務量大你們就自己來扛我有很多同學現在在不同的醫院有醫學中心有地區醫院有區域醫院結果他們被柔性勸導\n\n12\n00:04:00,094 --> 00:04:26,355\n第三季第四季說縮減一點門診門診有一些門診要關起來這個你們有聽說這個狀況嗎因為現在個別醫院是各自為政自己去做控管嘛那我是認為如果你剛剛講的以病人為中心以醫療服務為中心有一些醫院他就是沒有辦法因為區醫院地區醫院他自己在控管所以全部塞到像中榮這樣子的大醫院去\n\n13\n00:04:27,136 --> 00:04:45,294\n他自然就會爆量啊這個爆量也不是他能夠控制的嘛那你全國不同調最後受害的還是人民服務量降不下來的狀況你有沒有一個統一的規範可以去調整不然每一個醫院絕對是亂成一團現在有人是限制門診限制門診等一下我告訴你另外一個問題限制門診病人就擠到急診去\n\n14\n00:04:50,233 --> 00:05:08,789\n好報告委員我想我剛剛已經提到了我們要從根來解決由根本來解決醫療體系的問題怎麼樣讓人民更健康使用然後該盡量不要生病一生小病是有一個社區就可以得到一個很好的照顧讓他小病不要變大病\n\n15\n00:05:09,750 --> 00:05:27,149\n那大病應該有分級的各種不管是大小病或重大病或重病那有不同的不管從醫學中心去醫院甚至地區醫院都應該做好他的角色這個才是根本之道那我想也拜託民眾能夠了解到我們一直在推分級醫療也需要\n\n16\n00:05:27,589 --> 00:05:55,658\n全國的民眾大家來瞭解來配合我們市級包括基層醫療的醫師都是非常優秀都是從教學醫院的主治醫師出來的他願意到社區服務就是願意貼近民眾請大家多多利用那這樣的一個制度是能夠解決未來的問題那個別財務的管理是一個促使達到這樣目標的一個一個手段那至於說台中總統這樣我們真的這些好朋友們真的很辛苦\n\n17\n00:05:58,179 --> 00:06:12,546\n民眾也對他們很有信任,所以他們的成長率真的比較高但是憲保署方面也給他的最平均與中區6.6%之下,他給他7.9%的成長所以他實質上的收入比去年的同期是增加了2.5億元\n\n18\n00:06:19,509 --> 00:06:40,791\n不管怎麼樣我還是要補充一下我們希望醫學中心真的扮演他急重症的角色我再來要跟你討論急重症現在遇到什麼問題我們不想要看到很優秀的醫院被懲罰畢竟你說實際收入增加2.5億可是他還是有部分的醫療服務他什麼東西都沒有拿到這也是事實\n\n19\n00:06:42,185 --> 00:06:53,848\n這也是事實所以我們不想要第三劑第四劑又遇到同樣的問題因為我是在市井你剛剛講得很好要分急醫療急重症等等我給你看一下急診你遇到什麼大問題急診到現在66個醫師流失離職了\n\n20\n00:06:59,870 --> 00:07:17,483\n根據急診醫學會內部的統計還有40到50位醫生正在離職的路上所以他們推估今年有可能上看120位要離職那你知道今年通過專科醫師考試的只有92位耶只有92位這一些很有經驗的人離職新進來的心血還遠低於離職的人數\n\n21\n00:07:22,677 --> 00:07:38,164\n有一個記者跑去台中榮民總醫院嘉義分院擔任急診醫師的人去做採訪他是中榮最大的分院他們統計起來他們至少需要五個急診醫師可是他們只有四個人真人啟示貼了五年都還沒有來那\n\n22\n00:07:40,433 --> 00:07:52,483\n上次我想到說你二月的時候有用這個特別預算去做一些解決啦但是也有人提到說是不是把醫師的診療費診察費分出了護理費來挖東牆補西牆請問這個42億到底錢用到哪裡去實際作為是什麼為什麼我們現在的急診人力還在不斷的流失中\n\n23\n00:08:05,526 --> 00:08:28,584\n好,世事貿易的事情,等一下請業務單位監報署報告我還是要講整體醫療體系的事情那我想急診醫師,我們不能量數目是一件事情但是每一個急診醫師,每一個人都是一個非常優秀而且面臨很大壓力,一個一個都是我們想要照顧,也很心疼的\n\n24\n00:08:29,344 --> 00:08:43,476\n每一位議事人力啦齁那我最近也剛好回台大碰到基層部主任那也是我的學生齁我就問他說你們留師的狀況怎麼樣他說有一位退休一位想要到分練區我說為什麼要到分練區\n\n25\n00:08:44,705 --> 00:09:04,131\n我可能總院壓力很大但是已經欠說之下他是留下來啦所以台大主治醫師好像就是一個退休一個本來要走後來沒有離開這是大概三天前我問的事情那我但是當然我也希望所有的醫院真的要了解到我們急診尤其\n\n26\n00:09:05,531 --> 00:09:33,088\n大概每一顆啦其實每一顆都可能會有這種問題所以我們必須要整體來思考這件事情我不能說哪一顆就比較嚴重你可以整體思考但現在真的有一點危急因為我五月的時候就提過臨時提案面臨這個急診人力荒到現在都還沒回我難道你們是想不出解決方案了跟你講一個更嚴重的除了急診雲嘉南地區最近發生了一些網路上很大的事情\n\n27\n00:09:33,968 --> 00:09:59,228\n神經內科的醫生他們除了面臨這些我剛講的是急診醫生喔急診醫生還會出來講話重症醫生有些是默默的默默的就離開職場了他們處理的是最多醫療糾紛的事情他們除了面臨職場的壓力還要面臨網路上的網路霸凌有一位神內醫師他在網路上嚴重的被霸凌後來醫院經過了幾天站出來幫他講話結果呢我們來看一下\n\n28\n00:10:03,812 --> 00:10:22,946\n另外一位醫師他請大家認真歡迎的轉發並且鼓勵投書的Lancet真的很丟臉你以前人家說台灣醫療崩壞不准寫到的Lancet硬把這篇文章拉下來還有一大堆側翼去攻擊寫文章的醫生現在又有一個醫生站出來了\n\n29\n00:10:23,706 --> 00:10:49,605\n他說家常身為雲嘉南最後的後送中心因為本院神內嚴重的崩盤為了保存本院重症人力即日起實施第一個非適應症勿在此群組發文二無神經科人力無法收治腦中風請直接聯絡他院急診轉院勿在此群組發文三重症人力需用在刀口上\n\n30\n00:10:50,705 --> 00:11:13,421\n10pm到7am不再收治無明顯效應之轉診以上非常抱歉這是重症醫療崩盤的下下之策感佩還願意留在最前線的各位也希望帶回給各醫院高層與政府高層正式腦中風醫療崩壞善待願意留下來的各位歡迎轉發鼓勵推出TheLancet\n\n31\n00:11:18,390 --> 00:11:33,850\n你剛講得很好落實分級醫療希望集中症的人都可以留任你撥了42億說要鼓勵這些人留任這些人現在直接在網路上說拜託大家轉發鼓勵投書的Lancet你還要再把Lancet文章拉下來嗎\n\n32\n00:11:35,840 --> 00:12:01,338\n包委員我想這個要分幾個方面來講我剛剛有提過醫療體系真的要從根來就其那當然第二個健保的一個我們台灣健保30年是讓我們台灣窮人能夠得到很好的醫療所以我們要珍惜那健保現在的總額就是這樣子我們已經盡量做好幾乎所有的科都會覺得當然比其他國家幾戶都是\n\n33\n00:12:02,239 --> 00:12:18,330\n第一,這個我們真的也要想辦法,我想政府也一直,你看所以今年才會補助這麼多的公務的預算也希望未來立法院這邊也能夠多多幫忙,讓健保的資源能夠更加的充沛那我相信對於各級戶\n\n34\n00:12:19,891 --> 00:12:28,220\n畢竟在疫還是很重要的事情我知道像署長本人也是急診科醫師出身嘛所以我真的希望你們好好的去盤點現在急重症的人力因為他們已經在預警已經在示警了我不希望你們第三劑第四劑又遇到相同的問題\n\n35\n00:12:35,268 --> 00:12:56,632\n最後一個您出國的時候大家知道說我們最大的教學醫院的聖堂某一個科別從最基層的醫師到大教授都出了性侵害性騷擾等等事件所以針對醫師法第25條在這邊希望要求你們可以具體的把違背醫學倫理做含釋請問可以答應嗎最後公佈在你們的法規檢索系統\n\n36\n00:13:02,301 --> 00:13:05,365\n因為上次次長來報告他說正在跟每一個團體做討論跟研擬\n\n37\n00:13:07,935 --> 00:13:22,938\n我想我們醫生就是不能違背醫療倫理這是天經地義不變的真理我跟你說你出國的時候就是因為沒關係這個不管我出國不出國你出國的時候就是因為他沒有根據醫師法這25條把他送懲戒對就是因為沒有根據25條去送懲戒因為他沒有寫寫清楚哪些狀況有含釋違反醫療醫學倫理\n\n38\n00:13:36,536 --> 00:13:38,459\n所以之後你們可不可以我會追這個進度會趕快的把具體來回應委員的詢問好謝謝\n\n","tsv":"start\tend\ttext\n1090\t4751\t謝謝主席還有各位委員我請邱部長來請部長委員長部長好\n11479\t39506\t去年7月你還記得我們有一個朝野協商當時你說今年6月30以前要達成平均點值1.95元可是您在今年1月的時候受訪有一點沒信心那當然今天已經6月9號了所以大家都很關心你6月30號以前有沒有辦法達到平均點值1.0.95元我想我們第一季的成果已經出來了那可不可以請署長跟委員報告一下\n42330\t55942\t總額裡面主要有五個總額分別是醫院總額、西醫基層總額、牙醫、中醫以及透析總額目前看起來是在西醫基層的部分平均點子是0.946其餘的話都達到0.95以上\n60826\t65527\t這邊我幫你做出來了 也是要幫你鼓勵一下因為除了台北區0.936南區跟東區每一點都超過一元有一些事情做對了 比如說開源你們增加了712億 實質成長率突破8%加大投資 另外把一些醫療項目移出健保總額積極爭取 有一些用公務預算來挹注所以本席很關心的是 你們今年\n88352\t105532\t還是一樣要用8%這個成長率來規劃嗎還是更多這個是醫護人員期待的因為最終我們還是希望點只是1點1元我們現在衛福部建議的最高推估是跟去年跟今年是一樣的明年是5.5%\n108055\t133600\t那其他為什麼要到成長,獅子成長8%是因為我們把一些項目移出來那這個部分我們會再繼續來溝通來看看哪些項目可以再陸續來移出來那政府應該還會在一些計畫裡面,就像我們補治今年補治寒病原來在健保總會也有保障,再多了另外多了二十億那所以這個政府還會有\n136943\t152754\t還要基金也會再增加,所以我想增加從公務預算以及我們增加的量應該跟今年一樣那公務預算或移出來的這個部分補起來我想規模也會\n154855\t165792\t那其中你還有一個政策是比較關乎於節流是穩定點植有幫助您認為個別醫院總額目前你有沒有遇到什麼瓶頸\n166903\t194102\t好 我想個別醫院走合是希望能夠以區域來講 個別當然是我們希望有分級醫療能夠落實那也希望醫院能夠財務自己管理那我們也不是說只有醫院管理我們應該有區域的我們很希望只六個分區能夠所有的醫院自行來管理以病人的健康為中心因為就是那些錢\n195205\t205620\t那你怎麼樣讓病人更健康那我先給你看現在遇到什麼問題上禮拜大家這邊非常多委員啊官員都一起去觀摩這個中榮做得非常好的AI智能醫院那但是他卻被斷頭三億\n211648\t239034\t所以現在我們用這個三階段折付制度逐漸的去打折一旦報大量超過三階段就完全不予給付那你把大家一起承受這個系統性的風險轉到個別醫院去承擔就是說你們醫院服務量大你們就自己來扛我有很多同學現在在不同的醫院有醫學中心有地區醫院有區域醫院結果他們被柔性勸導\n240094\t266355\t第三季 第四季說 縮減一點門診門診 有一些門診要關起來這個你們有聽說這個狀況嗎因為現在個別醫院是各自為政自己去做控管嘛那我是認為如果你剛剛講的 以病人為中心以醫療服務為中心有一些醫院他就是沒有辦法因為區醫院 地區醫院他自己在控管所以全部塞到像中榮這樣子的大醫院去\n267136\t285294\t他自然就會爆量啊這個爆量也不是他能夠控制的嘛那你全國不同調最後受害的還是人民服務量降不下來的狀況你有沒有一個統一的規範可以去調整不然每一個醫院絕對是亂成一團現在有人是限制門診限制門診等一下我告訴你另外一個問題限制門診病人就擠到急診去\n290233\t308789\t好 報告委員 我想我剛剛已經提到了我們要從根來解決由根本來解決醫療體系的問題怎麼樣讓人民更健康使用然後該盡量不要生病一生小病是有一個社區就可以得到一個很好的照顧讓他小病不要變大病\n309750\t327149\t那大病應該有分級的各種不管是大小病或重大病或重病那有不同的不管從醫學中心去醫院甚至地區醫院都應該做好他的角色這個才是根本之道那我想也拜託民眾能夠了解到我們一直在推分級醫療也需要\n327589\t355658\t全國的民眾大家來瞭解來配合我們市級包括基層醫療的醫師都是非常優秀都是從教學醫院的主治醫師出來的他願意到社區服務就是願意貼近民眾請大家多多利用那這樣的一個制度是能夠解決未來的問題那個別財務的管理是一個促使達到這樣目標的一個一個手段那至於說台中總統這樣我們真的這些好朋友們真的很辛苦\n358179\t372546\t民眾也對他們很有信任,所以他們的成長率真的比較高但是憲保署方面也給他的最平均與中區6.6%之下,他給他7.9%的成長所以他實質上的收入比去年的同期是增加了2.5億元\n379509\t400791\t不管怎麼樣我還是要補充一下我們希望醫學中心真的扮演他急重症的角色我再來要跟你討論急重症現在遇到什麼問題我們不想要看到很優秀的醫院被懲罰畢竟你說實際收入增加2.5億可是他還是有部分的醫療服務他什麼東西都沒有拿到這也是事實\n402185\t413848\t這也是事實所以我們不想要第三劑 第四劑又遇到同樣的問題因為我是在市井你剛剛講得很好要分急醫療急重症等等我給你看一下急診你遇到什麼大問題急診到現在66個醫師流失離職了\n419870\t437483\t根據急診醫學會內部的統計還有40到50位醫生正在離職的路上所以他們推估今年有可能上看120位要離職那你知道今年通過專科醫師考試的只有92位耶只有92位這一些很有經驗的人離職新進來的心血還遠低於離職的人數\n442677\t458164\t有一個記者跑去台中榮民總醫院嘉義分院擔任急診醫師的人去做採訪他是中榮最大的分院他們統計起來他們至少需要五個急診醫師可是他們只有四個人真人啟示貼了五年都還沒有來那\n460433\t472483\t上次我想到說 你二月的時候有用這個特別預算去做一些解決啦但是也有人提到說 是不是把醫師的診療費 診察費分出了護理費來挖東牆 補西牆請問這個42億到底錢用到哪裡去 實際作為是什麼為什麼我們現在的急診人力還在不斷的流失中\n485526\t508584\t好,世事貿易的事情,等一下請業務單位監報署報告我還是要講整體醫療體系的事情那我想急診醫師,我們不能量數目是一件事情但是每一個急診醫師,每一個人都是一個非常優秀而且面臨很大壓力,一個一個都是我們想要照顧,也很心疼的\n509344\t523476\t每一位議事人力啦齁那我最近也剛好回台大碰到基層部主任那也是我的學生齁我就問他說你們留師的狀況怎麼樣他說有一位退休一位想要到分練區我說為什麼要到分練區\n524705\t544131\t我可能總院壓力很大但是已經欠說之下他是留下來啦所以台大主治醫師好像就是一個退休一個本來要走後來沒有離開這是大概三天前我問的事情那我但是當然我也希望所有的醫院真的要了解到我們急診尤其\n545531\t573088\t大概每一顆啦 其實每一顆都可能會有這種問題所以我們必須要整體來思考這件事情我不能說哪一顆就比較嚴重你可以整體思考 但現在真的有一點危急因為我五月的時候就提過臨時提案面臨這個急診人力荒 到現在都還沒回我難道你們是想不出解決方案了跟你講一個更嚴重的除了急診雲嘉南地區最近發生了一些網路上很大的事情\n573968\t599228\t神經內科的醫生他們除了面臨這些我剛講的是急診醫生喔急診醫生還會出來講話重症醫生有些是默默的默默的就離開職場了他們處理的是最多醫療糾紛的事情他們除了面臨職場的壓力還要面臨網路上的網路霸凌有一位神內醫師他在網路上嚴重的被霸凌後來醫院經過了幾天站出來幫他講話結果呢我們來看一下\n603812\t622946\t另外一位醫師他請大家認真歡迎的轉發並且鼓勵投書的Lancet真的很丟臉你以前人家說台灣醫療崩壞不准寫到的Lancet硬把這篇文章拉下來還有一大堆側翼去攻擊寫文章的醫生現在又有一個醫生站出來了\n623706\t649605\t他說家常身為雲嘉南最後的後送中心因為本院神內嚴重的崩盤為了保存本院重症人力即日起實施第一個非適應症勿在此群組發文二無神經科人力無法收治腦中風請直接聯絡他院急診轉院勿在此群組發文三重症人力需用在刀口上\n650705\t673421\t10pm到7am不再收治無明顯效應之轉診以上非常抱歉這是重症醫療崩盤的下下之策感佩還願意留在最前線的各位也希望帶回給各醫院高層與政府高層正式腦中風醫療崩壞善待願意留下來的各位歡迎轉發鼓勵推出The Lancet\n678390\t693850\t你剛講得很好 落實分級醫療希望集中症的人都可以留任你撥了42億 說要鼓勵這些人留任這些人現在直接在網路上說拜託大家轉發 鼓勵投書的Lancet你還要再把Lancet文章拉下來嗎\n695840\t721338\t包委員我想這個要分幾個方面來講我剛剛有提過醫療體系真的要從根來就其那當然第二個健保的一個我們台灣健保30年是讓我們台灣窮人能夠得到很好的醫療所以我們要珍惜那健保現在的總額就是這樣子我們已經盡量做好幾乎所有的科都會覺得當然比其他國家幾戶都是\n722239\t738330\t第一,這個我們真的也要想辦法,我想政府也一直,你看所以今年才會補助這麼多的公務的預算也希望未來立法院這邊也能夠多多幫忙,讓健保的資源能夠更加的充沛那我相信對於各級戶\n739891\t748220\t畢竟在疫還是很重要的事情我知道像署長本人也是急診科醫師出身嘛所以我真的希望你們好好的去盤點現在急重症的人力因為他們已經在預警已經在示警了我不希望你們第三劑第四劑又遇到相同的問題\n755268\t776632\t最後一個您出國的時候大家知道說我們最大的教學醫院的聖堂某一個科別從最基層的醫師到大教授都出了性侵害性騷擾等等事件所以針對醫師法第25條在這邊希望要求你們可以具體的把違背醫學倫理做含釋請問可以答應嗎最後公佈在你們的法規檢索系統\n782301\t785365\t因為上次次長來報告他說正在跟每一個團體做討論跟研擬\n787935\t802938\t我想我們醫生就是不能違背醫療倫理這是天經地義不變的真理我跟你說你出國的時候就是因為沒關係這個不管我出國不出國你出國的時候就是因為他沒有根據醫師法這25條把他送懲戒對就是因為沒有根據25條去送懲戒因為他沒有寫寫清楚哪些狀況有含釋違反醫療醫學倫理\n816536\t818459\t所以之後你們可不可以 我會追這個進度會趕快的把具體來回應委員的詢問好 謝謝\n","txt":"謝謝主席還有各位委員我請邱部長來請部長委員長部長好\n去年7月你還記得我們有一個朝野協商當時你說今年6月30以前要達成平均點值1.95元可是您在今年1月的時候受訪有一點沒信心那當然今天已經6月9號了所以大家都很關心你6月30號以前有沒有辦法達到平均點值1.0.95元我想我們第一季的成果已經出來了那可不可以請署長跟委員報告一下\n總額裡面主要有五個總額分別是醫院總額、西醫基層總額、牙醫、中醫以及透析總額目前看起來是在西醫基層的部分平均點子是0.946其餘的話都達到0.95以上\n這邊我幫你做出來了 也是要幫你鼓勵一下因為除了台北區0.936南區跟東區每一點都超過一元有一些事情做對了 比如說開源你們增加了712億 實質成長率突破8%加大投資 另外把一些醫療項目移出健保總額積極爭取 有一些用公務預算來挹注所以本席很關心的是 你們今年\n還是一樣要用8%這個成長率來規劃嗎還是更多這個是醫護人員期待的因為最終我們還是希望點只是1點1元我們現在衛福部建議的最高推估是跟去年跟今年是一樣的明年是5.5%\n那其他為什麼要到成長,獅子成長8%是因為我們把一些項目移出來那這個部分我們會再繼續來溝通來看看哪些項目可以再陸續來移出來那政府應該還會在一些計畫裡面,就像我們補治今年補治寒病原來在健保總會也有保障,再多了另外多了二十億那所以這個政府還會有\n還要基金也會再增加,所以我想增加從公務預算以及我們增加的量應該跟今年一樣那公務預算或移出來的這個部分補起來我想規模也會\n那其中你還有一個政策是比較關乎於節流是穩定點植有幫助您認為個別醫院總額目前你有沒有遇到什麼瓶頸\n好 我想個別醫院走合是希望能夠以區域來講 個別當然是我們希望有分級醫療能夠落實那也希望醫院能夠財務自己管理那我們也不是說只有醫院管理我們應該有區域的我們很希望只六個分區能夠所有的醫院自行來管理以病人的健康為中心因為就是那些錢\n那你怎麼樣讓病人更健康那我先給你看現在遇到什麼問題上禮拜大家這邊非常多委員啊官員都一起去觀摩這個中榮做得非常好的AI智能醫院那但是他卻被斷頭三億\n所以現在我們用這個三階段折付制度逐漸的去打折一旦報大量超過三階段就完全不予給付那你把大家一起承受這個系統性的風險轉到個別醫院去承擔就是說你們醫院服務量大你們就自己來扛我有很多同學現在在不同的醫院有醫學中心有地區醫院有區域醫院結果他們被柔性勸導\n第三季 第四季說 縮減一點門診門診 有一些門診要關起來這個你們有聽說這個狀況嗎因為現在個別醫院是各自為政自己去做控管嘛那我是認為如果你剛剛講的 以病人為中心以醫療服務為中心有一些醫院他就是沒有辦法因為區醫院 地區醫院他自己在控管所以全部塞到像中榮這樣子的大醫院去\n他自然就會爆量啊這個爆量也不是他能夠控制的嘛那你全國不同調最後受害的還是人民服務量降不下來的狀況你有沒有一個統一的規範可以去調整不然每一個醫院絕對是亂成一團現在有人是限制門診限制門診等一下我告訴你另外一個問題限制門診病人就擠到急診去\n好 報告委員 我想我剛剛已經提到了我們要從根來解決由根本來解決醫療體系的問題怎麼樣讓人民更健康使用然後該盡量不要生病一生小病是有一個社區就可以得到一個很好的照顧讓他小病不要變大病\n那大病應該有分級的各種不管是大小病或重大病或重病那有不同的不管從醫學中心去醫院甚至地區醫院都應該做好他的角色這個才是根本之道那我想也拜託民眾能夠了解到我們一直在推分級醫療也需要\n全國的民眾大家來瞭解來配合我們市級包括基層醫療的醫師都是非常優秀都是從教學醫院的主治醫師出來的他願意到社區服務就是願意貼近民眾請大家多多利用那這樣的一個制度是能夠解決未來的問題那個別財務的管理是一個促使達到這樣目標的一個一個手段那至於說台中總統這樣我們真的這些好朋友們真的很辛苦\n民眾也對他們很有信任,所以他們的成長率真的比較高但是憲保署方面也給他的最平均與中區6.6%之下,他給他7.9%的成長所以他實質上的收入比去年的同期是增加了2.5億元\n不管怎麼樣我還是要補充一下我們希望醫學中心真的扮演他急重症的角色我再來要跟你討論急重症現在遇到什麼問題我們不想要看到很優秀的醫院被懲罰畢竟你說實際收入增加2.5億可是他還是有部分的醫療服務他什麼東西都沒有拿到這也是事實\n這也是事實所以我們不想要第三劑 第四劑又遇到同樣的問題因為我是在市井你剛剛講得很好要分急醫療急重症等等我給你看一下急診你遇到什麼大問題急診到現在66個醫師流失離職了\n根據急診醫學會內部的統計還有40到50位醫生正在離職的路上所以他們推估今年有可能上看120位要離職那你知道今年通過專科醫師考試的只有92位耶只有92位這一些很有經驗的人離職新進來的心血還遠低於離職的人數\n有一個記者跑去台中榮民總醫院嘉義分院擔任急診醫師的人去做採訪他是中榮最大的分院他們統計起來他們至少需要五個急診醫師可是他們只有四個人真人啟示貼了五年都還沒有來那\n上次我想到說 你二月的時候有用這個特別預算去做一些解決啦但是也有人提到說 是不是把醫師的診療費 診察費分出了護理費來挖東牆 補西牆請問這個42億到底錢用到哪裡去 實際作為是什麼為什麼我們現在的急診人力還在不斷的流失中\n好,世事貿易的事情,等一下請業務單位監報署報告我還是要講整體醫療體系的事情那我想急診醫師,我們不能量數目是一件事情但是每一個急診醫師,每一個人都是一個非常優秀而且面臨很大壓力,一個一個都是我們想要照顧,也很心疼的\n每一位議事人力啦齁那我最近也剛好回台大碰到基層部主任那也是我的學生齁我就問他說你們留師的狀況怎麼樣他說有一位退休一位想要到分練區我說為什麼要到分練區\n我可能總院壓力很大但是已經欠說之下他是留下來啦所以台大主治醫師好像就是一個退休一個本來要走後來沒有離開這是大概三天前我問的事情那我但是當然我也希望所有的醫院真的要了解到我們急診尤其\n大概每一顆啦 其實每一顆都可能會有這種問題所以我們必須要整體來思考這件事情我不能說哪一顆就比較嚴重你可以整體思考 但現在真的有一點危急因為我五月的時候就提過臨時提案面臨這個急診人力荒 到現在都還沒回我難道你們是想不出解決方案了跟你講一個更嚴重的除了急診雲嘉南地區最近發生了一些網路上很大的事情\n神經內科的醫生他們除了面臨這些我剛講的是急診醫生喔急診醫生還會出來講話重症醫生有些是默默的默默的就離開職場了他們處理的是最多醫療糾紛的事情他們除了面臨職場的壓力還要面臨網路上的網路霸凌有一位神內醫師他在網路上嚴重的被霸凌後來醫院經過了幾天站出來幫他講話結果呢我們來看一下\n另外一位醫師他請大家認真歡迎的轉發並且鼓勵投書的Lancet真的很丟臉你以前人家說台灣醫療崩壞不准寫到的Lancet硬把這篇文章拉下來還有一大堆側翼去攻擊寫文章的醫生現在又有一個醫生站出來了\n他說家常身為雲嘉南最後的後送中心因為本院神內嚴重的崩盤為了保存本院重症人力即日起實施第一個非適應症勿在此群組發文二無神經科人力無法收治腦中風請直接聯絡他院急診轉院勿在此群組發文三重症人力需用在刀口上\n10pm到7am不再收治無明顯效應之轉診以上非常抱歉這是重症醫療崩盤的下下之策感佩還願意留在最前線的各位也希望帶回給各醫院高層與政府高層正式腦中風醫療崩壞善待願意留下來的各位歡迎轉發鼓勵推出The Lancet\n你剛講得很好 落實分級醫療希望集中症的人都可以留任你撥了42億 說要鼓勵這些人留任這些人現在直接在網路上說拜託大家轉發 鼓勵投書的Lancet你還要再把Lancet文章拉下來嗎\n包委員我想這個要分幾個方面來講我剛剛有提過醫療體系真的要從根來就其那當然第二個健保的一個我們台灣健保30年是讓我們台灣窮人能夠得到很好的醫療所以我們要珍惜那健保現在的總額就是這樣子我們已經盡量做好幾乎所有的科都會覺得當然比其他國家幾戶都是\n第一,這個我們真的也要想辦法,我想政府也一直,你看所以今年才會補助這麼多的公務的預算也希望未來立法院這邊也能夠多多幫忙,讓健保的資源能夠更加的充沛那我相信對於各級戶\n畢竟在疫還是很重要的事情我知道像署長本人也是急診科醫師出身嘛所以我真的希望你們好好的去盤點現在急重症的人力因為他們已經在預警已經在示警了我不希望你們第三劑第四劑又遇到相同的問題\n最後一個您出國的時候大家知道說我們最大的教學醫院的聖堂某一個科別從最基層的醫師到大教授都出了性侵害性騷擾等等事件所以針對醫師法第25條在這邊希望要求你們可以具體的把違背醫學倫理做含釋請問可以答應嗎最後公佈在你們的法規檢索系統\n因為上次次長來報告他說正在跟每一個團體做討論跟研擬\n我想我們醫生就是不能違背醫療倫理這是天經地義不變的真理我跟你說你出國的時候就是因為沒關係這個不管我出國不出國你出國的時候就是因為他沒有根據醫師法這25條把他送懲戒對就是因為沒有根據25條去送懲戒因為他沒有寫寫清楚哪些狀況有含釋違反醫療醫學倫理\n所以之後你們可不可以 我會追這個進度會趕快的把具體來回應委員的詢問好 謝謝\n","vtt":"WEBVTT\n\n00:01.090 --> 00:04.751\n謝謝主席還有各位委員我請邱部長來請部長委員長部長好\n\n00:11.479 --> 00:39.506\n去年7月你還記得我們有一個朝野協商當時你說今年6月30以前要達成平均點值1.95元可是您在今年1月的時候受訪有一點沒信心那當然今天已經6月9號了所以大家都很關心你6月30號以前有沒有辦法達到平均點值1.0.95元我想我們第一季的成果已經出來了那可不可以請署長跟委員報告一下\n\n00:42.330 --> 00:55.942\n總額裡面主要有五個總額分別是醫院總額、西醫基層總額、牙醫、中醫以及透析總額目前看起來是在西醫基層的部分平均點子是0.946其餘的話都達到0.95以上\n\n01:00.826 --> 01:05.527\n這邊我幫你做出來了也是要幫你鼓勵一下因為除了台北區0.936南區跟東區每一點都超過一元有一些事情做對了比如說開源你們增加了712億實質成長率突破8%加大投資另外把一些醫療項目移出健保總額積極爭取有一些用公務預算來挹注所以本席很關心的是你們今年\n\n01:28.352 --> 01:45.532\n還是一樣要用8%這個成長率來規劃嗎還是更多這個是醫護人員期待的因為最終我們還是希望點只是1點1元我們現在衛福部建議的最高推估是跟去年跟今年是一樣的明年是5.5%\n\n01:48.055 --> 02:13.600\n那其他為什麼要到成長,獅子成長8%是因為我們把一些項目移出來那這個部分我們會再繼續來溝通來看看哪些項目可以再陸續來移出來那政府應該還會在一些計畫裡面,就像我們補治今年補治寒病原來在健保總會也有保障,再多了另外多了二十億那所以這個政府還會有\n\n02:16.943 --> 02:32.754\n還要基金也會再增加,所以我想增加從公務預算以及我們增加的量應該跟今年一樣那公務預算或移出來的這個部分補起來我想規模也會\n\n02:34.855 --> 02:45.792\n那其中你還有一個政策是比較關乎於節流是穩定點植有幫助您認為個別醫院總額目前你有沒有遇到什麼瓶頸\n\n02:46.903 --> 03:14.102\n好我想個別醫院走合是希望能夠以區域來講個別當然是我們希望有分級醫療能夠落實那也希望醫院能夠財務自己管理那我們也不是說只有醫院管理我們應該有區域的我們很希望只六個分區能夠所有的醫院自行來管理以病人的健康為中心因為就是那些錢\n\n03:15.205 --> 03:25.620\n那你怎麼樣讓病人更健康那我先給你看現在遇到什麼問題上禮拜大家這邊非常多委員啊官員都一起去觀摩這個中榮做得非常好的AI智能醫院那但是他卻被斷頭三億\n\n03:31.648 --> 03:59.034\n所以現在我們用這個三階段折付制度逐漸的去打折一旦報大量超過三階段就完全不予給付那你把大家一起承受這個系統性的風險轉到個別醫院去承擔就是說你們醫院服務量大你們就自己來扛我有很多同學現在在不同的醫院有醫學中心有地區醫院有區域醫院結果他們被柔性勸導\n\n04:00.094 --> 04:26.355\n第三季第四季說縮減一點門診門診有一些門診要關起來這個你們有聽說這個狀況嗎因為現在個別醫院是各自為政自己去做控管嘛那我是認為如果你剛剛講的以病人為中心以醫療服務為中心有一些醫院他就是沒有辦法因為區醫院地區醫院他自己在控管所以全部塞到像中榮這樣子的大醫院去\n\n04:27.136 --> 04:45.294\n他自然就會爆量啊這個爆量也不是他能夠控制的嘛那你全國不同調最後受害的還是人民服務量降不下來的狀況你有沒有一個統一的規範可以去調整不然每一個醫院絕對是亂成一團現在有人是限制門診限制門診等一下我告訴你另外一個問題限制門診病人就擠到急診去\n\n04:50.233 --> 05:08.789\n好報告委員我想我剛剛已經提到了我們要從根來解決由根本來解決醫療體系的問題怎麼樣讓人民更健康使用然後該盡量不要生病一生小病是有一個社區就可以得到一個很好的照顧讓他小病不要變大病\n\n05:09.750 --> 05:27.149\n那大病應該有分級的各種不管是大小病或重大病或重病那有不同的不管從醫學中心去醫院甚至地區醫院都應該做好他的角色這個才是根本之道那我想也拜託民眾能夠了解到我們一直在推分級醫療也需要\n\n05:27.589 --> 05:55.658\n全國的民眾大家來瞭解來配合我們市級包括基層醫療的醫師都是非常優秀都是從教學醫院的主治醫師出來的他願意到社區服務就是願意貼近民眾請大家多多利用那這樣的一個制度是能夠解決未來的問題那個別財務的管理是一個促使達到這樣目標的一個一個手段那至於說台中總統這樣我們真的這些好朋友們真的很辛苦\n\n05:58.179 --> 06:12.546\n民眾也對他們很有信任,所以他們的成長率真的比較高但是憲保署方面也給他的最平均與中區6.6%之下,他給他7.9%的成長所以他實質上的收入比去年的同期是增加了2.5億元\n\n06:19.509 --> 06:40.791\n不管怎麼樣我還是要補充一下我們希望醫學中心真的扮演他急重症的角色我再來要跟你討論急重症現在遇到什麼問題我們不想要看到很優秀的醫院被懲罰畢竟你說實際收入增加2.5億可是他還是有部分的醫療服務他什麼東西都沒有拿到這也是事實\n\n06:42.185 --> 06:53.848\n這也是事實所以我們不想要第三劑第四劑又遇到同樣的問題因為我是在市井你剛剛講得很好要分急醫療急重症等等我給你看一下急診你遇到什麼大問題急診到現在66個醫師流失離職了\n\n06:59.870 --> 07:17.483\n根據急診醫學會內部的統計還有40到50位醫生正在離職的路上所以他們推估今年有可能上看120位要離職那你知道今年通過專科醫師考試的只有92位耶只有92位這一些很有經驗的人離職新進來的心血還遠低於離職的人數\n\n07:22.677 --> 07:38.164\n有一個記者跑去台中榮民總醫院嘉義分院擔任急診醫師的人去做採訪他是中榮最大的分院他們統計起來他們至少需要五個急診醫師可是他們只有四個人真人啟示貼了五年都還沒有來那\n\n07:40.433 --> 07:52.483\n上次我想到說你二月的時候有用這個特別預算去做一些解決啦但是也有人提到說是不是把醫師的診療費診察費分出了護理費來挖東牆補西牆請問這個42億到底錢用到哪裡去實際作為是什麼為什麼我們現在的急診人力還在不斷的流失中\n\n08:05.526 --> 08:28.584\n好,世事貿易的事情,等一下請業務單位監報署報告我還是要講整體醫療體系的事情那我想急診醫師,我們不能量數目是一件事情但是每一個急診醫師,每一個人都是一個非常優秀而且面臨很大壓力,一個一個都是我們想要照顧,也很心疼的\n\n08:29.344 --> 08:43.476\n每一位議事人力啦齁那我最近也剛好回台大碰到基層部主任那也是我的學生齁我就問他說你們留師的狀況怎麼樣他說有一位退休一位想要到分練區我說為什麼要到分練區\n\n08:44.705 --> 09:04.131\n我可能總院壓力很大但是已經欠說之下他是留下來啦所以台大主治醫師好像就是一個退休一個本來要走後來沒有離開這是大概三天前我問的事情那我但是當然我也希望所有的醫院真的要了解到我們急診尤其\n\n09:05.531 --> 09:33.088\n大概每一顆啦其實每一顆都可能會有這種問題所以我們必須要整體來思考這件事情我不能說哪一顆就比較嚴重你可以整體思考但現在真的有一點危急因為我五月的時候就提過臨時提案面臨這個急診人力荒到現在都還沒回我難道你們是想不出解決方案了跟你講一個更嚴重的除了急診雲嘉南地區最近發生了一些網路上很大的事情\n\n09:33.968 --> 09:59.228\n神經內科的醫生他們除了面臨這些我剛講的是急診醫生喔急診醫生還會出來講話重症醫生有些是默默的默默的就離開職場了他們處理的是最多醫療糾紛的事情他們除了面臨職場的壓力還要面臨網路上的網路霸凌有一位神內醫師他在網路上嚴重的被霸凌後來醫院經過了幾天站出來幫他講話結果呢我們來看一下\n\n10:03.812 --> 10:22.946\n另外一位醫師他請大家認真歡迎的轉發並且鼓勵投書的Lancet真的很丟臉你以前人家說台灣醫療崩壞不准寫到的Lancet硬把這篇文章拉下來還有一大堆側翼去攻擊寫文章的醫生現在又有一個醫生站出來了\n\n10:23.706 --> 10:49.605\n他說家常身為雲嘉南最後的後送中心因為本院神內嚴重的崩盤為了保存本院重症人力即日起實施第一個非適應症勿在此群組發文二無神經科人力無法收治腦中風請直接聯絡他院急診轉院勿在此群組發文三重症人力需用在刀口上\n\n10:50.705 --> 11:13.421\n10pm到7am不再收治無明顯效應之轉診以上非常抱歉這是重症醫療崩盤的下下之策感佩還願意留在最前線的各位也希望帶回給各醫院高層與政府高層正式腦中風醫療崩壞善待願意留下來的各位歡迎轉發鼓勵推出TheLancet\n\n11:18.390 --> 11:33.850\n你剛講得很好落實分級醫療希望集中症的人都可以留任你撥了42億說要鼓勵這些人留任這些人現在直接在網路上說拜託大家轉發鼓勵投書的Lancet你還要再把Lancet文章拉下來嗎\n\n11:35.840 --> 12:01.338\n包委員我想這個要分幾個方面來講我剛剛有提過醫療體系真的要從根來就其那當然第二個健保的一個我們台灣健保30年是讓我們台灣窮人能夠得到很好的醫療所以我們要珍惜那健保現在的總額就是這樣子我們已經盡量做好幾乎所有的科都會覺得當然比其他國家幾戶都是\n\n12:02.239 --> 12:18.330\n第一,這個我們真的也要想辦法,我想政府也一直,你看所以今年才會補助這麼多的公務的預算也希望未來立法院這邊也能夠多多幫忙,讓健保的資源能夠更加的充沛那我相信對於各級戶\n\n12:19.891 --> 12:28.220\n畢竟在疫還是很重要的事情我知道像署長本人也是急診科醫師出身嘛所以我真的希望你們好好的去盤點現在急重症的人力因為他們已經在預警已經在示警了我不希望你們第三劑第四劑又遇到相同的問題\n\n12:35.268 --> 12:56.632\n最後一個您出國的時候大家知道說我們最大的教學醫院的聖堂某一個科別從最基層的醫師到大教授都出了性侵害性騷擾等等事件所以針對醫師法第25條在這邊希望要求你們可以具體的把違背醫學倫理做含釋請問可以答應嗎最後公佈在你們的法規檢索系統\n\n13:02.301 --> 13:05.365\n因為上次次長來報告他說正在跟每一個團體做討論跟研擬\n\n13:07.935 --> 13:22.938\n我想我們醫生就是不能違背醫療倫理這是天經地義不變的真理我跟你說你出國的時候就是因為沒關係這個不管我出國不出國你出國的時候就是因為他沒有根據醫師法這25條把他送懲戒對就是因為沒有根據25條去送懲戒因為他沒有寫寫清楚哪些狀況有含釋違反醫療醫學倫理\n\n13:36.536 --> 13:38.459\n所以之後你們可不可以我會追這個進度會趕快的把具體來回應委員的詢問好謝謝\n\n","segments":[{"start":1.09,"end":4.751,"text":"謝謝主席還有各位委員我請邱部長來請部長委員長部長好"},{"start":11.479,"end":39.506,"text":"去年7月你還記得我們有一個朝野協商當時你說今年6月30以前要達成平均點值1.95元可是您在今年1月的時候受訪有一點沒信心那當然今天已經6月9號了所以大家都很關心你6月30號以前有沒有辦法達到平均點值1.0.95元我想我們第一季的成果已經出來了那可不可以請署長跟委員報告一下"},{"start":42.33,"end":55.942,"text":"總額裡面主要有五個總額分別是醫院總額、西醫基層總額、牙醫、中醫以及透析總額目前看起來是在西醫基層的部分平均點子是0.946其餘的話都達到0.95以上"},{"start":60.826,"end":65.527,"text":"這邊我幫你做出來了 也是要幫你鼓勵一下因為除了台北區0.936南區跟東區每一點都超過一元有一些事情做對了 比如說開源你們增加了712億 實質成長率突破8%加大投資 另外把一些醫療項目移出健保總額積極爭取 有一些用公務預算來挹注所以本席很關心的是 你們今年"},{"start":88.352,"end":105.532,"text":"還是一樣要用8%這個成長率來規劃嗎還是更多這個是醫護人員期待的因為最終我們還是希望點只是1點1元我們現在衛福部建議的最高推估是跟去年跟今年是一樣的明年是5.5%"},{"start":108.055,"end":133.6,"text":"那其他為什麼要到成長,獅子成長8%是因為我們把一些項目移出來那這個部分我們會再繼續來溝通來看看哪些項目可以再陸續來移出來那政府應該還會在一些計畫裡面,就像我們補治今年補治寒病原來在健保總會也有保障,再多了另外多了二十億那所以這個政府還會有"},{"start":136.943,"end":152.754,"text":"還要基金也會再增加,所以我想增加從公務預算以及我們增加的量應該跟今年一樣那公務預算或移出來的這個部分補起來我想規模也會"},{"start":154.855,"end":165.792,"text":"那其中你還有一個政策是比較關乎於節流是穩定點植有幫助您認為個別醫院總額目前你有沒有遇到什麼瓶頸"},{"start":166.903,"end":194.102,"text":"好 我想個別醫院走合是希望能夠以區域來講 個別當然是我們希望有分級醫療能夠落實那也希望醫院能夠財務自己管理那我們也不是說只有醫院管理我們應該有區域的我們很希望只六個分區能夠所有的醫院自行來管理以病人的健康為中心因為就是那些錢"},{"start":195.205,"end":205.62,"text":"那你怎麼樣讓病人更健康那我先給你看現在遇到什麼問題上禮拜大家這邊非常多委員啊官員都一起去觀摩這個中榮做得非常好的AI智能醫院那但是他卻被斷頭三億"},{"start":211.648,"end":239.034,"text":"所以現在我們用這個三階段折付制度逐漸的去打折一旦報大量超過三階段就完全不予給付那你把大家一起承受這個系統性的風險轉到個別醫院去承擔就是說你們醫院服務量大你們就自己來扛我有很多同學現在在不同的醫院有醫學中心有地區醫院有區域醫院結果他們被柔性勸導"},{"start":240.094,"end":266.355,"text":"第三季 第四季說 縮減一點門診門診 有一些門診要關起來這個你們有聽說這個狀況嗎因為現在個別醫院是各自為政自己去做控管嘛那我是認為如果你剛剛講的 以病人為中心以醫療服務為中心有一些醫院他就是沒有辦法因為區醫院 地區醫院他自己在控管所以全部塞到像中榮這樣子的大醫院去"},{"start":267.136,"end":285.294,"text":"他自然就會爆量啊這個爆量也不是他能夠控制的嘛那你全國不同調最後受害的還是人民服務量降不下來的狀況你有沒有一個統一的規範可以去調整不然每一個醫院絕對是亂成一團現在有人是限制門診限制門診等一下我告訴你另外一個問題限制門診病人就擠到急診去"},{"start":290.233,"end":308.789,"text":"好 報告委員 我想我剛剛已經提到了我們要從根來解決由根本來解決醫療體系的問題怎麼樣讓人民更健康使用然後該盡量不要生病一生小病是有一個社區就可以得到一個很好的照顧讓他小病不要變大病"},{"start":309.75,"end":327.149,"text":"那大病應該有分級的各種不管是大小病或重大病或重病那有不同的不管從醫學中心去醫院甚至地區醫院都應該做好他的角色這個才是根本之道那我想也拜託民眾能夠了解到我們一直在推分級醫療也需要"},{"start":327.589,"end":355.658,"text":"全國的民眾大家來瞭解來配合我們市級包括基層醫療的醫師都是非常優秀都是從教學醫院的主治醫師出來的他願意到社區服務就是願意貼近民眾請大家多多利用那這樣的一個制度是能夠解決未來的問題那個別財務的管理是一個促使達到這樣目標的一個一個手段那至於說台中總統這樣我們真的這些好朋友們真的很辛苦"},{"start":358.179,"end":372.546,"text":"民眾也對他們很有信任,所以他們的成長率真的比較高但是憲保署方面也給他的最平均與中區6.6%之下,他給他7.9%的成長所以他實質上的收入比去年的同期是增加了2.5億元"},{"start":379.509,"end":400.791,"text":"不管怎麼樣我還是要補充一下我們希望醫學中心真的扮演他急重症的角色我再來要跟你討論急重症現在遇到什麼問題我們不想要看到很優秀的醫院被懲罰畢竟你說實際收入增加2.5億可是他還是有部分的醫療服務他什麼東西都沒有拿到這也是事實"},{"start":402.185,"end":413.848,"text":"這也是事實所以我們不想要第三劑 第四劑又遇到同樣的問題因為我是在市井你剛剛講得很好要分急醫療急重症等等我給你看一下急診你遇到什麼大問題急診到現在66個醫師流失離職了"},{"start":419.87,"end":437.483,"text":"根據急診醫學會內部的統計還有40到50位醫生正在離職的路上所以他們推估今年有可能上看120位要離職那你知道今年通過專科醫師考試的只有92位耶只有92位這一些很有經驗的人離職新進來的心血還遠低於離職的人數"},{"start":442.677,"end":458.164,"text":"有一個記者跑去台中榮民總醫院嘉義分院擔任急診醫師的人去做採訪他是中榮最大的分院他們統計起來他們至少需要五個急診醫師可是他們只有四個人真人啟示貼了五年都還沒有來那"},{"start":460.433,"end":472.483,"text":"上次我想到說 你二月的時候有用這個特別預算去做一些解決啦但是也有人提到說 是不是把醫師的診療費 診察費分出了護理費來挖東牆 補西牆請問這個42億到底錢用到哪裡去 實際作為是什麼為什麼我們現在的急診人力還在不斷的流失中"},{"start":485.526,"end":508.584,"text":"好,世事貿易的事情,等一下請業務單位監報署報告我還是要講整體醫療體系的事情那我想急診醫師,我們不能量數目是一件事情但是每一個急診醫師,每一個人都是一個非常優秀而且面臨很大壓力,一個一個都是我們想要照顧,也很心疼的"},{"start":509.344,"end":523.476,"text":"每一位議事人力啦齁那我最近也剛好回台大碰到基層部主任那也是我的學生齁我就問他說你們留師的狀況怎麼樣他說有一位退休一位想要到分練區我說為什麼要到分練區"},{"start":524.705,"end":544.131,"text":"我可能總院壓力很大但是已經欠說之下他是留下來啦所以台大主治醫師好像就是一個退休一個本來要走後來沒有離開這是大概三天前我問的事情那我但是當然我也希望所有的醫院真的要了解到我們急診尤其"},{"start":545.531,"end":573.088,"text":"大概每一顆啦 其實每一顆都可能會有這種問題所以我們必須要整體來思考這件事情我不能說哪一顆就比較嚴重你可以整體思考 但現在真的有一點危急因為我五月的時候就提過臨時提案面臨這個急診人力荒 到現在都還沒回我難道你們是想不出解決方案了跟你講一個更嚴重的除了急診雲嘉南地區最近發生了一些網路上很大的事情"},{"start":573.968,"end":599.228,"text":"神經內科的醫生他們除了面臨這些我剛講的是急診醫生喔急診醫生還會出來講話重症醫生有些是默默的默默的就離開職場了他們處理的是最多醫療糾紛的事情他們除了面臨職場的壓力還要面臨網路上的網路霸凌有一位神內醫師他在網路上嚴重的被霸凌後來醫院經過了幾天站出來幫他講話結果呢我們來看一下"},{"start":603.812,"end":622.946,"text":"另外一位醫師他請大家認真歡迎的轉發並且鼓勵投書的Lancet真的很丟臉你以前人家說台灣醫療崩壞不准寫到的Lancet硬把這篇文章拉下來還有一大堆側翼去攻擊寫文章的醫生現在又有一個醫生站出來了"},{"start":623.706,"end":649.605,"text":"他說家常身為雲嘉南最後的後送中心因為本院神內嚴重的崩盤為了保存本院重症人力即日起實施第一個非適應症勿在此群組發文二無神經科人力無法收治腦中風請直接聯絡他院急診轉院勿在此群組發文三重症人力需用在刀口上"},{"start":650.705,"end":673.421,"text":"10pm到7am不再收治無明顯效應之轉診以上非常抱歉這是重症醫療崩盤的下下之策感佩還願意留在最前線的各位也希望帶回給各醫院高層與政府高層正式腦中風醫療崩壞善待願意留下來的各位歡迎轉發鼓勵推出The Lancet"},{"start":678.39,"end":693.85,"text":"你剛講得很好 落實分級醫療希望集中症的人都可以留任你撥了42億 說要鼓勵這些人留任這些人現在直接在網路上說拜託大家轉發 鼓勵投書的Lancet你還要再把Lancet文章拉下來嗎"},{"start":695.84,"end":721.338,"text":"包委員我想這個要分幾個方面來講我剛剛有提過醫療體系真的要從根來就其那當然第二個健保的一個我們台灣健保30年是讓我們台灣窮人能夠得到很好的醫療所以我們要珍惜那健保現在的總額就是這樣子我們已經盡量做好幾乎所有的科都會覺得當然比其他國家幾戶都是"},{"start":722.239,"end":738.33,"text":"第一,這個我們真的也要想辦法,我想政府也一直,你看所以今年才會補助這麼多的公務的預算也希望未來立法院這邊也能夠多多幫忙,讓健保的資源能夠更加的充沛那我相信對於各級戶"},{"start":739.891,"end":748.22,"text":"畢竟在疫還是很重要的事情我知道像署長本人也是急診科醫師出身嘛所以我真的希望你們好好的去盤點現在急重症的人力因為他們已經在預警已經在示警了我不希望你們第三劑第四劑又遇到相同的問題"},{"start":755.268,"end":776.632,"text":"最後一個您出國的時候大家知道說我們最大的教學醫院的聖堂某一個科別從最基層的醫師到大教授都出了性侵害性騷擾等等事件所以針對醫師法第25條在這邊希望要求你們可以具體的把違背醫學倫理做含釋請問可以答應嗎最後公佈在你們的法規檢索系統"},{"start":782.301,"end":785.365,"text":"因為上次次長來報告他說正在跟每一個團體做討論跟研擬"},{"start":787.935,"end":802.938,"text":"我想我們醫生就是不能違背醫療倫理這是天經地義不變的真理我跟你說你出國的時候就是因為沒關係這個不管我出國不出國你出國的時候就是因為他沒有根據醫師法這25條把他送懲戒對就是因為沒有根據25條去送懲戒因為他沒有寫寫清楚哪些狀況有含釋違反醫療醫學倫理"},{"start":816.536,"end":818.459,"text":"所以之後你們可不可以 我會追這個進度會趕快的把具體來回應委員的詢問好 謝謝"}]}}},"gazette":{"lineno":346,"blocks":[["陳委員菁徽：（9時55分）謝謝主席還有各位委員，我請邱部長。"],["主席：請部長。"],["邱部長泰源：委員早。"],["陳委員菁徽：部長好。你還記得去年7月，我們有一個朝野協商，當時你說今年6月30以前，要達成平均點值1點0.95元，可是您今年1月受訪時有一點沒信心，今天已經6月9號，所以大家都很關心，你6月30號以前有沒有辦法達到平均點值1點0.95元？"],["邱部長泰源：我們第一季的成果已經出來，可不可以請署長跟委員報告一下？"],["石署長崇良：跟委員報告，我們主要有五個總額，分別是醫院總額、西醫基層總額、牙醫、中醫以及透析總額，目前除了西醫基層的部分平均點值是0.946，其餘都達到0.95以上。"],["陳委員菁徽：投影片我幫你整理出來，也是要幫你鼓勵一下，因為除了臺北區0.936，南區跟東區每1點都超過1元。有一些事情做對了，比如說開源，你們增加了712億，實質成長率突破8%，加大投資，另外把一些醫療項目移出健保總額，積極爭取有一些用公務預算來挹注。所以本席很關心的是，你們今年還是一樣要用8%這個成長率來規劃嗎？還是更多？這個是醫護人員期待的，因為最終我們還是希望點值是1點1元。"],["邱部長泰源：我們現在衛福部建議的最高推估跟今年是一樣的……"],["陳委員菁徽：8%？"],["邱部長泰源：不是，5.5。為什麼實質成長會到8%？是因為我們把一些項目移出來，這個部分，我們會再繼續溝通看看哪些項目可以再陸續移出來，政府應該還會在一些計畫裡面，就像我們今年補助的罕病，原來在健保總額也有保障，再另外多了20億，癌藥基金今年也會再增加。所以從公務預算以及我們增加的量應該跟今年一樣，公務預算或移出來的這個部分補起來，規模應該也會……"],["陳委員菁徽：好，其中你還有一個政策是比較關乎於節流，對穩定點值有幫助，您認為「個別醫院總額」目前有沒有遇到什麼瓶頸？"],["邱部長泰源：好，以「個別醫院總額」來講，我們當然希望分級醫療能夠落實，也希望醫院能夠財務自主管理，我們也不是說只有醫院管理，我們很希望這六個分區所有的醫院能夠自行管理，以病人的健康為中心，因為就是那些錢，那你怎麼樣讓病人更健康。"],["陳委員菁徽：我先給你看現在遇到什麼問題，上禮拜這邊非常多委員、官員都一起去觀摩中榮，做得非常好的AI智能醫院，但是它卻被斷頭3億。現在我們用三階段折付制度逐漸去打折，一旦爆大量，超過三階段就完全不予給付，你把大家一起承受系統性的風險，轉到個別醫院去承擔，就是醫院服務量大者，就必須自己來扛。","我有很多同學，現在在不同的醫院，有醫學中心、有地區醫院、有區域醫院，結果他們被柔性勸導第三季、第四季縮減一點門診，有一些門診要關起來，你們有聽說這個狀況嗎？因為現在個別醫院是各自為政，自己去做控管，如果是你剛剛講的以病人為中心，以醫療服務為中心，但有一些醫院就是沒有辦法，因為區域醫院、地區醫院都在控管，所以全部塞到像中榮這樣的大醫院去，自然就會爆量，這個爆量也不是它能夠控制的，全國不同調，最後受害的還是人民。服務量降不下來的狀況，你有沒有一個統一的規範可以去調整？不然每一個醫院絕對是亂成一團。現在有人是限制門診，但限制門診我告訴你另外一個問題，限制門診病人就擠到急診去。"],["邱部長泰源：好，報告委員，我想我剛剛已經提到，我們要從根本來解決，由根本來解決醫療體系的問題。怎麼樣讓人民更健康？儘量不要生病，生小病在社區就可以得到很好的照顧，讓他小病不要變大病；大病應該有各種的分級，不管是大病或重病，不管是醫學中心、區域醫院，甚至地區醫院都應該做好它的角色，這個才是根本之道。","也拜託民眾能夠了解我們一直在推分級醫療，也需要全國的民眾大家來了解、配合，我們有四級，包括基層醫療的醫師，都是非常優秀，都是從教學醫院的主治醫師出來的，他願意到社區服務，就是願意貼近民眾，請大家多多利用，這樣的制度是能夠解決未來的問題。","個別財務的管理，是促使達到這樣目標的一個手段。至於臺中榮總的情況，這些好朋友們真的很辛苦，民眾對他們很信任，所以他們的成長率真的比較高，但是在中區平均6.6%之下，健保署給他們7.9%的成長，所以他們實質上的收入比去年的同期是增加了2.5億元，這是第一個。"],["陳委員菁徽：好，不管怎麼樣它其實……"],["邱部長泰源：我還是要補充一下，我們希望醫學中心真的扮演急重症的角色……"],["陳委員菁徽：我再來要跟你討論急重症現在遇到什麼問題。我們不想要看到很優秀的醫院被懲罰，畢竟你說實際收入增加2.5億，可是還是有部分的醫療服務是什麼東西都沒有拿到，這也是事實。所以我們不想要第三季、第四季又遇到同樣的問題，我是在示警。你剛剛講得很好，要分級醫療、急重症等等，我給你看現在急診遇到什麼大問題，急診到現在流失66個醫師、離職了！根據急診醫學會內部的統計，還有40到50位醫生正在離職的路上，所以他們推估今年有可能上看120位要離職，你知道今年通過專科醫師考試的只有92位，只有92位！這一些很有經驗的人離職，新進來的心血還遠低於離職的人數。","有一個記者跑去臺中榮民總醫院嘉義分院採訪急診醫師，嘉義分院是中榮最大的分院，統計起來至少需要5個急診醫師，可是他們只有4個人，徵人啟事貼了五年都還沒有來，我想到你2月的時候有用特別預算去做一些解決，但是也有人提到是不是把醫師的診療費、診察費分出護理費來挖東牆、補西牆？請問這42億到底錢用到哪裡去？實際作為是什麼？為什麼我們現在的急診人力還在不斷地流失中？"],["邱部長泰源：42億的事情，等一下請業務單位健保署報告。我還是要講整體醫療體系的事情，急診醫師部分，數目是一件事情，但是每一個急診醫師都是非常優秀，也面臨很大壓力，一個一個都是我們想要照顧，也很心疼的醫師人力。","我最近也剛好回臺大，碰到急診部主任，他也是我的學生，我問他說，你們流失的狀況怎麼樣？他說有一位退休，一位想要到分院去。我問為什麼要到分院去？他說可能總院壓力比較大。但是勸說之下他是留下來。所以臺大主治醫師好像就是一個退休，一個本來要走，後來沒有離開，這大概是三天前我問的事情。當然我也希望所有的醫院真的要了解到急診……其實每一科都可能會有這種問題，所以我們必須要整體來思考這件事情，我不能說哪一科就比較嚴重……"],["陳委員菁徽：你可以整體思考，但是現在真的有一點危急，因為我5月的時候就提過臨時提案，面臨這個急診人力荒，到現在都還沒回應我，難道你們是想不出解決方案？","跟你講一個更嚴重的，除了急診，雲嘉南地區最近在網路上發生一些很大的事情，我剛講的是急診醫生，急診醫生還會出來講話，重症醫生有些是默默的就離開職場，他們處理最多醫療糾紛的事情，他們除了面臨職場的壓力，還要面臨網路上的霸凌，有一位神內醫師，他在網路上被霸凌的很嚴重，後來醫院經過了幾天站出來幫他講話。另外一位醫師很認真的請大家轉發，並且鼓勵投書The Lancet。真的很丟臉，以前人家說臺灣醫療崩壞不准寫到The Lancet，硬把這篇文章拉下來，還有一大堆側翼去攻擊寫文章的醫生。現在又有一個醫生站出來了，他說：「嘉長身為雲嘉南最後後送中心，因為本院神內嚴重的崩盤，為了保存本院重症人力，即日起實施：第一個，非適應症勿在此群組發文。第二個，無神經科人力，無法收治腦中風者，請直接聯絡他院急診轉院，勿在此群組發文。第三個，重症人力需用在刀口上，10pm到7am不再收治無明顯效應之轉診，以上措施非常抱歉，這是重症醫療崩盤的下下之策，感佩還願意留在最前線的各位，也希望帶回給各醫院高層與政府高層，正視腦中風醫療崩壞，善待願意留下來的各位！歡迎轉發！鼓勵投書The Lancet。」你剛剛講得很好，落實分級醫療，希望急重症的人都可以留任，你撥了42億說要鼓勵這些人留任，這些人現在直接在網路上說，拜託大家轉發，鼓勵投書The Lancet，你還要再把The Lancet文章拉下來嗎？"],["邱部長泰源：報告委員，我想這要分幾個方面來講，我剛才有提過，醫療體系真的要從根救起。第二個，臺灣健保30年讓我們臺灣窮人能夠得到很好的醫療，所以我們要珍惜，健保現在的總額就是這樣子，我們已經儘量做好，幾乎所有的科都會覺得比其他國家給付都來的低，這個我們真的要想辦法，我想政府也一直努力，所以今年才會補助這麼多公務的預算，也希望未來立法院這邊也能多多幫忙，讓健保的資源能夠更加充沛。我相信對於各給付……畢竟待遇還是很重要的事情。"],["陳委員菁徽：我知道像署長本人也是急診科醫師出身，所以我真的希望你們好好的去盤點現在急重症的人力。"],["邱部長泰源：一定要的。"],["陳委員菁徽：因為他們已經在示警了，我不希望你們第三季、第四季又遇到相同的問題。最後一個，您出國的時候，大家都知道我們最大的教學醫院的聖堂，某一個科別從最基層的醫師到大教授，都出了性侵害、性騷擾等等事件，所以針對醫師法第二十五條，在這邊希望要求你們可以具體地把「違背醫學倫理」做函釋，最後公布在你們的法規檢索系統，請問可以答應嗎？因為上次次長來報告，他說正在跟每一個團體做討論跟研擬。"],["邱部長泰源：我想我們醫生就是不能違背醫療倫理，這是天經地義、不變的真理。"],["陳委員菁徽：我跟你說，你出國的時候，就是因為……"],["邱部長泰源：沒關係，不管我出國或不出國，我跟王育敏委員在拚國際事情的時候，我還是關心國內任何的事情。"],["陳委員菁徽：你出國的時候，就是因為沒有根據醫師法第二十五條把他送懲戒，因為沒有寫清楚哪些狀況是有關「違背醫學倫理」的函釋，之後我會追這個進度，你們可不可以把……"],["邱部長泰源：好，我們會趕快具體回應委員的詢問。"],["陳委員菁徽：好，謝謝。"],["邱部長泰源：謝謝委員。"],["主席：謝謝陳委員的詢答。","接下來請王育敏委員做詢答。","委員會公告，蘇清泉召委詢答結束後，休息10分鐘。"]],"agenda":{"page_end":188,"meet_id":"委員會-11-3-26-16","speakers":["劉建國","陳昭姿","王正旭","林月琴","陳菁徽","王育敏","蘇清泉","邱鎮軍","林淑芬","黃秀芳","盧縣一","鍾佳濱","廖偉翔","楊曜","翁曉玲","涂權吉","徐欣瑩","陳瑩"],"page_start":1,"meetingDate":["2025-06-09"],"gazette_id":"1145902","agenda_lcidc_ids":["1145902_00002"],"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16次全體委員會議紀錄","content":"審查一、行政院函請審議「全民健康保險資料管理條例草案」案；二、委員林月琴等 21 人擬具\n「全民健康保險資料管理條例草案」案","agenda_id":"1145902_00001"}}}