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\"score\": 0.799}, {\"word\": \"下\", \"start\": 946.533, \"end\": 947.134, \"score\": 0.848}, {\"word\": \"來\"}, {\"word\": \"請\"}, {\"word\": \"廖\", \"start\": 947.134, \"end\": 947.614, \"score\": 0.913}, {\"word\": \"偉\"}, {\"word\": \"祥\", \"start\": 947.614, \"end\": 947.874, \"score\": 0.796}, {\"word\": \"委\", \"start\": 947.874, \"end\": 947.994, \"score\": 0.842}, {\"word\": \"員\"}, {\"word\": \"發\"}, {\"word\": \"言\", \"start\": 947.994, \"end\": 948.014, \"score\": 0.013}], \"language\": \"zh\"}","srt":"1\n00:00:07,881 --> 00:00:21,449\n好謝謝主席主席在場的委員先進列席政務機關總統官員會長工作夥伴媒體記者女士先生有請我們邱部長請邱部長也請統計處的李處長統計處李處長委員好部長好那今天因為有一個個人資料保護完理委員會的事務組的組長直接請他過來請組長好很快來我們來看今天最新最新的\n\n2\n00:00:38,860 --> 00:01:01,752\n史上最大中國四四一比各支不設防全外線還有看到台灣的資料庫他們爆料者說從可以建立所有中國公民的行為社會經濟資料其中TWDB是台灣小款資料庫部長有沒有看到這樣的新聞爆料有今天有大家有討論過有討論過了你們的結論是什麼這跟你們之前有一位前主秘涉及洩密有沒有關係\n\n3\n00:01:04,557 --> 00:01:32,485\n有沒有這個可能要再查證喔你們預定多少才會查目前剪掉還在偵辦中目前剪掉偵辦中這個在剪掉偵辦中那這個咧上面今天才爆料的咧有沒有開始啟動了有沒有兩個單位在處理了有沒有去查一查可能是從哪裡出去的這個資料庫不見得是從衛福部不見得是從健保資料庫出去的但是因為前面發生的這個健保資料庫外洩所以我們也很疑惑說現在中國的\n\n4\n00:01:33,683 --> 00:01:54,273\n人民他們的各自外洩還包含了包含台灣的資料庫是不是趕快查部長要責任哪個單位你們目前這個檢調在查嘛對不對你們會主動的趕快去看看說這個資料跟他們所說的台灣資料庫有沒有關聯有沒有人可以來處理這檢調應該會調查\n\n5\n00:01:59,214 --> 00:02:09,463\n你們自己要趕快去查說現在今天爆料的這個台灣資料庫會不會跟你們之前的電寶資料庫有關聯是不是這樣子我們是不是資訊處這邊了解嗎這個我們可以去協同速發部我們資訊處協同速發部好那麼就拜託部長責成資訊處協同速發部趕快去查一下\n\n6\n00:02:21,694 --> 00:02:48,357\n到底這裡面的資料庫是什麼會不會跟你們之前洩出去的健保資料庫有關聯好不好謝謝好那今天呢我們資料庫先問到這來往下看介師今天有關於貧窮線的檢討雖然不是今天的主題但是我看了一下其實呢目前說有女性在擔任低收跟中低收的有三成是單親媽媽按照目前的算法我就不再贅述這個所謂的可自備所得的中位數的六成為最低生活費\n\n7\n00:02:49,076 --> 00:03:10,112\n那其中就是低收那麼如果是1.5倍的就是中低收其實呢有很多單親媽媽困在什麼譬如說娘家有一棟房子我常常在處理20年前我在屏東縣的時候我就在處理這個事情了那麼現在民團說貧窮人口目前實際可以符合的只有2%實際上要6%部長你覺得呢我們目前國家的貧窮人口是2%還是6%沒有辦法判斷我們的\n\n8\n00:03:16,943 --> 00:03:35,593\n我跟那個委員報告一下所謂的話貧窮人口佔百分之二的話他是已經經過那一種資產的然後百分之六的話呢是主計處公佈的主計處公佈的我們這個收入的是六趴但是取掉你們有資產能力的就只剩兩趴所以這六趴跟兩趴這樣來的好來部長我看一下你知不知道現在我們國家有多少人在繳稅所得稅你有繳吧\n\n9\n00:03:46,854 --> 00:04:10,172\n你覺得你是在比較多的那一邊還是比較少的那一邊有繳稅的有繳所得稅的比較多還是沒有繳所得稅的比較多你猜猜看應該我是算一般啦過去我不是說你所得高不高啦我說台灣有人不用繳所得稅的有要繳所得稅的你是屬於要繳所得稅的那一邊你覺得你這邊的人比較多還是比較少要繳所得稅的人比較多\n\n10\n00:04:13,902 --> 00:04:24,715\n比較多曾經在108年要繳所得稅的不繳所得稅的超過一半現在大概維持在四成七八左右不繳所得稅的從過去的26.5194年的26年免繳所得稅的比他這麼高這說明什麼\n\n11\n00:04:30,390 --> 00:04:51,140\n台灣的所得分配財務分配在惡化所得分配比資產惡化的更快所以為什麼我們查出來所得它是屬於中低收可能低收的有6%但是拿掉資產之後只剩2%我們台灣的所得分配的惡化程度比資產分布的惡化程度更快\n\n12\n00:04:52,000 --> 00:05:14,290\n那請問你今天我要維持生活我是靠我的資產而生活還是靠我的所得而生活所得是靠所得嘛所以我才說如果按照目前這個規定算出來目前如果要走主計總數的我們的中低收跟低收的標準的遠高於目前我們核定的標準人數啦就是因為你們把資產算進去之後我們就排除了\n\n13\n00:05:15,031 --> 00:05:33,219\n但是就像我說的很多的單親媽媽他沒有辦法靠娘家的移動房子的遺產繼承權他來養孩子啊所以我們的貧窮線造成我們的社會福利的給予啊就有問題往下看所以到底要先推估貧窮人口的比例還先畫定貧窮線先有蛋還是先有雞你們要先推估我們多少貧窮人口再來畫這條貧窮線還是先畫出貧窮線自然貧窮人口的比例又出來是先有蛋還是先有雞\n\n14\n00:05:43,902 --> 00:05:56,368\n很難回答對不對按照我們公共機關要依法兩個都要考量說得很好但是目前我們法律的規定寫在條文裡面的你先必須劃出貧窮線的定義然後呢再推出貧窮線的人口但是當你發現這已經跟現實脫離很遠的時候你要不要定期的檢討要不要定期檢討會不會要重新檢討你貧窮線的定義為什麼我們貧窮定義是用什麼是用可自備所得的六成作為\n\n15\n00:06:14,217 --> 00:06:34,045\n貧窮線的標準這個有沒有道理有沒有道理寫在法律裡面可不可以改部長可不可以改我們貧窮線的定義可不可以討論可不可以檢討當然可以嘛我們很多社會福利的包括我們現在的調整都有一個根據我們的通膨的指數每四年檢討一次有沒有\n\n16\n00:06:35,319 --> 00:06:51,174\n有沒有有嘛對不對所以未來我請你為何不趕快檢討我們貧窮縣的法定定義它的機制要不要訂入一個定期檢討譬如說每四年還是每多少年我們檢討一次每四年檢討一次或者說脫貨膨脹超過4%的時候我們就檢討一次不要讓這個貧窮縣變成造成我們真的貧窮人口陷於絕境部長可以嗎\n\n17\n00:07:01,367 --> 00:07:22,688\n往這方面來修法好不好我們立法院我們也會寫出我們的版本但是我們認為過去以來我長期在地方政府遇到的這些想要救救不了的人就是定在我們的貧窮性的定義數十年來如一日啊從我在地方縣政府20年前當副縣長那個一倍1.5倍到現在還是一倍1.5倍資產調查排除哪些限制有做些調整\n\n18\n00:07:23,729 --> 00:07:49,557\n像現在我們要求什麼要把資產從500萬提高到700萬類似這樣的問題好趕快我現在問比較重要的問題更重要的問題啦來個別醫院總額制的薪資隱憂有人提到遇到了總額制在加拿大就會遇到手術延期那我們國內也會產生這個情況那最近有提到說會不會排擠兒科病人因為譬如說因為分科嘛我醫院總額了我可能就拿兒科開刀限制悶診人數轉給其他的成人兒科別醫院的經營者會不會這樣做\n\n19\n00:07:53,832 --> 00:08:15,974\n醫院總和制會不會這樣做我們這個有一些剛性需求我們要保護的是的所以要趕快的會不會造成非緊急手術被延後或者排擠到類似像比較冷門的科額科的門診的這些解決方案有沒有開始在實施考量如果這樣的個別總和可以讓我們的分級醫療做得更好我支持那他們可以更有時間來開刀\n\n20\n00:08:17,535 --> 00:08:42,421\n是這樣子好那你們要把這些短過渡時期的這些這些泳射這些負面現象要趕快盤點出來好不好好的往下站好那我們來看一下上游政策下游對策你醫院的個別總和制之後你看我們怎樣中小型醫院跟診所他就等一下他少收住院病患也少收門診大家就跑到大醫院會不會這樣子因為大醫院不能拒收嘛所以台灣台中籠統就變成被擠爆嘛是不是這樣子\n\n21\n00:08:43,396 --> 00:09:00,793\n所以這個過渡時期的現象還發生在哪裡還往那看發生在我之前也在那天在財政委員會跟你問過了會這樣急診爆量可能會被斷頭醫院會被斷頭現場醫護呢待遇提升慢但是呢負荷量增加很快馬上產生離職離職之後就惡性循環部長上週我不是問過你這個問題\n\n22\n00:09:03,464 --> 00:09:29,524\n是不是有問過這個問題是所以我們在遇到一個要往理想制度過渡的過程當中會遇到哪些過渡的現象我們同時要因應解方這個問題你說你打算怎麼解了你上次已經回答過了我就不再細問往下看所以我們來想一下我們來看一下我屏東個別的情況屏東農總希望未來成為準一中是不是這樣他這有宣布嘛院長支不支持屏東農總往準一中去邁進他定在一一八年\n\n23\n00:09:31,889 --> 00:09:44,592\n院長知不知此地方屏東目前沒有醫學中心喔不是每個縣市都有醫學中心那我們很感恩我們有個屏東農總他也立志要成為準醫中您知不知此\n\n24\n00:09:46,156 --> 00:10:05,380\n我想如果屏東農總評估他們當地的醫療需求需要發展成準醫學中心那當然是我們會樂觀其成好但是上週公布了最賠錢的醫院有沒有包括屏東農總有屏東農總跟他的農全分院前五名屏東佔了兩名我們有沒有很光榮啊\n\n25\n00:10:06,807 --> 00:10:28,748\n這個是凸顯出一個我們醫療資源在都跟非都分布不均的情況這個不能規則於任何單一個人單一機關制度要想辦法去改變我希望我們努力去改變但是另外一個問題往下看現在是這樣現在我們的醫院總和智慧造成什麼呢假設我一個家庭有牢有小有幼有壯\n\n26\n00:10:30,339 --> 00:10:38,756\n主持加計程被要求每年的伙食費只能增加4%所以就分配去了每個成員的伙食費都只能每年增加4%\n\n27\n00:10:40,151 --> 00:10:59,620\n你問問看這個正在長大的他每年需要的伙食會難道只能成長4%嗎這些已經不再長大的還需要成長4%嗎你了解我的意思沒有了解所以在我們的地區的總和字你用個別醫院去算的時候要考慮到每個醫院的發展階段現在屏東農在什麼階段往上看屏東農在幼兒階段\n\n28\n00:11:01,195 --> 00:11:06,780\n如果這整個高平地區的總額固定成長4%你只給屏東農種按照去年的門診量診療量來增加4%他才剛開啊他每一年要成長的幅度是很大的如果只能幹到前一年成長4%你覺得他活著養得活嗎部長你怎麼看\n\n29\n00:11:21,101 --> 00:11:44,607\n剛剛您報的數據是這樣子是他的剛開的醫院遮臼力會比較快比較大所以變成會感覺上看起來比較虧損很多但是他的現金收入是一直是有增加的但是也受到你們區域總額的影響的分配所以你們不會說每個院都齊頭式的分配你們會按照每個醫院的發展狀況給是不是這樣\n\n30\n00:11:45,647 --> 00:12:14,749\n我們署長點頭了嗎你要不要讓署長講一下特別的考量跟委員報告當然在這個區域的總和下高頻的表現是很好他們的點值是趨近1.1塊錢那當然這個有些醫院它的成長會比較高於這個整體的區域成長那我們會實質上去看看它成長的情形然後後面再做一些適度的調整這樣所以目前我們屏東龍又要這個情況它要做的很多事\n\n31\n00:12:15,429 --> 00:12:40,306\n但是他按照什麼他是按照去年的同期的量能為基準點如果按照醫院個別總和制他又不能拒收看的越多住的越多虧越多是不是這樣這是惡性循環部長可以救嗎有沒有辦法改有沒有辦法解決我們再找院長來討論一下看看他整個是善意的找他來討論不是找他說為什麼中原幫你講話是不是這樣OK好南區實施健保個別醫院的總和三年多屏東龍總去年虧了快1.66億\n\n32\n00:12:41,857 --> 00:13:05,559\n怎麼樣朝準一中怎麼辦為了避免屏東病患如果屏東龍口不能成為準一中跑到高雄讓高雄的一中更嚴重這不是我們所熱見的所以我們希望部長可以承諾在未來我們推動醫院總和的制度之下考慮到在區域內的不同醫院的不同發展階段的不同定位給予一些不同的一些安排好不好好那月主再看我趕快下來把他結束掉往下看\n\n33\n00:13:05,979 --> 00:13:28,106\n好那接下來最後一個問題就是說現在呢我們地方的醫院跟我們公共部門的衛生所以前我在當副縣長的時候我們有33個衛生所我們的護理人員還包括校護我們要做什麼要不要做預防保健是衛生所要不要做宣導當然要有的衛生所有群醫他要做醫療是有的要打預防注射對不對是的醫院是不是也做這些事情是不是醫院也會做這些事情公共部門的衛生所也會做這些事情\n\n34\n00:13:34,008 --> 00:13:50,114\n但是經費從哪裡來有從國健署來的從衛福部來的從機關署來的從地方署來的還有從健保署來的請問做這些事情上面都有錢進入到給這些單位去申請但是畢竟健保支出的比例對象跟公務預算支出的是不是要區分部長是不是要區分我總不能都拿健保的錢來做預防保健跟宣導吧\n\n35\n00:13:57,455 --> 00:14:11,075\n比重啦我不是說完全沒有啦所以現在我們健保總額不夠用醫療院所挨挨救啊他說我要做很多事情啊但是你都從健保署錢去挖啊那公務預算要不要出公務預算要出一些啊\n\n36\n00:14:11,963 --> 00:14:40,269\n是不是署長你同不同意同意講得很大聲你看這個馬上同意署長當然同意那報告委員其實政府這年來真的是從很多防治預防保健方面的確是付出更多的公務預算對啦所以我這邊就幫你寫全盲健康保險法它是以醫療服務為主疾病傷害生育事故所以它的健保支出是應該做在這些醫療為主的\n\n37\n00:14:41,429 --> 00:15:07,039\n其他的一些事情像傳染病的防治我上週才問過你一次像COVID-19期間我們有特別預算去預註那現在不是COVID-19已經不是那個法定傳染病的最高級了那我們把它降下來公務預算還支不支持要不要支持醫院做這些傳染這些季節性的好發的我們要不要支持用公務預算幫忙你要說要啊那我說我一定幫你忙啊這樣我才有私利的餘地啊\n\n38\n00:15:09,675 --> 00:15:34,714\n這個就是我們要依據健保法啦或實際上當相關的法規來制定當然我們希望說相當公衛啦或者不在原來不在健保法裡面的的確是要用公務醫生很好最後一句話結論就來了最後一個結論所以全面檢討全民健康保險基金中預防保健及傳染病防治相關的幾副不符合健康保險法幾副的項目改為公務預認書可不可以\n\n39\n00:15:36,022 --> 00:15:48,014\n應該要朝著這個方向來那這兩個標準我就不再重念了可不可以這兩個報告給本席謝謝也謝謝主席的榮騰謝謝兩位謝謝宗嘉賓委員發言接下來請廖偉祥委員發言\n\n","tsv":"start\tend\ttext\n7881\t21449\t好 謝謝主席 主席在場的委員先進列席政務機關總統 官員 會長 工作夥伴 媒體 記者 女士先生有請我們邱部長請邱部長也請統計處的李處長統計處李處長委員好部長好 那今天因為有一個個人資料保護完理委員會的事務組的組長直接請他過來請組長好 很快 來我們來看今天最新最新的\n38860\t61752\t史上最大中國四四一比各支不設防全外線還有看到台灣的資料庫他們爆料者說從可以建立所有中國公民的行為社會經濟資料其中TWDB是台灣小款資料庫部長有沒有看到這樣的新聞爆料有今天有大家有討論過有討論過了你們的結論是什麼這跟你們之前有一位前主秘涉及洩密有沒有關係\n64557\t92485\t有沒有 這個可能要再查證喔你們預定多少才會查目前剪掉還在偵辦中目前剪掉偵辦中 這個在剪掉偵辦中那這個咧上面今天才爆料的咧有沒有開始啟動了有沒有兩個單位在處理了有沒有去查一查可能是從哪裡出去的這個資料庫不見得是從衛福部不見得是從健保資料庫出去的但是因為前面發生的這個健保資料庫外洩所以我們也很疑惑說現在中國的\n93683\t114273\t人民他們的各自外洩還包含了包含台灣的資料庫是不是趕快查部長要責任哪個單位你們目前這個檢調在查嘛對不對你們會主動的趕快去看看說這個資料跟他們所說的台灣資料庫有沒有關聯有沒有人可以來處理這檢調應該會調查\n119214\t129463\t你們自己要趕快去查說現在今天爆料的這個台灣資料庫會不會跟你們之前的電寶資料庫有關聯是不是這樣子我們是不是資訊處這邊了解嗎這個我們可以去協同速發部我們資訊處協同速發部好 那麼就拜託部長責成資訊處協同速發部趕快去查一下\n141694\t168357\t到底這裡面的資料庫是什麼會不會跟你們之前洩出去的健保資料庫有關聯好不好謝謝好那今天呢我們資料庫先問到這來往下看介師今天有關於貧窮線的檢討雖然不是今天的主題但是我看了一下其實呢目前說有女性在擔任低收跟中低收的有三成是單親媽媽按照目前的算法我就不再贅述這個所謂的可自備所得的中位數的六成為最低生活費\n169076\t190112\t那其中就是低收那麼如果是1.5倍的就是中低收其實呢有很多單親媽媽困在什麼譬如說娘家有一棟房子我常常在處理20年前我在屏東縣的時候我就在處理這個事情了那麼現在民團說貧窮人口目前實際可以符合的只有2%實際上要6% 部長你覺得呢我們目前國家的貧窮人口是2%還是6%沒有辦法判斷我們的\n196943\t215593\t我跟那個委員報告一下所謂的話貧窮人口佔百分之二的話他是已經經過那一種資產的然後百分之六的話呢是主計處公佈的主計處公佈的我們這個收入的是六趴但是取掉你們有資產能力的就只剩兩趴所以這六趴跟兩趴這樣來的好來部長我看一下你知不知道現在我們國家有多少人在繳稅所得稅你有繳吧\n226854\t250172\t你覺得你是在比較多的那一邊還是比較少的那一邊有繳稅的有繳所得稅的比較多還是沒有繳所得稅的比較多你猜猜看應該我是算一般啦過去我不是說你所得高不高啦我說台灣有人不用繳所得稅的有要繳所得稅的你是屬於要繳所得稅的那一邊你覺得你這邊的人比較多還是比較少要繳所得稅的人比較多\n253902\t264715\t比較多曾經在108年要繳所得稅的不繳所得稅的超過一半現在大概維持在四成七八左右不繳所得稅的從過去的26.51 94年的26年免繳所得稅的比他這麼高這說明什麼\n270390\t291140\t台灣的所得分配 財務分配在惡化所得分配比資產惡化的更快所以為什麼我們查出來所得它是屬於中低收可能低收的有6%但是拿掉資產之後只剩2%我們台灣的所得分配的惡化程度比資產分布的惡化程度更快\n292000\t314290\t那請問你今天我要維持生活我是靠我的資產而生活還是靠我的所得而生活所得是靠所得嘛所以我才說如果按照目前這個規定算出來目前如果要走主計總數的我們的中低收跟低收的標準的遠高於目前我們核定的標準人數啦就是因為你們把資產算進去之後我們就排除了\n315031\t333219\t但是就像我說的很多的單親媽媽他沒有辦法靠娘家的移動房子的遺產繼承權他來養孩子啊所以我們的貧窮線造成我們的社會福利的給予啊就有問題往下看所以到底要先推估貧窮人口的比例還先畫定貧窮線先有蛋還是先有雞你們要先推估我們多少貧窮人口再來畫這條貧窮線還是先畫出貧窮線自然貧窮人口的比例又出來是先有蛋還是先有雞\n343902\t356368\t很難回答對不對按照我們公共機關要依法兩個都要考量說得很好但是目前我們法律的規定寫在條文裡面的你先必須劃出貧窮線的定義然後呢再推出貧窮線的人口但是當你發現這已經跟現實脫離很遠的時候你要不要定期的檢討要不要定期檢討會不會要重新檢討你貧窮線的定義為什麼我們貧窮定義是用什麼是用可自備所得的六成作為\n374217\t394045\t貧窮線的標準這個有沒有道理有沒有道理寫在法律裡面可不可以改部長可不可以改我們貧窮線的定義可不可以討論可不可以檢討當然可以嘛我們很多社會福利的包括我們現在的調整都有一個根據我們的通膨的指數每四年檢討一次有沒有\n395319\t411174\t有沒有 有嘛 對不對所以未來我請你為何不趕快檢討我們貧窮縣的法定定義它的機制要不要訂入一個定期檢討譬如說每四年還是每多少年我們檢討一次每四年檢討一次或者說脫貨膨脹超過4%的時候我們就檢討一次不要讓這個貧窮縣變成造成我們真的貧窮人口陷於絕境部長可以嗎\n421367\t442688\t往這方面來修法好不好我們立法院我們也會寫出我們的版本但是我們認為過去以來我長期在地方政府遇到的這些想要救救不了的人就是定在我們的貧窮性的定義數十年來如一日啊從我在地方縣政府20年前當副縣長那個一倍1.5倍到現在還是一倍1.5倍資產調查排除哪些限制有做些調整\n443729\t469557\t像現在我們要求什麼 要把資產從500萬提高到700萬 類似這樣的問題好 趕快我現在問比較重要的問題 更重要的問題啦 來個別醫院總額制的薪資隱憂 有人提到遇到了總額制在加拿大 就會遇到手術延期那我們國內也會產生這個情況那最近有提到說 會不會排擠兒科病人因為譬如說 因為分科嘛 我醫院總額了我可能就拿兒科開刀 限制悶診人數轉給其他的成人兒科別醫院的經營者會不會這樣做\n473832\t495974\t醫院總和制會不會這樣做我們這個有一些剛性需求我們要保護的是的 所以要趕快的會不會造成非緊急手術被延後或者排擠到類似像比較冷門的科 額科的門診的這些解決方案有沒有開始在實施考量如果這樣的個別總和可以讓我們的分級醫療做得更好我支持那他們可以更有時間來開刀\n497535\t522421\t是這樣子好那你們要把這些短過渡時期的這些這些泳射這些負面現象要趕快盤點出來好不好好的往下站好那我們來看一下上游政策下游對策你醫院的個別總和制之後你看我們怎樣中小型醫院跟診所他就等一下他少收住院病患也少收門診大家就跑到大醫院會不會這樣子因為大醫院不能拒收嘛所以台灣台中籠統就變成被擠爆嘛是不是這樣子\n523396\t540793\t所以這個過渡時期的現象還發生在哪裡還往那看發生在我之前也在那天在財政委員會跟你問過了會這樣急診爆量可能會被斷頭醫院會被斷頭現場醫護呢待遇提升慢但是呢負荷量增加很快馬上產生離職離職之後就惡性循環部長上週我不是問過你這個問題\n543464\t569524\t是不是有問過這個問題是所以我們在遇到一個要往理想制度過渡的過程當中會遇到哪些過渡的現象我們同時要因應解方這個問題你說你打算怎麼解了你上次已經回答過了我就不再細問往下看所以我們來想一下我們來看一下我屏東個別的情況屏東農總希望未來成為準一中是不是這樣他這有宣布嘛院長支不支持屏東農總往準一中去邁進他定在一一八年\n571889\t584592\t院長知不知此地方屏東目前沒有醫學中心喔不是每個縣市都有醫學中心那我們很感恩我們有個屏東農總他也立志要成為準醫中您知不知此\n586156\t605380\t我想如果屏東農總評估他們當地的醫療需求需要發展成準醫學中心那當然是我們會樂觀其成好 但是上週公布了最賠錢的醫院有沒有包括屏東農總有 屏東農總跟他的農全分院前五名屏東佔了兩名我們有沒有很光榮啊\n606807\t628748\t這個是凸顯出一個我們醫療資源在都跟非都分布不均的情況這個不能規則於任何單一個人 單一機關 制度要想辦法去改變我希望我們努力去改變 但是另外一個問題往下看現在是這樣 現在我們的醫院總和智慧造成什麼呢假設我一個家庭 有牢 有小 有幼 有壯\n630339\t638756\t主持加計程被要求每年的伙食費只能增加4%所以就分配去了每個成員的伙食費都只能每年增加4%\n640151\t659620\t你問問看這個正在長大的他每年需要的伙食會難道只能成長4%嗎這些已經不再長大的還需要成長4%嗎你了解我的意思沒有了解所以在我們的地區的總和字你用個別醫院去算的時候要考慮到每個醫院的發展階段現在屏東農在什麼階段往上看屏東農在幼兒階段\n661195\t666780\t如果這整個高平地區的總額固定成長4%你只給屏東農種按照去年的門診量診療量來增加4%他才剛開啊他每一年要成長的幅度是很大的如果只能幹到前一年成長4%你覺得他活著養得活嗎部長你怎麼看\n681101\t704607\t剛剛您報的數據是這樣子是他的剛開的醫院遮臼力會比較快比較大所以變成會感覺上看起來比較虧損很多但是他的現金收入是一直是有增加的但是也受到你們區域總額的影響的分配所以你們不會說每個院都齊頭式的分配你們會按照每個醫院的發展狀況給是不是這樣\n705647\t734749\t我們署長點頭了嗎你要不要讓署長講一下特別的考量跟委員報告 當然在這個區域的總和下高頻的表現是很好他們的點值是趨近1.1塊錢那當然這個有些醫院它的成長會比較高於這個整體的區域成長那我們會實質上去看看它成長的情形然後後面再做一些適度的調整這樣所以目前我們屏東龍又要這個情況它要做的很多事\n735429\t760306\t但是他按照什麼 他是按照去年的同期的量能為基準點如果按照醫院個別總和制 他又不能拒收看的越多 住的越多 虧越多 是不是這樣 這是惡性循環部長可以救嗎 有沒有辦法改 有沒有辦法解決我們再找院長來討論一下 看看他整個是善意的找他來討論 不是找他說為什麼中原幫你講話是不是這樣 OK好南區實施健保個別醫院的總和三年多 屏東龍總去年虧了快1.66億\n761857\t785559\t怎麼樣朝準一中怎麼辦為了避免屏東病患如果屏東龍口不能成為準一中跑到高雄讓高雄的一中更嚴重這不是我們所熱見的所以我們希望部長可以承諾在未來我們推動醫院總和的制度之下考慮到在區域內的不同醫院的不同發展階段的不同定位給予一些不同的一些安排好不好好 那月主再看我趕快下來把他結束掉 往下看\n785979\t808106\t好那接下來最後一個問題就是說現在呢我們地方的醫院跟我們公共部門的衛生所以前我在當副縣長的時候我們有33個衛生所我們的護理人員還包括校護我們要做什麼要不要做預防保健是衛生所要不要做宣導當然要有的衛生所有群醫他要做醫療是有的要打預防注射對不對是的醫院是不是也做這些事情是不是醫院也會做這些事情公共部門的衛生所也會做這些事情\n814008\t830114\t但是經費從哪裡來 有從國健署來的 從衛福部來的 從機關署來的 從地方署來的 還有從健保署來的請問做這些事情上面都有錢進入到給這些單位去申請但是畢竟健保支出的比例對象跟公務預算支出的是不是要區分部長是不是要區分我總不能都拿健保的錢來做預防保健跟宣導吧\n837455\t851075\t比重啦我不是說完全沒有啦所以現在我們健保總額不夠用醫療院所挨挨救啊他說我要做很多事情啊但是你都從健保署錢去挖啊那公務預算要不要出公務預算要出一些啊\n851963\t880269\t是不是 署長你同不同意同意講得很大聲 你看這個馬上同意署長當然同意那報告委員其實政府這年來真的是從很多防治預防保健方面的確是付出更多的公務預算對啦 所以我這邊就幫你寫全盲健康保險法它是以醫療服務為主疾病傷害生育事故所以它的健保支出是應該做在這些醫療為主的\n881429\t907039\t其他的一些事情像傳染病的防治我上週才問過你一次像COVID-19期間我們有特別預算去預註那現在不是COVID-19已經不是那個法定傳染病的最高級了那我們把它降下來公務預算還支不支持要不要支持醫院做這些傳染這些季節性的好發的我們要不要支持用公務預算幫忙你要說要啊那我說我一定幫你忙啊這樣我才有私利的餘地啊\n909675\t934714\t這個就是我們要依據健保法啦或實際上當相關的法規來制定當然我們希望說相當公衛啦或者不在原來不在健保法裡面的的確是要用公務醫生很好最後一句話結論就來了最後一個結論所以全面檢討全民健康保險基金中預防保健及傳染病防治相關的幾副不符合健康保險法幾副的項目改為公務預認書可不可以\n936022\t948014\t應該要朝著這個方向來那這兩個標準我就不再重念了可不可以這兩個報告給本席謝謝也謝謝主席的榮騰謝謝兩位謝謝宗嘉賓委員發言接下來請廖偉祥委員發言\n","txt":"好 謝謝主席 主席在場的委員先進列席政務機關總統 官員 會長 工作夥伴 媒體 記者 女士先生有請我們邱部長請邱部長也請統計處的李處長統計處李處長委員好部長好 那今天因為有一個個人資料保護完理委員會的事務組的組長直接請他過來請組長好 很快 來我們來看今天最新最新的\n史上最大中國四四一比各支不設防全外線還有看到台灣的資料庫他們爆料者說從可以建立所有中國公民的行為社會經濟資料其中TWDB是台灣小款資料庫部長有沒有看到這樣的新聞爆料有今天有大家有討論過有討論過了你們的結論是什麼這跟你們之前有一位前主秘涉及洩密有沒有關係\n有沒有 這個可能要再查證喔你們預定多少才會查目前剪掉還在偵辦中目前剪掉偵辦中 這個在剪掉偵辦中那這個咧上面今天才爆料的咧有沒有開始啟動了有沒有兩個單位在處理了有沒有去查一查可能是從哪裡出去的這個資料庫不見得是從衛福部不見得是從健保資料庫出去的但是因為前面發生的這個健保資料庫外洩所以我們也很疑惑說現在中國的\n人民他們的各自外洩還包含了包含台灣的資料庫是不是趕快查部長要責任哪個單位你們目前這個檢調在查嘛對不對你們會主動的趕快去看看說這個資料跟他們所說的台灣資料庫有沒有關聯有沒有人可以來處理這檢調應該會調查\n你們自己要趕快去查說現在今天爆料的這個台灣資料庫會不會跟你們之前的電寶資料庫有關聯是不是這樣子我們是不是資訊處這邊了解嗎這個我們可以去協同速發部我們資訊處協同速發部好 那麼就拜託部長責成資訊處協同速發部趕快去查一下\n到底這裡面的資料庫是什麼會不會跟你們之前洩出去的健保資料庫有關聯好不好謝謝好那今天呢我們資料庫先問到這來往下看介師今天有關於貧窮線的檢討雖然不是今天的主題但是我看了一下其實呢目前說有女性在擔任低收跟中低收的有三成是單親媽媽按照目前的算法我就不再贅述這個所謂的可自備所得的中位數的六成為最低生活費\n那其中就是低收那麼如果是1.5倍的就是中低收其實呢有很多單親媽媽困在什麼譬如說娘家有一棟房子我常常在處理20年前我在屏東縣的時候我就在處理這個事情了那麼現在民團說貧窮人口目前實際可以符合的只有2%實際上要6% 部長你覺得呢我們目前國家的貧窮人口是2%還是6%沒有辦法判斷我們的\n我跟那個委員報告一下所謂的話貧窮人口佔百分之二的話他是已經經過那一種資產的然後百分之六的話呢是主計處公佈的主計處公佈的我們這個收入的是六趴但是取掉你們有資產能力的就只剩兩趴所以這六趴跟兩趴這樣來的好來部長我看一下你知不知道現在我們國家有多少人在繳稅所得稅你有繳吧\n你覺得你是在比較多的那一邊還是比較少的那一邊有繳稅的有繳所得稅的比較多還是沒有繳所得稅的比較多你猜猜看應該我是算一般啦過去我不是說你所得高不高啦我說台灣有人不用繳所得稅的有要繳所得稅的你是屬於要繳所得稅的那一邊你覺得你這邊的人比較多還是比較少要繳所得稅的人比較多\n比較多曾經在108年要繳所得稅的不繳所得稅的超過一半現在大概維持在四成七八左右不繳所得稅的從過去的26.51 94年的26年免繳所得稅的比他這麼高這說明什麼\n台灣的所得分配 財務分配在惡化所得分配比資產惡化的更快所以為什麼我們查出來所得它是屬於中低收可能低收的有6%但是拿掉資產之後只剩2%我們台灣的所得分配的惡化程度比資產分布的惡化程度更快\n那請問你今天我要維持生活我是靠我的資產而生活還是靠我的所得而生活所得是靠所得嘛所以我才說如果按照目前這個規定算出來目前如果要走主計總數的我們的中低收跟低收的標準的遠高於目前我們核定的標準人數啦就是因為你們把資產算進去之後我們就排除了\n但是就像我說的很多的單親媽媽他沒有辦法靠娘家的移動房子的遺產繼承權他來養孩子啊所以我們的貧窮線造成我們的社會福利的給予啊就有問題往下看所以到底要先推估貧窮人口的比例還先畫定貧窮線先有蛋還是先有雞你們要先推估我們多少貧窮人口再來畫這條貧窮線還是先畫出貧窮線自然貧窮人口的比例又出來是先有蛋還是先有雞\n很難回答對不對按照我們公共機關要依法兩個都要考量說得很好但是目前我們法律的規定寫在條文裡面的你先必須劃出貧窮線的定義然後呢再推出貧窮線的人口但是當你發現這已經跟現實脫離很遠的時候你要不要定期的檢討要不要定期檢討會不會要重新檢討你貧窮線的定義為什麼我們貧窮定義是用什麼是用可自備所得的六成作為\n貧窮線的標準這個有沒有道理有沒有道理寫在法律裡面可不可以改部長可不可以改我們貧窮線的定義可不可以討論可不可以檢討當然可以嘛我們很多社會福利的包括我們現在的調整都有一個根據我們的通膨的指數每四年檢討一次有沒有\n有沒有 有嘛 對不對所以未來我請你為何不趕快檢討我們貧窮縣的法定定義它的機制要不要訂入一個定期檢討譬如說每四年還是每多少年我們檢討一次每四年檢討一次或者說脫貨膨脹超過4%的時候我們就檢討一次不要讓這個貧窮縣變成造成我們真的貧窮人口陷於絕境部長可以嗎\n往這方面來修法好不好我們立法院我們也會寫出我們的版本但是我們認為過去以來我長期在地方政府遇到的這些想要救救不了的人就是定在我們的貧窮性的定義數十年來如一日啊從我在地方縣政府20年前當副縣長那個一倍1.5倍到現在還是一倍1.5倍資產調查排除哪些限制有做些調整\n像現在我們要求什麼 要把資產從500萬提高到700萬 類似這樣的問題好 趕快我現在問比較重要的問題 更重要的問題啦 來個別醫院總額制的薪資隱憂 有人提到遇到了總額制在加拿大 就會遇到手術延期那我們國內也會產生這個情況那最近有提到說 會不會排擠兒科病人因為譬如說 因為分科嘛 我醫院總額了我可能就拿兒科開刀 限制悶診人數轉給其他的成人兒科別醫院的經營者會不會這樣做\n醫院總和制會不會這樣做我們這個有一些剛性需求我們要保護的是的 所以要趕快的會不會造成非緊急手術被延後或者排擠到類似像比較冷門的科 額科的門診的這些解決方案有沒有開始在實施考量如果這樣的個別總和可以讓我們的分級醫療做得更好我支持那他們可以更有時間來開刀\n是這樣子好那你們要把這些短過渡時期的這些這些泳射這些負面現象要趕快盤點出來好不好好的往下站好那我們來看一下上游政策下游對策你醫院的個別總和制之後你看我們怎樣中小型醫院跟診所他就等一下他少收住院病患也少收門診大家就跑到大醫院會不會這樣子因為大醫院不能拒收嘛所以台灣台中籠統就變成被擠爆嘛是不是這樣子\n所以這個過渡時期的現象還發生在哪裡還往那看發生在我之前也在那天在財政委員會跟你問過了會這樣急診爆量可能會被斷頭醫院會被斷頭現場醫護呢待遇提升慢但是呢負荷量增加很快馬上產生離職離職之後就惡性循環部長上週我不是問過你這個問題\n是不是有問過這個問題是所以我們在遇到一個要往理想制度過渡的過程當中會遇到哪些過渡的現象我們同時要因應解方這個問題你說你打算怎麼解了你上次已經回答過了我就不再細問往下看所以我們來想一下我們來看一下我屏東個別的情況屏東農總希望未來成為準一中是不是這樣他這有宣布嘛院長支不支持屏東農總往準一中去邁進他定在一一八年\n院長知不知此地方屏東目前沒有醫學中心喔不是每個縣市都有醫學中心那我們很感恩我們有個屏東農總他也立志要成為準醫中您知不知此\n我想如果屏東農總評估他們當地的醫療需求需要發展成準醫學中心那當然是我們會樂觀其成好 但是上週公布了最賠錢的醫院有沒有包括屏東農總有 屏東農總跟他的農全分院前五名屏東佔了兩名我們有沒有很光榮啊\n這個是凸顯出一個我們醫療資源在都跟非都分布不均的情況這個不能規則於任何單一個人 單一機關 制度要想辦法去改變我希望我們努力去改變 但是另外一個問題往下看現在是這樣 現在我們的醫院總和智慧造成什麼呢假設我一個家庭 有牢 有小 有幼 有壯\n主持加計程被要求每年的伙食費只能增加4%所以就分配去了每個成員的伙食費都只能每年增加4%\n你問問看這個正在長大的他每年需要的伙食會難道只能成長4%嗎這些已經不再長大的還需要成長4%嗎你了解我的意思沒有了解所以在我們的地區的總和字你用個別醫院去算的時候要考慮到每個醫院的發展階段現在屏東農在什麼階段往上看屏東農在幼兒階段\n如果這整個高平地區的總額固定成長4%你只給屏東農種按照去年的門診量診療量來增加4%他才剛開啊他每一年要成長的幅度是很大的如果只能幹到前一年成長4%你覺得他活著養得活嗎部長你怎麼看\n剛剛您報的數據是這樣子是他的剛開的醫院遮臼力會比較快比較大所以變成會感覺上看起來比較虧損很多但是他的現金收入是一直是有增加的但是也受到你們區域總額的影響的分配所以你們不會說每個院都齊頭式的分配你們會按照每個醫院的發展狀況給是不是這樣\n我們署長點頭了嗎你要不要讓署長講一下特別的考量跟委員報告 當然在這個區域的總和下高頻的表現是很好他們的點值是趨近1.1塊錢那當然這個有些醫院它的成長會比較高於這個整體的區域成長那我們會實質上去看看它成長的情形然後後面再做一些適度的調整這樣所以目前我們屏東龍又要這個情況它要做的很多事\n但是他按照什麼 他是按照去年的同期的量能為基準點如果按照醫院個別總和制 他又不能拒收看的越多 住的越多 虧越多 是不是這樣 這是惡性循環部長可以救嗎 有沒有辦法改 有沒有辦法解決我們再找院長來討論一下 看看他整個是善意的找他來討論 不是找他說為什麼中原幫你講話是不是這樣 OK好南區實施健保個別醫院的總和三年多 屏東龍總去年虧了快1.66億\n怎麼樣朝準一中怎麼辦為了避免屏東病患如果屏東龍口不能成為準一中跑到高雄讓高雄的一中更嚴重這不是我們所熱見的所以我們希望部長可以承諾在未來我們推動醫院總和的制度之下考慮到在區域內的不同醫院的不同發展階段的不同定位給予一些不同的一些安排好不好好 那月主再看我趕快下來把他結束掉 往下看\n好那接下來最後一個問題就是說現在呢我們地方的醫院跟我們公共部門的衛生所以前我在當副縣長的時候我們有33個衛生所我們的護理人員還包括校護我們要做什麼要不要做預防保健是衛生所要不要做宣導當然要有的衛生所有群醫他要做醫療是有的要打預防注射對不對是的醫院是不是也做這些事情是不是醫院也會做這些事情公共部門的衛生所也會做這些事情\n但是經費從哪裡來 有從國健署來的 從衛福部來的 從機關署來的 從地方署來的 還有從健保署來的請問做這些事情上面都有錢進入到給這些單位去申請但是畢竟健保支出的比例對象跟公務預算支出的是不是要區分部長是不是要區分我總不能都拿健保的錢來做預防保健跟宣導吧\n比重啦我不是說完全沒有啦所以現在我們健保總額不夠用醫療院所挨挨救啊他說我要做很多事情啊但是你都從健保署錢去挖啊那公務預算要不要出公務預算要出一些啊\n是不是 署長你同不同意同意講得很大聲 你看這個馬上同意署長當然同意那報告委員其實政府這年來真的是從很多防治預防保健方面的確是付出更多的公務預算對啦 所以我這邊就幫你寫全盲健康保險法它是以醫療服務為主疾病傷害生育事故所以它的健保支出是應該做在這些醫療為主的\n其他的一些事情像傳染病的防治我上週才問過你一次像COVID-19期間我們有特別預算去預註那現在不是COVID-19已經不是那個法定傳染病的最高級了那我們把它降下來公務預算還支不支持要不要支持醫院做這些傳染這些季節性的好發的我們要不要支持用公務預算幫忙你要說要啊那我說我一定幫你忙啊這樣我才有私利的餘地啊\n這個就是我們要依據健保法啦或實際上當相關的法規來制定當然我們希望說相當公衛啦或者不在原來不在健保法裡面的的確是要用公務醫生很好最後一句話結論就來了最後一個結論所以全面檢討全民健康保險基金中預防保健及傳染病防治相關的幾副不符合健康保險法幾副的項目改為公務預認書可不可以\n應該要朝著這個方向來那這兩個標準我就不再重念了可不可以這兩個報告給本席謝謝也謝謝主席的榮騰謝謝兩位謝謝宗嘉賓委員發言接下來請廖偉祥委員發言\n","vtt":"WEBVTT\n\n00:07.881 --> 00:21.449\n好謝謝主席主席在場的委員先進列席政務機關總統官員會長工作夥伴媒體記者女士先生有請我們邱部長請邱部長也請統計處的李處長統計處李處長委員好部長好那今天因為有一個個人資料保護完理委員會的事務組的組長直接請他過來請組長好很快來我們來看今天最新最新的\n\n00:38.860 --> 01:01.752\n史上最大中國四四一比各支不設防全外線還有看到台灣的資料庫他們爆料者說從可以建立所有中國公民的行為社會經濟資料其中TWDB是台灣小款資料庫部長有沒有看到這樣的新聞爆料有今天有大家有討論過有討論過了你們的結論是什麼這跟你們之前有一位前主秘涉及洩密有沒有關係\n\n01:04.557 --> 01:32.485\n有沒有這個可能要再查證喔你們預定多少才會查目前剪掉還在偵辦中目前剪掉偵辦中這個在剪掉偵辦中那這個咧上面今天才爆料的咧有沒有開始啟動了有沒有兩個單位在處理了有沒有去查一查可能是從哪裡出去的這個資料庫不見得是從衛福部不見得是從健保資料庫出去的但是因為前面發生的這個健保資料庫外洩所以我們也很疑惑說現在中國的\n\n01:33.683 --> 01:54.273\n人民他們的各自外洩還包含了包含台灣的資料庫是不是趕快查部長要責任哪個單位你們目前這個檢調在查嘛對不對你們會主動的趕快去看看說這個資料跟他們所說的台灣資料庫有沒有關聯有沒有人可以來處理這檢調應該會調查\n\n01:59.214 --> 02:09.463\n你們自己要趕快去查說現在今天爆料的這個台灣資料庫會不會跟你們之前的電寶資料庫有關聯是不是這樣子我們是不是資訊處這邊了解嗎這個我們可以去協同速發部我們資訊處協同速發部好那麼就拜託部長責成資訊處協同速發部趕快去查一下\n\n02:21.694 --> 02:48.357\n到底這裡面的資料庫是什麼會不會跟你們之前洩出去的健保資料庫有關聯好不好謝謝好那今天呢我們資料庫先問到這來往下看介師今天有關於貧窮線的檢討雖然不是今天的主題但是我看了一下其實呢目前說有女性在擔任低收跟中低收的有三成是單親媽媽按照目前的算法我就不再贅述這個所謂的可自備所得的中位數的六成為最低生活費\n\n02:49.076 --> 03:10.112\n那其中就是低收那麼如果是1.5倍的就是中低收其實呢有很多單親媽媽困在什麼譬如說娘家有一棟房子我常常在處理20年前我在屏東縣的時候我就在處理這個事情了那麼現在民團說貧窮人口目前實際可以符合的只有2%實際上要6%部長你覺得呢我們目前國家的貧窮人口是2%還是6%沒有辦法判斷我們的\n\n03:16.943 --> 03:35.593\n我跟那個委員報告一下所謂的話貧窮人口佔百分之二的話他是已經經過那一種資產的然後百分之六的話呢是主計處公佈的主計處公佈的我們這個收入的是六趴但是取掉你們有資產能力的就只剩兩趴所以這六趴跟兩趴這樣來的好來部長我看一下你知不知道現在我們國家有多少人在繳稅所得稅你有繳吧\n\n03:46.854 --> 04:10.172\n你覺得你是在比較多的那一邊還是比較少的那一邊有繳稅的有繳所得稅的比較多還是沒有繳所得稅的比較多你猜猜看應該我是算一般啦過去我不是說你所得高不高啦我說台灣有人不用繳所得稅的有要繳所得稅的你是屬於要繳所得稅的那一邊你覺得你這邊的人比較多還是比較少要繳所得稅的人比較多\n\n04:13.902 --> 04:24.715\n比較多曾經在108年要繳所得稅的不繳所得稅的超過一半現在大概維持在四成七八左右不繳所得稅的從過去的26.5194年的26年免繳所得稅的比他這麼高這說明什麼\n\n04:30.390 --> 04:51.140\n台灣的所得分配財務分配在惡化所得分配比資產惡化的更快所以為什麼我們查出來所得它是屬於中低收可能低收的有6%但是拿掉資產之後只剩2%我們台灣的所得分配的惡化程度比資產分布的惡化程度更快\n\n04:52.000 --> 05:14.290\n那請問你今天我要維持生活我是靠我的資產而生活還是靠我的所得而生活所得是靠所得嘛所以我才說如果按照目前這個規定算出來目前如果要走主計總數的我們的中低收跟低收的標準的遠高於目前我們核定的標準人數啦就是因為你們把資產算進去之後我們就排除了\n\n05:15.031 --> 05:33.219\n但是就像我說的很多的單親媽媽他沒有辦法靠娘家的移動房子的遺產繼承權他來養孩子啊所以我們的貧窮線造成我們的社會福利的給予啊就有問題往下看所以到底要先推估貧窮人口的比例還先畫定貧窮線先有蛋還是先有雞你們要先推估我們多少貧窮人口再來畫這條貧窮線還是先畫出貧窮線自然貧窮人口的比例又出來是先有蛋還是先有雞\n\n05:43.902 --> 05:56.368\n很難回答對不對按照我們公共機關要依法兩個都要考量說得很好但是目前我們法律的規定寫在條文裡面的你先必須劃出貧窮線的定義然後呢再推出貧窮線的人口但是當你發現這已經跟現實脫離很遠的時候你要不要定期的檢討要不要定期檢討會不會要重新檢討你貧窮線的定義為什麼我們貧窮定義是用什麼是用可自備所得的六成作為\n\n06:14.217 --> 06:34.045\n貧窮線的標準這個有沒有道理有沒有道理寫在法律裡面可不可以改部長可不可以改我們貧窮線的定義可不可以討論可不可以檢討當然可以嘛我們很多社會福利的包括我們現在的調整都有一個根據我們的通膨的指數每四年檢討一次有沒有\n\n06:35.319 --> 06:51.174\n有沒有有嘛對不對所以未來我請你為何不趕快檢討我們貧窮縣的法定定義它的機制要不要訂入一個定期檢討譬如說每四年還是每多少年我們檢討一次每四年檢討一次或者說脫貨膨脹超過4%的時候我們就檢討一次不要讓這個貧窮縣變成造成我們真的貧窮人口陷於絕境部長可以嗎\n\n07:01.367 --> 07:22.688\n往這方面來修法好不好我們立法院我們也會寫出我們的版本但是我們認為過去以來我長期在地方政府遇到的這些想要救救不了的人就是定在我們的貧窮性的定義數十年來如一日啊從我在地方縣政府20年前當副縣長那個一倍1.5倍到現在還是一倍1.5倍資產調查排除哪些限制有做些調整\n\n07:23.729 --> 07:49.557\n像現在我們要求什麼要把資產從500萬提高到700萬類似這樣的問題好趕快我現在問比較重要的問題更重要的問題啦來個別醫院總額制的薪資隱憂有人提到遇到了總額制在加拿大就會遇到手術延期那我們國內也會產生這個情況那最近有提到說會不會排擠兒科病人因為譬如說因為分科嘛我醫院總額了我可能就拿兒科開刀限制悶診人數轉給其他的成人兒科別醫院的經營者會不會這樣做\n\n07:53.832 --> 08:15.974\n醫院總和制會不會這樣做我們這個有一些剛性需求我們要保護的是的所以要趕快的會不會造成非緊急手術被延後或者排擠到類似像比較冷門的科額科的門診的這些解決方案有沒有開始在實施考量如果這樣的個別總和可以讓我們的分級醫療做得更好我支持那他們可以更有時間來開刀\n\n08:17.535 --> 08:42.421\n是這樣子好那你們要把這些短過渡時期的這些這些泳射這些負面現象要趕快盤點出來好不好好的往下站好那我們來看一下上游政策下游對策你醫院的個別總和制之後你看我們怎樣中小型醫院跟診所他就等一下他少收住院病患也少收門診大家就跑到大醫院會不會這樣子因為大醫院不能拒收嘛所以台灣台中籠統就變成被擠爆嘛是不是這樣子\n\n08:43.396 --> 09:00.793\n所以這個過渡時期的現象還發生在哪裡還往那看發生在我之前也在那天在財政委員會跟你問過了會這樣急診爆量可能會被斷頭醫院會被斷頭現場醫護呢待遇提升慢但是呢負荷量增加很快馬上產生離職離職之後就惡性循環部長上週我不是問過你這個問題\n\n09:03.464 --> 09:29.524\n是不是有問過這個問題是所以我們在遇到一個要往理想制度過渡的過程當中會遇到哪些過渡的現象我們同時要因應解方這個問題你說你打算怎麼解了你上次已經回答過了我就不再細問往下看所以我們來想一下我們來看一下我屏東個別的情況屏東農總希望未來成為準一中是不是這樣他這有宣布嘛院長支不支持屏東農總往準一中去邁進他定在一一八年\n\n09:31.889 --> 09:44.592\n院長知不知此地方屏東目前沒有醫學中心喔不是每個縣市都有醫學中心那我們很感恩我們有個屏東農總他也立志要成為準醫中您知不知此\n\n09:46.156 --> 10:05.380\n我想如果屏東農總評估他們當地的醫療需求需要發展成準醫學中心那當然是我們會樂觀其成好但是上週公布了最賠錢的醫院有沒有包括屏東農總有屏東農總跟他的農全分院前五名屏東佔了兩名我們有沒有很光榮啊\n\n10:06.807 --> 10:28.748\n這個是凸顯出一個我們醫療資源在都跟非都分布不均的情況這個不能規則於任何單一個人單一機關制度要想辦法去改變我希望我們努力去改變但是另外一個問題往下看現在是這樣現在我們的醫院總和智慧造成什麼呢假設我一個家庭有牢有小有幼有壯\n\n10:30.339 --> 10:38.756\n主持加計程被要求每年的伙食費只能增加4%所以就分配去了每個成員的伙食費都只能每年增加4%\n\n10:40.151 --> 10:59.620\n你問問看這個正在長大的他每年需要的伙食會難道只能成長4%嗎這些已經不再長大的還需要成長4%嗎你了解我的意思沒有了解所以在我們的地區的總和字你用個別醫院去算的時候要考慮到每個醫院的發展階段現在屏東農在什麼階段往上看屏東農在幼兒階段\n\n11:01.195 --> 11:06.780\n如果這整個高平地區的總額固定成長4%你只給屏東農種按照去年的門診量診療量來增加4%他才剛開啊他每一年要成長的幅度是很大的如果只能幹到前一年成長4%你覺得他活著養得活嗎部長你怎麼看\n\n11:21.101 --> 11:44.607\n剛剛您報的數據是這樣子是他的剛開的醫院遮臼力會比較快比較大所以變成會感覺上看起來比較虧損很多但是他的現金收入是一直是有增加的但是也受到你們區域總額的影響的分配所以你們不會說每個院都齊頭式的分配你們會按照每個醫院的發展狀況給是不是這樣\n\n11:45.647 --> 12:14.749\n我們署長點頭了嗎你要不要讓署長講一下特別的考量跟委員報告當然在這個區域的總和下高頻的表現是很好他們的點值是趨近1.1塊錢那當然這個有些醫院它的成長會比較高於這個整體的區域成長那我們會實質上去看看它成長的情形然後後面再做一些適度的調整這樣所以目前我們屏東龍又要這個情況它要做的很多事\n\n12:15.429 --> 12:40.306\n但是他按照什麼他是按照去年的同期的量能為基準點如果按照醫院個別總和制他又不能拒收看的越多住的越多虧越多是不是這樣這是惡性循環部長可以救嗎有沒有辦法改有沒有辦法解決我們再找院長來討論一下看看他整個是善意的找他來討論不是找他說為什麼中原幫你講話是不是這樣OK好南區實施健保個別醫院的總和三年多屏東龍總去年虧了快1.66億\n\n12:41.857 --> 13:05.559\n怎麼樣朝準一中怎麼辦為了避免屏東病患如果屏東龍口不能成為準一中跑到高雄讓高雄的一中更嚴重這不是我們所熱見的所以我們希望部長可以承諾在未來我們推動醫院總和的制度之下考慮到在區域內的不同醫院的不同發展階段的不同定位給予一些不同的一些安排好不好好那月主再看我趕快下來把他結束掉往下看\n\n13:05.979 --> 13:28.106\n好那接下來最後一個問題就是說現在呢我們地方的醫院跟我們公共部門的衛生所以前我在當副縣長的時候我們有33個衛生所我們的護理人員還包括校護我們要做什麼要不要做預防保健是衛生所要不要做宣導當然要有的衛生所有群醫他要做醫療是有的要打預防注射對不對是的醫院是不是也做這些事情是不是醫院也會做這些事情公共部門的衛生所也會做這些事情\n\n13:34.008 --> 13:50.114\n但是經費從哪裡來有從國健署來的從衛福部來的從機關署來的從地方署來的還有從健保署來的請問做這些事情上面都有錢進入到給這些單位去申請但是畢竟健保支出的比例對象跟公務預算支出的是不是要區分部長是不是要區分我總不能都拿健保的錢來做預防保健跟宣導吧\n\n13:57.455 --> 14:11.075\n比重啦我不是說完全沒有啦所以現在我們健保總額不夠用醫療院所挨挨救啊他說我要做很多事情啊但是你都從健保署錢去挖啊那公務預算要不要出公務預算要出一些啊\n\n14:11.963 --> 14:40.269\n是不是署長你同不同意同意講得很大聲你看這個馬上同意署長當然同意那報告委員其實政府這年來真的是從很多防治預防保健方面的確是付出更多的公務預算對啦所以我這邊就幫你寫全盲健康保險法它是以醫療服務為主疾病傷害生育事故所以它的健保支出是應該做在這些醫療為主的\n\n14:41.429 --> 15:07.039\n其他的一些事情像傳染病的防治我上週才問過你一次像COVID-19期間我們有特別預算去預註那現在不是COVID-19已經不是那個法定傳染病的最高級了那我們把它降下來公務預算還支不支持要不要支持醫院做這些傳染這些季節性的好發的我們要不要支持用公務預算幫忙你要說要啊那我說我一定幫你忙啊這樣我才有私利的餘地啊\n\n15:09.675 --> 15:34.714\n這個就是我們要依據健保法啦或實際上當相關的法規來制定當然我們希望說相當公衛啦或者不在原來不在健保法裡面的的確是要用公務醫生很好最後一句話結論就來了最後一個結論所以全面檢討全民健康保險基金中預防保健及傳染病防治相關的幾副不符合健康保險法幾副的項目改為公務預認書可不可以\n\n15:36.022 --> 15:48.014\n應該要朝著這個方向來那這兩個標準我就不再重念了可不可以這兩個報告給本席謝謝也謝謝主席的榮騰謝謝兩位謝謝宗嘉賓委員發言接下來請廖偉祥委員發言\n\n","segments":[{"start":7.881,"end":21.449,"text":"好 謝謝主席 主席在場的委員先進列席政務機關總統 官員 會長 工作夥伴 媒體 記者 女士先生有請我們邱部長請邱部長也請統計處的李處長統計處李處長委員好部長好 那今天因為有一個個人資料保護完理委員會的事務組的組長直接請他過來請組長好 很快 來我們來看今天最新最新的"},{"start":38.86,"end":61.752,"text":"史上最大中國四四一比各支不設防全外線還有看到台灣的資料庫他們爆料者說從可以建立所有中國公民的行為社會經濟資料其中TWDB是台灣小款資料庫部長有沒有看到這樣的新聞爆料有今天有大家有討論過有討論過了你們的結論是什麼這跟你們之前有一位前主秘涉及洩密有沒有關係"},{"start":64.557,"end":92.485,"text":"有沒有 這個可能要再查證喔你們預定多少才會查目前剪掉還在偵辦中目前剪掉偵辦中 這個在剪掉偵辦中那這個咧上面今天才爆料的咧有沒有開始啟動了有沒有兩個單位在處理了有沒有去查一查可能是從哪裡出去的這個資料庫不見得是從衛福部不見得是從健保資料庫出去的但是因為前面發生的這個健保資料庫外洩所以我們也很疑惑說現在中國的"},{"start":93.683,"end":114.273,"text":"人民他們的各自外洩還包含了包含台灣的資料庫是不是趕快查部長要責任哪個單位你們目前這個檢調在查嘛對不對你們會主動的趕快去看看說這個資料跟他們所說的台灣資料庫有沒有關聯有沒有人可以來處理這檢調應該會調查"},{"start":119.214,"end":129.463,"text":"你們自己要趕快去查說現在今天爆料的這個台灣資料庫會不會跟你們之前的電寶資料庫有關聯是不是這樣子我們是不是資訊處這邊了解嗎這個我們可以去協同速發部我們資訊處協同速發部好 那麼就拜託部長責成資訊處協同速發部趕快去查一下"},{"start":141.694,"end":168.357,"text":"到底這裡面的資料庫是什麼會不會跟你們之前洩出去的健保資料庫有關聯好不好謝謝好那今天呢我們資料庫先問到這來往下看介師今天有關於貧窮線的檢討雖然不是今天的主題但是我看了一下其實呢目前說有女性在擔任低收跟中低收的有三成是單親媽媽按照目前的算法我就不再贅述這個所謂的可自備所得的中位數的六成為最低生活費"},{"start":169.076,"end":190.112,"text":"那其中就是低收那麼如果是1.5倍的就是中低收其實呢有很多單親媽媽困在什麼譬如說娘家有一棟房子我常常在處理20年前我在屏東縣的時候我就在處理這個事情了那麼現在民團說貧窮人口目前實際可以符合的只有2%實際上要6% 部長你覺得呢我們目前國家的貧窮人口是2%還是6%沒有辦法判斷我們的"},{"start":196.943,"end":215.593,"text":"我跟那個委員報告一下所謂的話貧窮人口佔百分之二的話他是已經經過那一種資產的然後百分之六的話呢是主計處公佈的主計處公佈的我們這個收入的是六趴但是取掉你們有資產能力的就只剩兩趴所以這六趴跟兩趴這樣來的好來部長我看一下你知不知道現在我們國家有多少人在繳稅所得稅你有繳吧"},{"start":226.854,"end":250.172,"text":"你覺得你是在比較多的那一邊還是比較少的那一邊有繳稅的有繳所得稅的比較多還是沒有繳所得稅的比較多你猜猜看應該我是算一般啦過去我不是說你所得高不高啦我說台灣有人不用繳所得稅的有要繳所得稅的你是屬於要繳所得稅的那一邊你覺得你這邊的人比較多還是比較少要繳所得稅的人比較多"},{"start":253.902,"end":264.715,"text":"比較多曾經在108年要繳所得稅的不繳所得稅的超過一半現在大概維持在四成七八左右不繳所得稅的從過去的26.51 94年的26年免繳所得稅的比他這麼高這說明什麼"},{"start":270.39,"end":291.14,"text":"台灣的所得分配 財務分配在惡化所得分配比資產惡化的更快所以為什麼我們查出來所得它是屬於中低收可能低收的有6%但是拿掉資產之後只剩2%我們台灣的所得分配的惡化程度比資產分布的惡化程度更快"},{"start":292,"end":314.29,"text":"那請問你今天我要維持生活我是靠我的資產而生活還是靠我的所得而生活所得是靠所得嘛所以我才說如果按照目前這個規定算出來目前如果要走主計總數的我們的中低收跟低收的標準的遠高於目前我們核定的標準人數啦就是因為你們把資產算進去之後我們就排除了"},{"start":315.031,"end":333.219,"text":"但是就像我說的很多的單親媽媽他沒有辦法靠娘家的移動房子的遺產繼承權他來養孩子啊所以我們的貧窮線造成我們的社會福利的給予啊就有問題往下看所以到底要先推估貧窮人口的比例還先畫定貧窮線先有蛋還是先有雞你們要先推估我們多少貧窮人口再來畫這條貧窮線還是先畫出貧窮線自然貧窮人口的比例又出來是先有蛋還是先有雞"},{"start":343.902,"end":356.368,"text":"很難回答對不對按照我們公共機關要依法兩個都要考量說得很好但是目前我們法律的規定寫在條文裡面的你先必須劃出貧窮線的定義然後呢再推出貧窮線的人口但是當你發現這已經跟現實脫離很遠的時候你要不要定期的檢討要不要定期檢討會不會要重新檢討你貧窮線的定義為什麼我們貧窮定義是用什麼是用可自備所得的六成作為"},{"start":374.217,"end":394.045,"text":"貧窮線的標準這個有沒有道理有沒有道理寫在法律裡面可不可以改部長可不可以改我們貧窮線的定義可不可以討論可不可以檢討當然可以嘛我們很多社會福利的包括我們現在的調整都有一個根據我們的通膨的指數每四年檢討一次有沒有"},{"start":395.319,"end":411.174,"text":"有沒有 有嘛 對不對所以未來我請你為何不趕快檢討我們貧窮縣的法定定義它的機制要不要訂入一個定期檢討譬如說每四年還是每多少年我們檢討一次每四年檢討一次或者說脫貨膨脹超過4%的時候我們就檢討一次不要讓這個貧窮縣變成造成我們真的貧窮人口陷於絕境部長可以嗎"},{"start":421.367,"end":442.688,"text":"往這方面來修法好不好我們立法院我們也會寫出我們的版本但是我們認為過去以來我長期在地方政府遇到的這些想要救救不了的人就是定在我們的貧窮性的定義數十年來如一日啊從我在地方縣政府20年前當副縣長那個一倍1.5倍到現在還是一倍1.5倍資產調查排除哪些限制有做些調整"},{"start":443.729,"end":469.557,"text":"像現在我們要求什麼 要把資產從500萬提高到700萬 類似這樣的問題好 趕快我現在問比較重要的問題 更重要的問題啦 來個別醫院總額制的薪資隱憂 有人提到遇到了總額制在加拿大 就會遇到手術延期那我們國內也會產生這個情況那最近有提到說 會不會排擠兒科病人因為譬如說 因為分科嘛 我醫院總額了我可能就拿兒科開刀 限制悶診人數轉給其他的成人兒科別醫院的經營者會不會這樣做"},{"start":473.832,"end":495.974,"text":"醫院總和制會不會這樣做我們這個有一些剛性需求我們要保護的是的 所以要趕快的會不會造成非緊急手術被延後或者排擠到類似像比較冷門的科 額科的門診的這些解決方案有沒有開始在實施考量如果這樣的個別總和可以讓我們的分級醫療做得更好我支持那他們可以更有時間來開刀"},{"start":497.535,"end":522.421,"text":"是這樣子好那你們要把這些短過渡時期的這些這些泳射這些負面現象要趕快盤點出來好不好好的往下站好那我們來看一下上游政策下游對策你醫院的個別總和制之後你看我們怎樣中小型醫院跟診所他就等一下他少收住院病患也少收門診大家就跑到大醫院會不會這樣子因為大醫院不能拒收嘛所以台灣台中籠統就變成被擠爆嘛是不是這樣子"},{"start":523.396,"end":540.793,"text":"所以這個過渡時期的現象還發生在哪裡還往那看發生在我之前也在那天在財政委員會跟你問過了會這樣急診爆量可能會被斷頭醫院會被斷頭現場醫護呢待遇提升慢但是呢負荷量增加很快馬上產生離職離職之後就惡性循環部長上週我不是問過你這個問題"},{"start":543.464,"end":569.524,"text":"是不是有問過這個問題是所以我們在遇到一個要往理想制度過渡的過程當中會遇到哪些過渡的現象我們同時要因應解方這個問題你說你打算怎麼解了你上次已經回答過了我就不再細問往下看所以我們來想一下我們來看一下我屏東個別的情況屏東農總希望未來成為準一中是不是這樣他這有宣布嘛院長支不支持屏東農總往準一中去邁進他定在一一八年"},{"start":571.889,"end":584.592,"text":"院長知不知此地方屏東目前沒有醫學中心喔不是每個縣市都有醫學中心那我們很感恩我們有個屏東農總他也立志要成為準醫中您知不知此"},{"start":586.156,"end":605.38,"text":"我想如果屏東農總評估他們當地的醫療需求需要發展成準醫學中心那當然是我們會樂觀其成好 但是上週公布了最賠錢的醫院有沒有包括屏東農總有 屏東農總跟他的農全分院前五名屏東佔了兩名我們有沒有很光榮啊"},{"start":606.807,"end":628.748,"text":"這個是凸顯出一個我們醫療資源在都跟非都分布不均的情況這個不能規則於任何單一個人 單一機關 制度要想辦法去改變我希望我們努力去改變 但是另外一個問題往下看現在是這樣 現在我們的醫院總和智慧造成什麼呢假設我一個家庭 有牢 有小 有幼 有壯"},{"start":630.339,"end":638.756,"text":"主持加計程被要求每年的伙食費只能增加4%所以就分配去了每個成員的伙食費都只能每年增加4%"},{"start":640.151,"end":659.62,"text":"你問問看這個正在長大的他每年需要的伙食會難道只能成長4%嗎這些已經不再長大的還需要成長4%嗎你了解我的意思沒有了解所以在我們的地區的總和字你用個別醫院去算的時候要考慮到每個醫院的發展階段現在屏東農在什麼階段往上看屏東農在幼兒階段"},{"start":661.195,"end":666.78,"text":"如果這整個高平地區的總額固定成長4%你只給屏東農種按照去年的門診量診療量來增加4%他才剛開啊他每一年要成長的幅度是很大的如果只能幹到前一年成長4%你覺得他活著養得活嗎部長你怎麼看"},{"start":681.101,"end":704.607,"text":"剛剛您報的數據是這樣子是他的剛開的醫院遮臼力會比較快比較大所以變成會感覺上看起來比較虧損很多但是他的現金收入是一直是有增加的但是也受到你們區域總額的影響的分配所以你們不會說每個院都齊頭式的分配你們會按照每個醫院的發展狀況給是不是這樣"},{"start":705.647,"end":734.749,"text":"我們署長點頭了嗎你要不要讓署長講一下特別的考量跟委員報告 當然在這個區域的總和下高頻的表現是很好他們的點值是趨近1.1塊錢那當然這個有些醫院它的成長會比較高於這個整體的區域成長那我們會實質上去看看它成長的情形然後後面再做一些適度的調整這樣所以目前我們屏東龍又要這個情況它要做的很多事"},{"start":735.429,"end":760.306,"text":"但是他按照什麼 他是按照去年的同期的量能為基準點如果按照醫院個別總和制 他又不能拒收看的越多 住的越多 虧越多 是不是這樣 這是惡性循環部長可以救嗎 有沒有辦法改 有沒有辦法解決我們再找院長來討論一下 看看他整個是善意的找他來討論 不是找他說為什麼中原幫你講話是不是這樣 OK好南區實施健保個別醫院的總和三年多 屏東龍總去年虧了快1.66億"},{"start":761.857,"end":785.559,"text":"怎麼樣朝準一中怎麼辦為了避免屏東病患如果屏東龍口不能成為準一中跑到高雄讓高雄的一中更嚴重這不是我們所熱見的所以我們希望部長可以承諾在未來我們推動醫院總和的制度之下考慮到在區域內的不同醫院的不同發展階段的不同定位給予一些不同的一些安排好不好好 那月主再看我趕快下來把他結束掉 往下看"},{"start":785.979,"end":808.106,"text":"好那接下來最後一個問題就是說現在呢我們地方的醫院跟我們公共部門的衛生所以前我在當副縣長的時候我們有33個衛生所我們的護理人員還包括校護我們要做什麼要不要做預防保健是衛生所要不要做宣導當然要有的衛生所有群醫他要做醫療是有的要打預防注射對不對是的醫院是不是也做這些事情是不是醫院也會做這些事情公共部門的衛生所也會做這些事情"},{"start":814.008,"end":830.114,"text":"但是經費從哪裡來 有從國健署來的 從衛福部來的 從機關署來的 從地方署來的 還有從健保署來的請問做這些事情上面都有錢進入到給這些單位去申請但是畢竟健保支出的比例對象跟公務預算支出的是不是要區分部長是不是要區分我總不能都拿健保的錢來做預防保健跟宣導吧"},{"start":837.455,"end":851.075,"text":"比重啦我不是說完全沒有啦所以現在我們健保總額不夠用醫療院所挨挨救啊他說我要做很多事情啊但是你都從健保署錢去挖啊那公務預算要不要出公務預算要出一些啊"},{"start":851.963,"end":880.269,"text":"是不是 署長你同不同意同意講得很大聲 你看這個馬上同意署長當然同意那報告委員其實政府這年來真的是從很多防治預防保健方面的確是付出更多的公務預算對啦 所以我這邊就幫你寫全盲健康保險法它是以醫療服務為主疾病傷害生育事故所以它的健保支出是應該做在這些醫療為主的"},{"start":881.429,"end":907.039,"text":"其他的一些事情像傳染病的防治我上週才問過你一次像COVID-19期間我們有特別預算去預註那現在不是COVID-19已經不是那個法定傳染病的最高級了那我們把它降下來公務預算還支不支持要不要支持醫院做這些傳染這些季節性的好發的我們要不要支持用公務預算幫忙你要說要啊那我說我一定幫你忙啊這樣我才有私利的餘地啊"},{"start":909.675,"end":934.714,"text":"這個就是我們要依據健保法啦或實際上當相關的法規來制定當然我們希望說相當公衛啦或者不在原來不在健保法裡面的的確是要用公務醫生很好最後一句話結論就來了最後一個結論所以全面檢討全民健康保險基金中預防保健及傳染病防治相關的幾副不符合健康保險法幾副的項目改為公務預認書可不可以"},{"start":936.022,"end":948.014,"text":"應該要朝著這個方向來那這兩個標準我就不再重念了可不可以這兩個報告給本席謝謝也謝謝主席的榮騰謝謝兩位謝謝宗嘉賓委員發言接下來請廖偉祥委員發言"}]}}},"gazette":{"lineno":724,"blocks":[["鍾委員佳濱：（12時1分）好，謝謝主席。主席、在場的委員先進、列席的政府機關首長、官員、會場工作夥伴、媒體記者女士、先生。有請邱部長。"],["主席：請邱部長。"],["鍾委員佳濱：也請統計處李處長。"],["主席：統計處李處長。"],["邱部長泰源：委員好。"],["鍾委員佳濱：部長好。今天還有個人資料保護管理委員會事務組組長，直接請他過來。","很快我們馬上來看今天最新最新的，「史上最大！中國40億筆個資不設防全外洩」還有看到臺灣的資料庫，爆料者說幾乎可以建立所有中國公民的行為、經濟和社會資料，其中「tw_db」是臺灣相關的資料庫。部長，有沒有看到這樣的新聞爆料？"],["邱部長泰源：有，今天大家有討論過了。"],["鍾委員佳濱：討論過了，你們的結論是什麼？這跟你們之前有一位前主秘涉及洩密有沒有關係？"],["邱部長泰源：這個可能要再查證。"],["鍾委員佳濱：你們預定多久會查？"],["邱部長泰源：目前檢調還在偵辦中。"],["鍾委員佳濱：檢調偵辦中，那有關上面今天才爆料的呢？有沒有開始啟動了？有沒有哪個單位在處理了？有沒有去查一查可能是從哪裡出去的？這個資料庫不見得是從衛福部、不見得是從健保資料庫出去的，但是因為前面發生健保資料庫外洩，所以我們也很疑惑現在中國人民的個資外洩，還包含了臺灣的資料庫，是不是要趕快查？部長，要責成哪個單位？你們目前是檢調在查嘛！對不對？你們是不是主動趕快去看看這個資料跟他們所說的臺灣資料庫有沒有關聯？有沒有人可以來處理？"],["邱部長泰源：這檢調應該會調查。"],["鍾委員佳濱：你們自己要趕快去查今天爆料的臺灣資料庫會不會跟你們之前的健保資料庫有關聯？是不是這樣子？"],["邱部長泰源：我們是不是請資訊處這邊瞭解？"],["李處長建璋：這個我們可以去協調數發部……"],["邱部長泰源：我們資訊處協同數發部。"],["鍾委員佳濱：好，那麼就拜託部長責成資訊處協同數發部趕快去查一下，到底這裡面的資料庫是什麼？會不會跟你們之前洩出去的健保資料庫有關聯？好不好？"],["邱部長泰源：好。"],["鍾委員佳濱：謝謝。今天的資料庫我們先問到這。","再來，是有關於貧窮線的檢討，雖然不是今天的主題，但是我看了一下，目前由女性擔任低收跟中低收家計負責人有三成是單親媽媽，按照目前的算法，我就不再贅述，所謂可支配所得的中位數六成為最低生活費，其中低於的就是低收，如果為1.5倍的就是中低收，其實有很多單親媽媽困在什麼？譬如娘家一棟房子，我常常在處理，20年前我在屏東縣政府時就在處理這個事情了。現在民團說貧窮人口實際符合的只有2%，實際上是6%，部長，你覺得呢？我們目前國家的貧窮人口是2%還是6%？沒有辦法判斷？"],["李處長秋嬿：我跟委員報告一下，所謂貧窮人口占百分之二的話，它是已經經過去掉資產的，然後百分之六的話是主計處公布的。"],["鍾委員佳濱：主計處公布的，符合這個收入的是6%。"],["李處長秋嬿：對，可是去掉那些……"],["鍾委員佳濱：可是去掉那些有資產能力的就只剩2%。"],["李處長秋嬿：是。"],["鍾委員佳濱：所以這6%跟2%這樣來的。部長，我繼續講，你知不知道現在我們國家有多少人在繳所得稅？你有繳吧？"],["邱部長泰源：當然有。"],["鍾委員佳濱：你覺得你是在比較多的那一邊，還是比較少的那一邊？有繳所得稅的比較多，還是沒有繳所得稅的比較多？你猜猜看。"],["邱部長泰源：應該我是算……一般過去……"],["鍾委員佳濱：我不是說你所得高不高，我說臺灣有人不用繳所得稅的，有要繳所得稅的，你是屬於要繳所得那一邊，你覺得你這邊的人比較多，還是比較少？"],["邱部長泰源：要繳所得稅的人比較多。"],["鍾委員佳濱：曾經在108年不繳所得稅的超過一半，現在大概維持在四成七、八左右，就是不繳所得稅的。從過去94年免繳所得稅的比例為26.51%，現在拉到這麼高，這說明什麼？臺灣的所得分配、財務分配在惡化，所得分配比資產惡化得更快，所以為什麼我們查出來他的所得是屬於中低收，可能低收的有6%，但是拿掉資產之後只剩2%，我們臺灣的所得分配惡化程度比資產分布的惡化程度更快。請問今天我要維持生活是靠我的資產而生活，還是靠我的所得而生活？"],["邱部長泰源：所得。"],["鍾委員佳濱：是靠所得嘛！所以我才說，如果按照目前這個規定算出來，如果要依主計總處中低收和低收的標準，遠高於目前我們核定的標準，人數啦！就是因為你們把資產算進去之後，我們就排除了，但是就像我說的，很多的單親媽媽沒有辦法靠娘家一棟房子的遺產繼承權來養孩子，所以我們的貧窮線造成社會福利的給予就有問題。","所以到底要先推估貧窮人口的比例，還是先畫定貧窮線？先有蛋，還是先有雞？你們要先推估有多少貧窮人口，再來畫這條貧窮線，還是先畫出貧窮線，貧窮人口的比例自然就出來？是先有蛋，還是先有雞？很難回答，對不對？按照我們公務機關要依法……"],["邱部長泰源：兩個都要考量。"],["鍾委員佳濱：兩個都要考量，說得很好，但是目前我們法律的規定是寫在條文裡面的，你必須先畫出貧窮線的定義，然後再推出貧窮線的人口，但是當你發現這已經跟現實脫離很遠的時候，你要不要定期檢討？會不會重新檢討貧窮線的定義？為什麼我們貧窮線的定義是用可支配所得的六成作為貧窮線的標準？這個有沒有道理？寫在法律裡面可不可以改？部長，可不可以改？我們貧窮線的定義可不可以討論？可不可以檢討？"],["邱部長泰源：當然都可以……"],["鍾委員佳濱：當然可以嘛！我們很多社會福利包括薪資的調整都有根據通膨的指數每4年檢討一次，有沒有？有嘛！對不對？所以未來我請衛福部趕快檢討貧窮線的法定定義及它的機制要不要定一個定期檢討？比如每4年還是每多少年檢討一次，或者通貨膨脹超過4%的時候，我們就檢討一次，不要讓這個貧窮線造成真正的貧窮人口陷於絕境，部長可以嗎？往這方面來修法，好不好？"],["邱部長泰源：可以、可以……"],["鍾委員佳濱：立法院也會提出我們的版本。"],["邱部長泰源：好的。"],["鍾委員佳濱：但是我們認為，過去以來我長期在地方政府遇到這些想要救卻救不了的人，就是因為我們貧窮線的定義數十年來如一日，從我在地方縣政府20年前當副縣長當時的1倍、1.5倍，到現在還是1倍、1.5倍，資產調查排除哪些限制有做一些調整，縣政府還要求什麼？要把資產從500萬提高到700萬，類似這樣的問題！","趕快，我現在要問比較重要的問題，也是更重要的問題──個別醫院總額制的新制隱憂。有人提到，總額制在加拿大就遇到手術被延期，我們國內也會產生這個情況。最近有提到會不會排擠兒科病人？譬如因為分科，醫院總額可能就拿兒科開刀，限制門診人數，轉給其他成人科別，醫院的經營者會不會這樣做？醫院總額制會不會這樣做？"],["邱部長泰源：這個有一些剛性需求，我們要保護的。"],["鍾委員佳濱：是的，所以要趕快，會不會造成非緊急手術被延後或者排擠到類似兒科這種比較冷門門診的解決方案有沒有開始在考量？"],["邱部長泰源：如果這樣的個別總額可以讓我們的分級醫療做得更好……"],["鍾委員佳濱：我支持！"],["邱部長泰源：讓他們可以更有時間開刀……"],["鍾委員佳濱：是這樣子？好，那你們要把過渡時期的這些壅塞及負面現象趕快盤點出來，好不好？"],["邱部長泰源：好的。"],["鍾委員佳濱：我們來看上有政策下有對策的狀況，在實施個別醫院總額制之後，中小型醫院和診所少收住院病患也少收門診，大家就跑到大醫院，會不會這樣子？因為大醫院不能拒收，所以臺中榮總就變成被擠爆，是不是這樣子？像這種過渡時期的現象還發生在哪裡？那天在財政委員會我也問過你，急診爆量、醫院可能會被斷頭，現場醫護待遇提升慢，但是負荷量增加很快，因此馬上產生離職，離職之後就惡性循環。部長，上週我是不是問過你這個問題？"],["邱部長泰源：是。"],["鍾委員佳濱：所以我們要往理想制度過渡的過程當中，會遇到哪些過渡的現象，我們同時要有因應的解方。這個問題你打算怎麼解，你上次已經回答過了，所以我就不再細問。我們來看一下屏東個別的情況，屏東榮總希望未來成為準醫中，是不是這樣？它有這樣宣布嘛，請問部長支不支持？屏東榮總往準醫中邁進訂在118年，請問部長支不支持？屏東目前沒有醫學中心，並不是每個縣市都有醫學中心，很感恩我們有個屏東榮總，它也立志要成為準醫中，您支不支持？"],["邱部長泰源：我想如果屏東榮總評估當地的醫療需求需要發展成準醫學中心，我們當然會樂觀其成。"],["鍾委員佳濱：但是上週公布最賠錢的醫院有沒有包括屏東榮總？有！屏東榮總跟它的龍泉分院，前五名屏東占了兩名，我們有沒有很光榮？這凸顯出醫療資源在都和非都分布不均的情況，這不能歸責於任何單一個人或單一機關，制度要想辦法去改變，我希望我們努力去改變。但是遇到一個問題，現在我們的醫院總額制會造成什麼呢？假設一個家庭有老有小、有幼有壯，主持家計的人被要求每年的伙食費只能增加4%，所以就分配每個成員的伙食費都是每年只能增加4%，你問問看正在長大的，他每年需要的伙食費難道只能成長4%嗎？這些已經不再長大的還需要成長4%嗎？你了解我的意思沒有？"],["邱部長泰源：了解。"],["鍾委員佳濱：所以在我們地區的總額制，你用個別醫院去算的時候，要考慮到每個醫院的發展階段，現在屏東榮總在什麼階段？屏東榮總在幼兒階段，如果整個高屏地區的總額固定成長4%，你只給屏東榮總按照去年的門診量、診療量增加4%，它才剛開啊！它每一年要成長的幅度是很大的，如果只能按照前一年成長4%，你覺得它養得活嗎？部長你怎麼看？"],["邱部長泰源：關於您剛剛提到的數據，剛開的醫院折舊率會比較快、比較大，所以感覺上看起來比較明顯……"],["鍾委員佳濱：虧損很多。"],["邱部長泰源：對，虧損，但是它的現金收入是有增加的。"],["鍾委員佳濱：是，但是也受到你們區域總額分配的影響嘛！所以你們不會每個醫院都齊頭式的分配，而是按照每個醫院的發展狀況給，是不是這樣？我看到署長點頭了。"],["邱部長泰源：新的醫院有特別的考量。"],["鍾委員佳濱：要不要讓署長講一下？"],["石署長崇良：跟委員報告，在區域的總額下，高屏的表現很好，他們的點值是趨近於一點一塊錢，當然有一些醫院的成長會高於整體的區域成長，我們會實質上去看看它成長的情形，然後再做一些適度的調整。"],["鍾委員佳濱：目前屏東榮總遇到這個情況，它要做很多事，如果按照醫院個別總額制，以去年同期的量能為基準點，它又不能拒收，看診越多、住院越多就虧越多，是不是這樣？這是惡性循環，部長可以救嗎？有沒有辦法改？有沒有辦法解決？"],["石署長崇良：我們再找院長來討論一下，看看它整個醫院的……"],["鍾委員佳濱：是善意的找他來討論，而不是找他來說為什麼鍾委員幫你講話？是不是這樣？"],["石署長崇良：對。"],["鍾委員佳濱：南區實施健保個別醫院總額三年多，屏東榮總去年虧了將近1.66億，怎麼樣朝準醫中邁進？怎麼辦？如果屏東榮總不能成為準醫中，屏東病患跑到高雄，讓高雄的醫中情況更嚴重，這不是我們所樂見的，所以我們希望部長可以承諾在未來推動醫院總額的制度之下，考慮到區域內不同醫院不同發展階段的不同定位，給予一些不同的安排好不好？"],["邱部長泰源：好。"],["鍾委員佳濱：接下來最後一個問題是有關現在地方的醫院跟公部門的衛生所，以前我在當副縣長的時候，我們有33個衛生所，我們的護理人員還有包括校護要做什麼？要不要做預防保健？衛生所要不要做宣導？"],["邱部長泰源：當然要啊！"],["鍾委員佳濱：有的衛生所有群醫，他要做醫療，有的要打預防注射對不對？"],["邱部長泰源：是的。"],["鍾委員佳濱：醫院是不是也做這些事情？醫院也會做這些事情，公部門的衛生所也會做這些事情，但是經費從哪裡來？有從國健署來的、從衛福部來的、從疾管署來的，從地方來的，還有從健保署來的，做這些事情上面都有錢讓這些單位去申請，但畢竟健保支出的比例、對象跟公務預算支出的是不是要區分？部長，是不是要區分？總不能都拿健保的錢來做預防保健跟宣導吧？我講的是比重，我不是說完全沒有啦！現在我們健保總額不夠，所以醫療院所「哀哀叫」，它說它要做很多事情，但是你都從健保署去挖錢，那公務預算要不要出？公務預算要也出一些，是不是？署長你同不同意？"],["石署長崇良：同意。"],["鍾委員佳濱：講得很大聲，你看這個他馬上同意！"],["邱部長泰源：署長當然同意啊！報告委員，其實政府這一年來，在防治、預防保健方面的確編了更多的公務預算。"],["鍾委員佳濱：對啦，所以我這邊就幫你寫了，全民健康保險法是以醫療服務為主，包括疾病、傷害、生育事故，所以它的健保支出應該是以這些醫療為主，至於其他事情，像傳染病的防治，我上週才問過你一次，像COVID-19期間我們有特別預算去挹注，現在COVID-19已經不是法定傳染病的最高級了，我們把它降下來，那公務預算還支不支持？要不要支持？醫院做這些季節性好發的疾病防治，我們要不要支持用公務預算幫忙？你應該說要啊！然後我就可以說立法院幫你忙，這樣我才有施力的餘地啊！"],["邱部長泰源：這個就是我們要依據健保法或相關的法規來制定，當然我們希望相關的公衛或是原來不在健保法的規範裡面，的確是要用公務預算支出。"],["鍾委員佳濱：很好！最後一句話結論就來了，所以全面檢討全民健康保險基金中預防保健及傳染病防治相關給付項目，不符合健康保險法給付的項目改以公務預算支付，可不可以？"],["邱部長泰源：應該要朝著這個方向來努力。"],["鍾委員佳濱：好，這兩個標準我就不再重唸了，可不可以把這兩個報告給本席？"],["邱部長泰源：好。"],["鍾委員佳濱：謝謝，也謝謝主席的容忍，謝謝兩位。"],["主席：謝謝鍾佳濱委員發言。","接下來請廖偉翔委員發言。"]],"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"}}}