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569.767, \"end\": 569.787, \"score\": 0.907}]}, {\"start\": 570.547, \"end\": 596.207, \"text\": \"所以有再去促成這件事嗎因為我們最擔心的就是這個在這個總額被限制的制度裡面門診量跟手術量大的醫生聽起來也是會不會相對被變相被處罰因為事情卻做得越多跟報酬卻無法增加那要怎麼去避免這種狀況根文報告我們都有相關的這監測那麼我剛剛也提到有一些的門診的次數確實可以減少那麼醫療人員的\", \"words\": [{\"word\": \"所\", \"start\": 570.547, \"end\": 570.707, \"score\": 0.875}, {\"word\": \"以\", \"start\": 570.707, \"end\": 571.268, \"score\": 0.963}, {\"word\": \"有\", \"start\": 571.268, \"end\": 571.588, \"score\": 0.97}, {\"word\": \"再\", \"start\": 571.588, \"end\": 571.988, \"score\": 0.964}, {\"word\": \"去\", \"start\": 571.988, \"end\": 572.308, \"score\": 0.992}, {\"word\": \"促\", \"start\": 572.308, \"end\": 572.529, \"score\": 0.891}, {\"word\": \"成\", \"start\": 572.529, \"end\": 572.949, \"score\": 0.86}, {\"word\": \"這\"}, {\"word\": \"件\", \"start\": 572.949, \"end\": 573.209, \"score\": 0.922}, {\"word\": \"事\", \"start\": 573.209, \"end\": 573.609, \"score\": 0.902}, {\"word\": \"嗎\"}, {\"word\": \"因\", \"start\": 573.609, 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884.534, \"end\": 884.655, \"score\": 0.833}, {\"word\": \"委\", \"start\": 884.655, \"end\": 884.735, \"score\": 0.75}, {\"word\": \"員\"}, {\"word\": \"謝\"}, {\"word\": \"謝\"}, {\"word\": \"部\", \"start\": 884.735, \"end\": 884.755, \"score\": 0.0}, {\"word\": \"長\"}], \"language\": \"zh\"}","srt":"1\n00:00:06,996 --> 00:00:19,249\n主席麻煩邱部長委員好部長晚安晚安不好意思\n\n2\n00:00:23,538 --> 00:00:39,888\n上禮拜一的那個丹納斯颱風造成中南部很嚴重的災情台電人員在這週都還在搶救那到7月12號就上週六的中午為止急救的那個責任醫院收治的緊急傷病患總計大概713人\n\n3\n00:00:41,389 --> 00:00:56,201\n突顯在緊急天災的時候維持醫療的量能的重要性可是有媒體報導颱風期間有很多中部的醫院事實上是縮減服務有的甚至停止門診這情形在過去不太明顯不過本席認為為了維護醫療人員的\n\n4\n00:00:58,823 --> 00:01:19,404\n安全的話颱風天醫院縮減服務大概是情有可願可是有一屆人是懷疑今年的特例跟剛上路的醫院個別總額的事辦計畫是有關的所以對醫院來說恐怕會擔心就診的人數超過總額那導致點數打折所以颱風天就乾脆就\n\n5\n00:01:22,455 --> 00:01:47,336\n所以想問部長說如果這是事實的話那就是一個很嚴重的警訊所以請部長針對媒體提出來的疑問做回應好謝謝委員的垂行跟關心我們在颱風天或者一般時候的一個醫療的運作那像張基總院陳木寬院長所提的要信諾對病人的承諾我想所有的醫院的院長\n\n6\n00:01:48,317 --> 00:02:13,013\n都是懷抱有這樣的情懷所以不會受到幾乎是不會因為颱風天而是很故意就除了說向南部就沒水沒電那當然是沒辦法反而我們現在都要去補助他那中部這個我跟委員報告一下我們7月1號到15號也就是在風災這段期間中區分歧的\n\n7\n00:02:14,134 --> 00:02:40,426\n健保IC卡的上傳件數還比去年113人成長11.5%表示他們的看診並沒有受到風災的影響所以這個我相信中部的醫院應該是不質疑因為可能停班你如果停班讓你去外面來就變成假班所以那可能有些\n\n8\n00:02:41,627 --> 00:02:46,852\n現在颱風天上班也不好,基層的醫護也是非常重視這個醫院也很重視安全,所以現在都有颱風天上班的規定所以我們在安全的經營之下\n\n9\n00:02:59,813 --> 00:03:12,393\n其實便宜也都只能在運作除了它真的被因為台灣現在風險也比較高隨時又有可能短時間內出現我們的大量傷患健保支付制度如果沒有妥善規劃的話影響到緊急狀況的\n\n10\n00:03:15,537 --> 00:03:32,831\n醫療量能的話這是民眾很擔心的事情請民眾安心我們的各位醫院總和現在運轉得很好而且也沒有發生人球的事件可是在此之前醫院個別總和制在南區就已經試辦大概實施了三年到今年一月中\n\n11\n00:03:33,491 --> 00:03:49,269\n一月在中区开始实施全国最晚实施的是台北区从今年的4月1号开始所以请问部长台北区最晚实施的原因是不是因为医学中心比别的地区多那需要更多的时间沟通是因为这个原因吗\n\n12\n00:03:50,074 --> 00:04:16,768\n是因為台北區的文化因為我在台北市也很久他們都覺得他們是要接受很嚴重的病人不能沒有後路了啦所以比較大的醫院包括台大籠總他會覺得說他們有先天的使命所以他們很擔心這樣的一個是不是影響到他們照顧病人結果我們溝通以後他們也發現說如果讓我們的這樣一個一定的\n\n13\n00:04:18,318 --> 00:04:47,260\n總而之下也根本也有一些剛性需求的話也不受影響需要的集中症那個都不受影響另外也可以把一些比較輕症的病人能夠盡量在分級醫療的理念之下放給那個比較屬於中小型或地區的醫院這樣反而形成一個良好的一個分級醫療而且有一點點財務的控制財務控制是其實不只醫院啦也是區域都在管那是不是我們也跟他\n\n14\n00:04:48,001 --> 00:05:15,467\n跟他溝通就是未來的方向也要讓民眾健康促進讓整個所有的健保也要朝向讓民眾更健康那這樣的話就變成一個分級醫療以此做對人民健康最好的一個模式那以到目前來講北區也得大家應做得相當好那用醫院個別總而治來控制健保經費支出這當然直接影響到醫院門診檢查手術甚至急救\n\n15\n00:05:16,247 --> 00:05:36,014\n等可以收治的病人數量我們擔心醫院為了健保點數不要超過總額發生拒收重症病患的狀況所以也要請教部長說那這樣子要怎麼去避免這種狀況發生好謝謝委員我是不是請站派署署長簡調的跟大家報告一下\n\n16\n00:05:36,494 --> 00:05:51,071\n跟委員報告從我們的統計來看我們在疫情前國人就醫的次數每年是15次在所有的OECD國家是非常非常的高那麼到了疫後我們從去年的數字又再往上升已經逼近17次了\n\n17\n00:05:51,892 --> 00:06:09,809\n所以這中間一定可以有管理的地方所以我們希望透過醫院的個別總額來強化分級醫療那麼對於慢性病的管理也好跟病人的就醫能夠有適當的一些好的管理措施那也可以讓國人得到照顧\n\n18\n00:06:10,530 --> 00:06:37,744\n所以急重症的部分呢我們都是在個別總和裡面呢都是保障在中區的話他們是沒有限制只要你是急重症的他都是保障成長所以不會有斷頭的情形可是中區當然我覺得目前看起來不是太我寧願已經實施三年可是民眾普遍相信台北的醫院又多又好啦所以外縣市的急重症的病患經常都會到台北區的那個教學\n\n19\n00:06:38,744 --> 00:06:57,200\n醫學中心來所以從圖表上可以看到是說台北區的健保點子從前年到去年增加的幅度是非常明顯的可是病人總不能都擠到台北區所以應該是就近就醫才比較好所以如果說要盡可能讓他們就近就醫的話你們的對策是什麼\n\n20\n00:06:57,780 --> 00:07:13,474\n跟文包我們都有在監測流入跟流出所以從這幾年這幾個我們按季按月都在監測這個台北區的流入情形並沒有增加整個比例是沒有增加那當然各地區的醫院的數量\n\n21\n00:07:14,355 --> 00:07:35,638\n還有這個病床數確實也有變動所以像北區或台北區北區這幾年的醫院的加速是增加病床數也增加那當然他就會影響到這個分佈的情形所以並沒有讓台北區的就醫人數有明顯的增加所以我覺得後期可以觀察因為接下來台北也要執行\n\n22\n00:07:38,019 --> 00:07:52,646\n中的榮總因二零二五年第一劑的健保申報的點數就超出額度那遭健保署核三了三億元那另外張基也是光總院就核三掉一點二億元這凸顯醫院在個別總額\n\n23\n00:07:54,987 --> 00:08:13,347\n好的上邊來看的話馬上就會面對到一些困境那健保署的說法呢事實上是健保總額執行已經行之有年的話那現行的個別醫院的總額制的是南區實施的做法那南區的經驗現在是成功的那推行到全國\n\n24\n00:08:14,608 --> 00:08:41,798\n我剛講台北事件4月1號執行的話那後邊到底會怎麼樣不太確定因為南區只有兩家醫學中心而且健保點子都是比較高的那一樣的制度在台北區可能會不會面對到很多問題所以想問說對醫院來說要控制健保總額要避免虧損除了要減少病患以外就是從醫護人員的薪水下手這是我們最擔心的衛福部有沒有應對的措施去解決這種可能出現的\n\n25\n00:08:42,998 --> 00:09:04,291\n醫護減薪然後不賬薪或是預缺不補的問題跟委員報告我們第一劑今年的第一劑跟去年的第一劑相比所有的醫院的點值都是大幅的提升以台北區為例去年醫院的點值在沒有斷頭之前那麼大概不到0.9那今年呢已經是0.93\n\n26\n00:09:07,453 --> 00:09:29,787\n所以比去年都是提升的那醫院的營收也都是成長的那但是相對的醫院的病床的規模並沒有明顯的增加啦在台北區而言所以我們現在正在積極的希望呢醫院把這個增加的這個收入呢那麼能夠轉化成在人員的加薪上面我們在做這個努力\n\n27\n00:09:30,547 --> 00:09:56,207\n所以有再去促成這件事嗎因為我們最擔心的就是這個在這個總額被限制的制度裡面門診量跟手術量大的醫生聽起來也是會不會相對被變相被處罰因為事情卻做得越多跟報酬卻無法增加那要怎麼去避免這種狀況根文報告我們都有相關的這監測那麼我剛剛也提到有一些的門診的次數確實可以減少那麼醫療人員的\n\n28\n00:10:01,251 --> 00:10:24,851\n這個過勞情形其實也是蠻重的所以我們希望透過好的管理也讓這個醫護人員減壓啦那至於是剛性的需求這個在我們的總額裡面都是保障的而且在明年在談總額成長的時候個別醫院總額成長的時候也會看他的人力的投入情形有沒有增加薪資的這個署長剛剛也提到南區\n\n29\n00:10:25,872 --> 00:10:49,671\n事實上你覺得是成功經驗可是媒體有報導說在最早開始用這個制度的時候南區就已經開始有部分醫院用降薪限制醫生門診量跟手術量還有全力鼓吹病患自費等等的方式去控制不讓醫療點數超過每劑的總額所以想問說為了避免無效醫療當我們覺得浪費資源或過度控制手術量\n\n30\n00:10:50,653 --> 00:11:02,597\n門診量跟檢查量是需要的必要的一個措施在可是如果醫院為了省錢讓手術量門診量跟檢查量下降就會傷害當地區的醫療量能這個問題你們要怎麼去應對\n\n31\n00:11:04,592 --> 00:11:25,332\n跟委員報告其實這個我們南區先實施之後高屏區然後北區就是陸陸續續大家還跟進也就是大家互相在學習一個制度剛上路的時候難免有需要調整的地方但是經過南區先行這幾年之後那麼發現了他其實大家都\n\n32\n00:11:25,973 --> 00:11:51,589\n都很滿意啦所以才持續擴大到其他的各區以現在第一劑為例南區的點值超過1.1塊錢了那麼高屏區也是差不多是0.99啦所以靠近這個1啦所以相對於這個沒有實施之前來講呢那麼其實這個對醫院的營收更穩定那它更能夠做比較中長期的規劃\n\n33\n00:11:53,117 --> 00:12:08,395\n好疏解醫院門診壓力的解方就是弱勢分級醫療所以為了控制總額各醫院可能把重症的病人轉出去重症病人事實上是不會往送去診所而是到各大醫院\n\n34\n00:12:09,256 --> 00:12:28,549\n的那個診間去轉診踢來踢去最後把被送到不能再將病人轉出去的部立醫院或者醫學中心結果導致呢部立醫院跟醫學中心負擔更大醫護工作量更大所以部長想問說你們衛福怎麼去因應病人如果被當人球轉來轉去的問題\n\n35\n00:12:31,091 --> 00:12:54,846\n這個我們都有監測的指標在看就是病人的轉出轉入在我們的健保系統裡面都看得非常的清楚從哪邊轉來的比例有多少這個都很清楚的指標都在而且我們剛剛也提到說在急重症的部分他是剛性需求是被保障成長的那相對的呢你這個轉診的不當轉診呢那我們就會把你調降成為用\n\n36\n00:12:55,586 --> 00:13:17,401\n不保障點植的方式去處理所以對醫院我們也會有一些處罰的措施不過署長寫請教一下以南區為例在個別總額以下過去三年大醫院的輕症病轉回地區醫院或診所的成效怎麼樣因為你剛剛講說我不知道你有沒有掌握這個成效\n\n37\n00:13:18,820 --> 00:13:46,269\n就是轉診的部分那個南區的轉診成效都是蠻好的沒有什麼問題我們再提供詳細的數字給再麻煩那最後想問因為我覺得不管天災或平時台灣醫療體系的需求越來越大政府有餘裕應該是投入社會福利或醫療體系而不是普發現金這是我的看法所以請問部長因為的確我們現在隨著需求越大的時候\n\n38\n00:13:47,509 --> 00:13:58,744\n那大家很遺憾的是最近立法院通過的普發現金要把兩千三百五十億發出去而不是投入我們關心的社會福利或是醫療體系對此部長有什麼看法\n\n39\n00:13:59,475 --> 00:14:19,686\n我想醫療體系跟社福它是一個長久的一個規劃所以如果國家有財富比較盈利的時候應該把醫療的需求符合來醫療的需求跟社福的需求這應該是會比較能夠一本多利能夠有時候要看它的\n\n40\n00:14:20,866 --> 00:14:44,755\n效率也許能夠創造創造人民更多的健康更長遠穩定的事情會創造更多的健康跟幸福最後就請我們的衛福部應該要確保我們的醫療量能然後輕重症的病患都能夠受到妥善照顧還有就要保障醫護人員的一個權益還有落實醫療分級以上謝謝好謝謝林委員謝謝林委員謝謝部長\n\n","tsv":"start\tend\ttext\n6996\t19249\t主席麻煩邱部長委員好部長晚安晚安不好意思\n23538\t39888\t上禮拜一的那個丹納斯颱風造成中南部很嚴重的災情台電人員在這週都還在搶救那到7月12號就上週六的中午為止急救的那個責任醫院收治的緊急傷病患總計大概713人\n41389\t56201\t突顯在緊急天災的時候維持醫療的量能的重要性可是有媒體報導颱風期間有很多中部的醫院事實上是縮減服務有的甚至停止門診這情形在過去不太明顯不過本席認為為了維護醫療人員的\n58823\t79404\t安全的話 颱風天醫院縮減服務大概是情有可願 可是有一屆人是懷疑今年的特例跟剛上路的醫院個別總額的事辦計畫是有關的所以對醫院來說恐怕會擔心就診的人數超過總額那導致點數打折 所以颱風天就乾脆就\n82455\t107336\t所以想問部長說如果這是事實的話那就是一個很嚴重的警訊所以請部長針對媒體提出來的疑問做回應好 謝謝委員的垂行跟關心我們在颱風天或者一般時候的一個醫療的運作那像張基總院陳木寬院長所提的要信諾對病人的承諾我想所有的醫院的院長\n108317\t133013\t都是懷抱有這樣的情懷所以不會受到幾乎是不會因為颱風天而是很故意就除了說向南部就沒水沒電那當然是沒辦法反而我們現在都要去補助他那中部這個我跟委員報告一下我們7月1號到15號也就是在風災這段期間中區分歧的\n134134\t160426\t健保IC卡的上傳件數還比去年113人成長11.5%表示他們的看診並沒有受到風災的影響所以這個我相信中部的醫院應該是不質疑因為可能停班你如果停班讓你去外面來就變成假班所以那可能有些\n161627\t166852\t現在颱風天上班也不好,基層的醫護也是非常重視這個醫院也很重視安全,所以現在都有颱風天上班的規定所以我們在安全的經營之下\n179813\t192393\t其實便宜也都只能在運作除了它真的被因為台灣現在風險也比較高隨時又有可能短時間內出現我們的大量傷患健保支付制度如果沒有妥善規劃的話影響到緊急狀況的\n195537\t212831\t醫療量能的話這是民眾很擔心的事情請民眾安心我們的各位醫院總和現在運轉得很好而且也沒有發生人球的事件可是在此之前醫院個別總和制在南區就已經試辦大概實施了三年到今年一月中\n213491\t229269\t一月在中区开始实施全国最晚实施的是台北区从今年的4月1号开始所以请问部长台北区最晚实施的原因是不是因为医学中心比别的地区多那需要更多的时间沟通是因为这个原因吗\n230074\t256768\t是因為台北區的文化因為我在台北市也很久他們都覺得他們是要接受很嚴重的病人不能沒有後路了啦所以比較大的醫院包括台大籠總他會覺得說他們有先天的使命所以他們很擔心這樣的一個是不是影響到他們照顧病人結果我們溝通以後他們也發現說如果讓我們的這樣一個一定的\n258318\t287260\t總而之下也根本也有一些剛性需求的話也不受影響需要的集中症那個都不受影響另外也可以把一些比較輕症的病人能夠盡量在分級醫療的理念之下放給那個比較屬於中小型或地區的醫院這樣反而形成一個良好的一個分級醫療而且有一點點財務的控制財務控制是其實不只醫院啦也是區域都在管那是不是我們也跟他\n288001\t315467\t跟他溝通就是未來的方向也要讓民眾健康促進讓整個所有的健保也要朝向讓民眾更健康那這樣的話就變成一個分級醫療以此做對人民健康最好的一個模式那以到目前來講北區也得大家應做得相當好那用醫院個別總而治來控制健保經費支出這當然直接影響到醫院門診檢查手術甚至急救\n316247\t336014\t等可以收治的病人數量我們擔心醫院為了健保點數不要超過總額發生拒收重症病患的狀況所以也要請教部長說那這樣子要怎麼去避免這種狀況發生好 謝謝委員我是不是請站派署署長簡調的跟大家報告一下\n336494\t351071\t跟委員報告從我們的統計來看我們在疫情前國人就醫的次數每年是15次在所有的OECD國家是非常非常的高那麼到了疫後我們從去年的數字又再往上升已經逼近17次了\n351892\t369809\t所以這中間一定可以有管理的地方所以我們希望透過醫院的個別總額來強化分級醫療那麼對於慢性病的管理也好跟病人的就醫能夠有適當的一些好的管理措施那也可以讓國人得到照顧\n370530\t397744\t所以急重症的部分呢我們都是在個別總和裡面呢都是保障在中區的話他們是沒有限制只要你是急重症的他都是保障成長所以不會有斷頭的情形可是中區當然我覺得目前看起來不是太我寧願已經實施三年可是民眾普遍相信台北的醫院又多又好啦所以外縣市的急重症的病患經常都會到台北區的那個教學\n398744\t417200\t醫學中心來所以從圖表上可以看到是說台北區的健保點子從前年到去年增加的幅度是非常明顯的可是病人總不能都擠到台北區所以應該是就近就醫才比較好所以如果說要盡可能讓他們就近就醫的話你們的對策是什麼\n417780\t433474\t跟文包我們都有在監測流入跟流出所以從這幾年這幾個我們按季按月都在監測這個台北區的流入情形並沒有增加整個比例是沒有增加那當然各地區的醫院的數量\n434355\t455638\t還有這個病床數確實也有變動所以像北區或台北區北區這幾年的醫院的加速是增加病床數也增加那當然他就會影響到這個分佈的情形所以並沒有讓台北區的就醫人數有明顯的增加所以我覺得後期可以觀察因為接下來台北也要執行\n458019\t472646\t中的榮總因二零二五年第一劑的健保申報的點數就超出額度那遭健保署核三了三億元那另外張基也是光總院就核三掉一點二億元這凸顯醫院在個別總額\n474987\t493347\t好的上邊來看的話馬上就會面對到一些困境那健保署的說法呢事實上是健保總額執行已經行之有年的話那現行的個別醫院的總額制的是南區實施的做法那南區的經驗現在是成功的那推行到全國\n494608\t521798\t我剛講台北事件4月1號執行的話那後邊到底會怎麼樣不太確定因為南區只有兩家醫學中心而且健保點子都是比較高的那一樣的制度在台北區可能會不會面對到很多問題所以想問說對醫院來說要控制健保總額要避免虧損除了要減少病患以外就是從醫護人員的薪水下手這是我們最擔心的衛福部有沒有應對的措施去解決這種可能出現的\n522998\t544291\t醫護減薪然後不賬薪或是預缺不補的問題跟委員報告我們第一劑今年的第一劑跟去年的第一劑相比所有的醫院的點值都是大幅的提升以台北區為例去年醫院的點值在沒有斷頭之前那麼大概不到0.9那今年呢已經是0.93\n547453\t569787\t所以比去年都是提升的那醫院的營收也都是成長的那但是相對的醫院的病床的規模並沒有明顯的增加啦在台北區而言所以我們現在正在積極的希望呢醫院把這個增加的這個收入呢那麼能夠轉化成在人員的加薪上面我們在做這個努力\n570547\t596207\t所以有再去促成這件事嗎因為我們最擔心的就是這個在這個總額被限制的制度裡面門診量跟手術量大的醫生聽起來也是會不會相對被變相被處罰因為事情卻做得越多跟報酬卻無法增加那要怎麼去避免這種狀況根文報告我們都有相關的這監測那麼我剛剛也提到有一些的門診的次數確實可以減少那麼醫療人員的\n601251\t624851\t這個過勞情形其實也是蠻重的所以我們希望透過好的管理也讓這個醫護人員減壓啦那至於是剛性的需求這個在我們的總額裡面都是保障的而且在明年在談總額成長的時候個別醫院總額成長的時候也會看他的人力的投入情形有沒有增加薪資的這個署長剛剛也提到南區\n625872\t649671\t事實上你覺得是成功經驗可是媒體有報導說在最早開始用這個制度的時候南區就已經開始有部分醫院用降薪限制醫生門診量跟手術量還有全力鼓吹病患自費等等的方式去控制不讓醫療點數超過每劑的總額所以想問說為了避免無效醫療當我們覺得浪費資源或過度控制手術量\n650653\t662597\t門診量跟檢查量是需要的 必要的一個措施在可是如果醫院為了省錢讓手術量門診量跟檢查量下降就會傷害當地區的醫療量能這個問題你們要怎麼去應對\n664592\t685332\t跟委員報告其實這個我們南區先實施之後高屏區然後北區就是陸陸續續大家還跟進也就是大家互相在學習一個制度剛上路的時候難免有需要調整的地方但是經過南區先行這幾年之後那麼發現了他其實大家都\n685973\t711589\t都很滿意啦所以才持續擴大到其他的各區以現在第一劑為例南區的點值超過1.1塊錢了那麼高屏區也是差不多是0.99啦所以靠近這個1啦所以相對於這個沒有實施之前來講呢那麼其實這個對醫院的營收更穩定那它更能夠做比較中長期的規劃\n713117\t728395\t好 疏解醫院門診壓力的解方就是弱勢分級醫療所以為了控制總額各醫院可能把重症的病人轉出去重症病人事實上是不會往送去診所而是到各大醫院\n729256\t748549\t的那個診間去轉診踢來踢去最後把被送到不能再將病人轉出去的部立醫院或者醫學中心結果導致呢部立醫院跟醫學中心負擔更大醫護工作量更大所以部長想問說你們衛福怎麼去因應病人如果被當人球轉來轉去的問題\n751091\t774846\t這個我們都有監測的指標在看就是病人的轉出轉入在我們的健保系統裡面都看得非常的清楚從哪邊轉來的比例有多少這個都很清楚的指標都在而且我們剛剛也提到說在急重症的部分他是剛性需求是被保障成長的那相對的呢你這個轉診的不當轉診呢那我們就會把你調降成為用\n775586\t797401\t不保障點植的方式去處理所以對醫院我們也會有一些處罰的措施不過署長寫請教一下以南區為例在個別總額以下過去三年大醫院的輕症病轉回地區醫院或診所的成效怎麼樣因為你剛剛講說我不知道你有沒有掌握這個成效\n798820\t826269\t就是轉診的部分那個南區的轉診成效都是蠻好的沒有什麼問題我們再提供詳細的數字給再麻煩那最後想問因為我覺得不管天災或平時台灣醫療體系的需求越來越大政府有餘裕應該是投入社會福利或醫療體系而不是普發現金這是我的看法所以請問部長因為的確我們現在隨著需求越大的時候\n827509\t838744\t那大家很遺憾的是最近立法院通過的普發現金要把兩千三百五十億發出去而不是投入我們關心的社會福利或是醫療體系對此部長有什麼看法\n839475\t859686\t我想醫療體系跟社福它是一個長久的一個規劃所以如果國家有財富比較盈利的時候應該把醫療的需求符合來醫療的需求跟社福的需求這應該是會比較能夠一本多利能夠有時候要看它的\n860866\t884755\t效率也許能夠創造 創造人民更多的健康 更長遠穩定的事情會創造更多的健康跟幸福最後就請我們的衛福部應該要確保我們的醫療量能然後輕重症的病患都能夠受到妥善照顧還有就要保障醫護人員的一個權益 還有落實醫療分級 以上謝謝好 謝謝林委員謝謝林委員 謝謝部長\n","txt":"主席麻煩邱部長委員好部長晚安晚安不好意思\n上禮拜一的那個丹納斯颱風造成中南部很嚴重的災情台電人員在這週都還在搶救那到7月12號就上週六的中午為止急救的那個責任醫院收治的緊急傷病患總計大概713人\n突顯在緊急天災的時候維持醫療的量能的重要性可是有媒體報導颱風期間有很多中部的醫院事實上是縮減服務有的甚至停止門診這情形在過去不太明顯不過本席認為為了維護醫療人員的\n安全的話 颱風天醫院縮減服務大概是情有可願 可是有一屆人是懷疑今年的特例跟剛上路的醫院個別總額的事辦計畫是有關的所以對醫院來說恐怕會擔心就診的人數超過總額那導致點數打折 所以颱風天就乾脆就\n所以想問部長說如果這是事實的話那就是一個很嚴重的警訊所以請部長針對媒體提出來的疑問做回應好 謝謝委員的垂行跟關心我們在颱風天或者一般時候的一個醫療的運作那像張基總院陳木寬院長所提的要信諾對病人的承諾我想所有的醫院的院長\n都是懷抱有這樣的情懷所以不會受到幾乎是不會因為颱風天而是很故意就除了說向南部就沒水沒電那當然是沒辦法反而我們現在都要去補助他那中部這個我跟委員報告一下我們7月1號到15號也就是在風災這段期間中區分歧的\n健保IC卡的上傳件數還比去年113人成長11.5%表示他們的看診並沒有受到風災的影響所以這個我相信中部的醫院應該是不質疑因為可能停班你如果停班讓你去外面來就變成假班所以那可能有些\n現在颱風天上班也不好,基層的醫護也是非常重視這個醫院也很重視安全,所以現在都有颱風天上班的規定所以我們在安全的經營之下\n其實便宜也都只能在運作除了它真的被因為台灣現在風險也比較高隨時又有可能短時間內出現我們的大量傷患健保支付制度如果沒有妥善規劃的話影響到緊急狀況的\n醫療量能的話這是民眾很擔心的事情請民眾安心我們的各位醫院總和現在運轉得很好而且也沒有發生人球的事件可是在此之前醫院個別總和制在南區就已經試辦大概實施了三年到今年一月中\n一月在中区开始实施全国最晚实施的是台北区从今年的4月1号开始所以请问部长台北区最晚实施的原因是不是因为医学中心比别的地区多那需要更多的时间沟通是因为这个原因吗\n是因為台北區的文化因為我在台北市也很久他們都覺得他們是要接受很嚴重的病人不能沒有後路了啦所以比較大的醫院包括台大籠總他會覺得說他們有先天的使命所以他們很擔心這樣的一個是不是影響到他們照顧病人結果我們溝通以後他們也發現說如果讓我們的這樣一個一定的\n總而之下也根本也有一些剛性需求的話也不受影響需要的集中症那個都不受影響另外也可以把一些比較輕症的病人能夠盡量在分級醫療的理念之下放給那個比較屬於中小型或地區的醫院這樣反而形成一個良好的一個分級醫療而且有一點點財務的控制財務控制是其實不只醫院啦也是區域都在管那是不是我們也跟他\n跟他溝通就是未來的方向也要讓民眾健康促進讓整個所有的健保也要朝向讓民眾更健康那這樣的話就變成一個分級醫療以此做對人民健康最好的一個模式那以到目前來講北區也得大家應做得相當好那用醫院個別總而治來控制健保經費支出這當然直接影響到醫院門診檢查手術甚至急救\n等可以收治的病人數量我們擔心醫院為了健保點數不要超過總額發生拒收重症病患的狀況所以也要請教部長說那這樣子要怎麼去避免這種狀況發生好 謝謝委員我是不是請站派署署長簡調的跟大家報告一下\n跟委員報告從我們的統計來看我們在疫情前國人就醫的次數每年是15次在所有的OECD國家是非常非常的高那麼到了疫後我們從去年的數字又再往上升已經逼近17次了\n所以這中間一定可以有管理的地方所以我們希望透過醫院的個別總額來強化分級醫療那麼對於慢性病的管理也好跟病人的就醫能夠有適當的一些好的管理措施那也可以讓國人得到照顧\n所以急重症的部分呢我們都是在個別總和裡面呢都是保障在中區的話他們是沒有限制只要你是急重症的他都是保障成長所以不會有斷頭的情形可是中區當然我覺得目前看起來不是太我寧願已經實施三年可是民眾普遍相信台北的醫院又多又好啦所以外縣市的急重症的病患經常都會到台北區的那個教學\n醫學中心來所以從圖表上可以看到是說台北區的健保點子從前年到去年增加的幅度是非常明顯的可是病人總不能都擠到台北區所以應該是就近就醫才比較好所以如果說要盡可能讓他們就近就醫的話你們的對策是什麼\n跟文包我們都有在監測流入跟流出所以從這幾年這幾個我們按季按月都在監測這個台北區的流入情形並沒有增加整個比例是沒有增加那當然各地區的醫院的數量\n還有這個病床數確實也有變動所以像北區或台北區北區這幾年的醫院的加速是增加病床數也增加那當然他就會影響到這個分佈的情形所以並沒有讓台北區的就醫人數有明顯的增加所以我覺得後期可以觀察因為接下來台北也要執行\n中的榮總因二零二五年第一劑的健保申報的點數就超出額度那遭健保署核三了三億元那另外張基也是光總院就核三掉一點二億元這凸顯醫院在個別總額\n好的上邊來看的話馬上就會面對到一些困境那健保署的說法呢事實上是健保總額執行已經行之有年的話那現行的個別醫院的總額制的是南區實施的做法那南區的經驗現在是成功的那推行到全國\n我剛講台北事件4月1號執行的話那後邊到底會怎麼樣不太確定因為南區只有兩家醫學中心而且健保點子都是比較高的那一樣的制度在台北區可能會不會面對到很多問題所以想問說對醫院來說要控制健保總額要避免虧損除了要減少病患以外就是從醫護人員的薪水下手這是我們最擔心的衛福部有沒有應對的措施去解決這種可能出現的\n醫護減薪然後不賬薪或是預缺不補的問題跟委員報告我們第一劑今年的第一劑跟去年的第一劑相比所有的醫院的點值都是大幅的提升以台北區為例去年醫院的點值在沒有斷頭之前那麼大概不到0.9那今年呢已經是0.93\n所以比去年都是提升的那醫院的營收也都是成長的那但是相對的醫院的病床的規模並沒有明顯的增加啦在台北區而言所以我們現在正在積極的希望呢醫院把這個增加的這個收入呢那麼能夠轉化成在人員的加薪上面我們在做這個努力\n所以有再去促成這件事嗎因為我們最擔心的就是這個在這個總額被限制的制度裡面門診量跟手術量大的醫生聽起來也是會不會相對被變相被處罰因為事情卻做得越多跟報酬卻無法增加那要怎麼去避免這種狀況根文報告我們都有相關的這監測那麼我剛剛也提到有一些的門診的次數確實可以減少那麼醫療人員的\n這個過勞情形其實也是蠻重的所以我們希望透過好的管理也讓這個醫護人員減壓啦那至於是剛性的需求這個在我們的總額裡面都是保障的而且在明年在談總額成長的時候個別醫院總額成長的時候也會看他的人力的投入情形有沒有增加薪資的這個署長剛剛也提到南區\n事實上你覺得是成功經驗可是媒體有報導說在最早開始用這個制度的時候南區就已經開始有部分醫院用降薪限制醫生門診量跟手術量還有全力鼓吹病患自費等等的方式去控制不讓醫療點數超過每劑的總額所以想問說為了避免無效醫療當我們覺得浪費資源或過度控制手術量\n門診量跟檢查量是需要的 必要的一個措施在可是如果醫院為了省錢讓手術量門診量跟檢查量下降就會傷害當地區的醫療量能這個問題你們要怎麼去應對\n跟委員報告其實這個我們南區先實施之後高屏區然後北區就是陸陸續續大家還跟進也就是大家互相在學習一個制度剛上路的時候難免有需要調整的地方但是經過南區先行這幾年之後那麼發現了他其實大家都\n都很滿意啦所以才持續擴大到其他的各區以現在第一劑為例南區的點值超過1.1塊錢了那麼高屏區也是差不多是0.99啦所以靠近這個1啦所以相對於這個沒有實施之前來講呢那麼其實這個對醫院的營收更穩定那它更能夠做比較中長期的規劃\n好 疏解醫院門診壓力的解方就是弱勢分級醫療所以為了控制總額各醫院可能把重症的病人轉出去重症病人事實上是不會往送去診所而是到各大醫院\n的那個診間去轉診踢來踢去最後把被送到不能再將病人轉出去的部立醫院或者醫學中心結果導致呢部立醫院跟醫學中心負擔更大醫護工作量更大所以部長想問說你們衛福怎麼去因應病人如果被當人球轉來轉去的問題\n這個我們都有監測的指標在看就是病人的轉出轉入在我們的健保系統裡面都看得非常的清楚從哪邊轉來的比例有多少這個都很清楚的指標都在而且我們剛剛也提到說在急重症的部分他是剛性需求是被保障成長的那相對的呢你這個轉診的不當轉診呢那我們就會把你調降成為用\n不保障點植的方式去處理所以對醫院我們也會有一些處罰的措施不過署長寫請教一下以南區為例在個別總額以下過去三年大醫院的輕症病轉回地區醫院或診所的成效怎麼樣因為你剛剛講說我不知道你有沒有掌握這個成效\n就是轉診的部分那個南區的轉診成效都是蠻好的沒有什麼問題我們再提供詳細的數字給再麻煩那最後想問因為我覺得不管天災或平時台灣醫療體系的需求越來越大政府有餘裕應該是投入社會福利或醫療體系而不是普發現金這是我的看法所以請問部長因為的確我們現在隨著需求越大的時候\n那大家很遺憾的是最近立法院通過的普發現金要把兩千三百五十億發出去而不是投入我們關心的社會福利或是醫療體系對此部長有什麼看法\n我想醫療體系跟社福它是一個長久的一個規劃所以如果國家有財富比較盈利的時候應該把醫療的需求符合來醫療的需求跟社福的需求這應該是會比較能夠一本多利能夠有時候要看它的\n效率也許能夠創造 創造人民更多的健康 更長遠穩定的事情會創造更多的健康跟幸福最後就請我們的衛福部應該要確保我們的醫療量能然後輕重症的病患都能夠受到妥善照顧還有就要保障醫護人員的一個權益 還有落實醫療分級 以上謝謝好 謝謝林委員謝謝林委員 謝謝部長\n","vtt":"WEBVTT\n\n00:06.996 --> 00:19.249\n主席麻煩邱部長委員好部長晚安晚安不好意思\n\n00:23.538 --> 00:39.888\n上禮拜一的那個丹納斯颱風造成中南部很嚴重的災情台電人員在這週都還在搶救那到7月12號就上週六的中午為止急救的那個責任醫院收治的緊急傷病患總計大概713人\n\n00:41.389 --> 00:56.201\n突顯在緊急天災的時候維持醫療的量能的重要性可是有媒體報導颱風期間有很多中部的醫院事實上是縮減服務有的甚至停止門診這情形在過去不太明顯不過本席認為為了維護醫療人員的\n\n00:58.823 --> 01:19.404\n安全的話颱風天醫院縮減服務大概是情有可願可是有一屆人是懷疑今年的特例跟剛上路的醫院個別總額的事辦計畫是有關的所以對醫院來說恐怕會擔心就診的人數超過總額那導致點數打折所以颱風天就乾脆就\n\n01:22.455 --> 01:47.336\n所以想問部長說如果這是事實的話那就是一個很嚴重的警訊所以請部長針對媒體提出來的疑問做回應好謝謝委員的垂行跟關心我們在颱風天或者一般時候的一個醫療的運作那像張基總院陳木寬院長所提的要信諾對病人的承諾我想所有的醫院的院長\n\n01:48.317 --> 02:13.013\n都是懷抱有這樣的情懷所以不會受到幾乎是不會因為颱風天而是很故意就除了說向南部就沒水沒電那當然是沒辦法反而我們現在都要去補助他那中部這個我跟委員報告一下我們7月1號到15號也就是在風災這段期間中區分歧的\n\n02:14.134 --> 02:40.426\n健保IC卡的上傳件數還比去年113人成長11.5%表示他們的看診並沒有受到風災的影響所以這個我相信中部的醫院應該是不質疑因為可能停班你如果停班讓你去外面來就變成假班所以那可能有些\n\n02:41.627 --> 02:46.852\n現在颱風天上班也不好,基層的醫護也是非常重視這個醫院也很重視安全,所以現在都有颱風天上班的規定所以我們在安全的經營之下\n\n02:59.813 --> 03:12.393\n其實便宜也都只能在運作除了它真的被因為台灣現在風險也比較高隨時又有可能短時間內出現我們的大量傷患健保支付制度如果沒有妥善規劃的話影響到緊急狀況的\n\n03:15.537 --> 03:32.831\n醫療量能的話這是民眾很擔心的事情請民眾安心我們的各位醫院總和現在運轉得很好而且也沒有發生人球的事件可是在此之前醫院個別總和制在南區就已經試辦大概實施了三年到今年一月中\n\n03:33.491 --> 03:49.269\n一月在中区开始实施全国最晚实施的是台北区从今年的4月1号开始所以请问部长台北区最晚实施的原因是不是因为医学中心比别的地区多那需要更多的时间沟通是因为这个原因吗\n\n03:50.074 --> 04:16.768\n是因為台北區的文化因為我在台北市也很久他們都覺得他們是要接受很嚴重的病人不能沒有後路了啦所以比較大的醫院包括台大籠總他會覺得說他們有先天的使命所以他們很擔心這樣的一個是不是影響到他們照顧病人結果我們溝通以後他們也發現說如果讓我們的這樣一個一定的\n\n04:18.318 --> 04:47.260\n總而之下也根本也有一些剛性需求的話也不受影響需要的集中症那個都不受影響另外也可以把一些比較輕症的病人能夠盡量在分級醫療的理念之下放給那個比較屬於中小型或地區的醫院這樣反而形成一個良好的一個分級醫療而且有一點點財務的控制財務控制是其實不只醫院啦也是區域都在管那是不是我們也跟他\n\n04:48.001 --> 05:15.467\n跟他溝通就是未來的方向也要讓民眾健康促進讓整個所有的健保也要朝向讓民眾更健康那這樣的話就變成一個分級醫療以此做對人民健康最好的一個模式那以到目前來講北區也得大家應做得相當好那用醫院個別總而治來控制健保經費支出這當然直接影響到醫院門診檢查手術甚至急救\n\n05:16.247 --> 05:36.014\n等可以收治的病人數量我們擔心醫院為了健保點數不要超過總額發生拒收重症病患的狀況所以也要請教部長說那這樣子要怎麼去避免這種狀況發生好謝謝委員我是不是請站派署署長簡調的跟大家報告一下\n\n05:36.494 --> 05:51.071\n跟委員報告從我們的統計來看我們在疫情前國人就醫的次數每年是15次在所有的OECD國家是非常非常的高那麼到了疫後我們從去年的數字又再往上升已經逼近17次了\n\n05:51.892 --> 06:09.809\n所以這中間一定可以有管理的地方所以我們希望透過醫院的個別總額來強化分級醫療那麼對於慢性病的管理也好跟病人的就醫能夠有適當的一些好的管理措施那也可以讓國人得到照顧\n\n06:10.530 --> 06:37.744\n所以急重症的部分呢我們都是在個別總和裡面呢都是保障在中區的話他們是沒有限制只要你是急重症的他都是保障成長所以不會有斷頭的情形可是中區當然我覺得目前看起來不是太我寧願已經實施三年可是民眾普遍相信台北的醫院又多又好啦所以外縣市的急重症的病患經常都會到台北區的那個教學\n\n06:38.744 --> 06:57.200\n醫學中心來所以從圖表上可以看到是說台北區的健保點子從前年到去年增加的幅度是非常明顯的可是病人總不能都擠到台北區所以應該是就近就醫才比較好所以如果說要盡可能讓他們就近就醫的話你們的對策是什麼\n\n06:57.780 --> 07:13.474\n跟文包我們都有在監測流入跟流出所以從這幾年這幾個我們按季按月都在監測這個台北區的流入情形並沒有增加整個比例是沒有增加那當然各地區的醫院的數量\n\n07:14.355 --> 07:35.638\n還有這個病床數確實也有變動所以像北區或台北區北區這幾年的醫院的加速是增加病床數也增加那當然他就會影響到這個分佈的情形所以並沒有讓台北區的就醫人數有明顯的增加所以我覺得後期可以觀察因為接下來台北也要執行\n\n07:38.019 --> 07:52.646\n中的榮總因二零二五年第一劑的健保申報的點數就超出額度那遭健保署核三了三億元那另外張基也是光總院就核三掉一點二億元這凸顯醫院在個別總額\n\n07:54.987 --> 08:13.347\n好的上邊來看的話馬上就會面對到一些困境那健保署的說法呢事實上是健保總額執行已經行之有年的話那現行的個別醫院的總額制的是南區實施的做法那南區的經驗現在是成功的那推行到全國\n\n08:14.608 --> 08:41.798\n我剛講台北事件4月1號執行的話那後邊到底會怎麼樣不太確定因為南區只有兩家醫學中心而且健保點子都是比較高的那一樣的制度在台北區可能會不會面對到很多問題所以想問說對醫院來說要控制健保總額要避免虧損除了要減少病患以外就是從醫護人員的薪水下手這是我們最擔心的衛福部有沒有應對的措施去解決這種可能出現的\n\n08:42.998 --> 09:04.291\n醫護減薪然後不賬薪或是預缺不補的問題跟委員報告我們第一劑今年的第一劑跟去年的第一劑相比所有的醫院的點值都是大幅的提升以台北區為例去年醫院的點值在沒有斷頭之前那麼大概不到0.9那今年呢已經是0.93\n\n09:07.453 --> 09:29.787\n所以比去年都是提升的那醫院的營收也都是成長的那但是相對的醫院的病床的規模並沒有明顯的增加啦在台北區而言所以我們現在正在積極的希望呢醫院把這個增加的這個收入呢那麼能夠轉化成在人員的加薪上面我們在做這個努力\n\n09:30.547 --> 09:56.207\n所以有再去促成這件事嗎因為我們最擔心的就是這個在這個總額被限制的制度裡面門診量跟手術量大的醫生聽起來也是會不會相對被變相被處罰因為事情卻做得越多跟報酬卻無法增加那要怎麼去避免這種狀況根文報告我們都有相關的這監測那麼我剛剛也提到有一些的門診的次數確實可以減少那麼醫療人員的\n\n10:01.251 --> 10:24.851\n這個過勞情形其實也是蠻重的所以我們希望透過好的管理也讓這個醫護人員減壓啦那至於是剛性的需求這個在我們的總額裡面都是保障的而且在明年在談總額成長的時候個別醫院總額成長的時候也會看他的人力的投入情形有沒有增加薪資的這個署長剛剛也提到南區\n\n10:25.872 --> 10:49.671\n事實上你覺得是成功經驗可是媒體有報導說在最早開始用這個制度的時候南區就已經開始有部分醫院用降薪限制醫生門診量跟手術量還有全力鼓吹病患自費等等的方式去控制不讓醫療點數超過每劑的總額所以想問說為了避免無效醫療當我們覺得浪費資源或過度控制手術量\n\n10:50.653 --> 11:02.597\n門診量跟檢查量是需要的必要的一個措施在可是如果醫院為了省錢讓手術量門診量跟檢查量下降就會傷害當地區的醫療量能這個問題你們要怎麼去應對\n\n11:04.592 --> 11:25.332\n跟委員報告其實這個我們南區先實施之後高屏區然後北區就是陸陸續續大家還跟進也就是大家互相在學習一個制度剛上路的時候難免有需要調整的地方但是經過南區先行這幾年之後那麼發現了他其實大家都\n\n11:25.973 --> 11:51.589\n都很滿意啦所以才持續擴大到其他的各區以現在第一劑為例南區的點值超過1.1塊錢了那麼高屏區也是差不多是0.99啦所以靠近這個1啦所以相對於這個沒有實施之前來講呢那麼其實這個對醫院的營收更穩定那它更能夠做比較中長期的規劃\n\n11:53.117 --> 12:08.395\n好疏解醫院門診壓力的解方就是弱勢分級醫療所以為了控制總額各醫院可能把重症的病人轉出去重症病人事實上是不會往送去診所而是到各大醫院\n\n12:09.256 --> 12:28.549\n的那個診間去轉診踢來踢去最後把被送到不能再將病人轉出去的部立醫院或者醫學中心結果導致呢部立醫院跟醫學中心負擔更大醫護工作量更大所以部長想問說你們衛福怎麼去因應病人如果被當人球轉來轉去的問題\n\n12:31.091 --> 12:54.846\n這個我們都有監測的指標在看就是病人的轉出轉入在我們的健保系統裡面都看得非常的清楚從哪邊轉來的比例有多少這個都很清楚的指標都在而且我們剛剛也提到說在急重症的部分他是剛性需求是被保障成長的那相對的呢你這個轉診的不當轉診呢那我們就會把你調降成為用\n\n12:55.586 --> 13:17.401\n不保障點植的方式去處理所以對醫院我們也會有一些處罰的措施不過署長寫請教一下以南區為例在個別總額以下過去三年大醫院的輕症病轉回地區醫院或診所的成效怎麼樣因為你剛剛講說我不知道你有沒有掌握這個成效\n\n13:18.820 --> 13:46.269\n就是轉診的部分那個南區的轉診成效都是蠻好的沒有什麼問題我們再提供詳細的數字給再麻煩那最後想問因為我覺得不管天災或平時台灣醫療體系的需求越來越大政府有餘裕應該是投入社會福利或醫療體系而不是普發現金這是我的看法所以請問部長因為的確我們現在隨著需求越大的時候\n\n13:47.509 --> 13:58.744\n那大家很遺憾的是最近立法院通過的普發現金要把兩千三百五十億發出去而不是投入我們關心的社會福利或是醫療體系對此部長有什麼看法\n\n13:59.475 --> 14:19.686\n我想醫療體系跟社福它是一個長久的一個規劃所以如果國家有財富比較盈利的時候應該把醫療的需求符合來醫療的需求跟社福的需求這應該是會比較能夠一本多利能夠有時候要看它的\n\n14:20.866 --> 14:44.755\n效率也許能夠創造創造人民更多的健康更長遠穩定的事情會創造更多的健康跟幸福最後就請我們的衛福部應該要確保我們的醫療量能然後輕重症的病患都能夠受到妥善照顧還有就要保障醫護人員的一個權益還有落實醫療分級以上謝謝好謝謝林委員謝謝林委員謝謝部長\n\n","segments":[{"start":6.996,"end":19.249,"text":"主席麻煩邱部長委員好部長晚安晚安不好意思"},{"start":23.538,"end":39.888,"text":"上禮拜一的那個丹納斯颱風造成中南部很嚴重的災情台電人員在這週都還在搶救那到7月12號就上週六的中午為止急救的那個責任醫院收治的緊急傷病患總計大概713人"},{"start":41.389,"end":56.201,"text":"突顯在緊急天災的時候維持醫療的量能的重要性可是有媒體報導颱風期間有很多中部的醫院事實上是縮減服務有的甚至停止門診這情形在過去不太明顯不過本席認為為了維護醫療人員的"},{"start":58.823,"end":79.404,"text":"安全的話 颱風天醫院縮減服務大概是情有可願 可是有一屆人是懷疑今年的特例跟剛上路的醫院個別總額的事辦計畫是有關的所以對醫院來說恐怕會擔心就診的人數超過總額那導致點數打折 所以颱風天就乾脆就"},{"start":82.455,"end":107.336,"text":"所以想問部長說如果這是事實的話那就是一個很嚴重的警訊所以請部長針對媒體提出來的疑問做回應好 謝謝委員的垂行跟關心我們在颱風天或者一般時候的一個醫療的運作那像張基總院陳木寬院長所提的要信諾對病人的承諾我想所有的醫院的院長"},{"start":108.317,"end":133.013,"text":"都是懷抱有這樣的情懷所以不會受到幾乎是不會因為颱風天而是很故意就除了說向南部就沒水沒電那當然是沒辦法反而我們現在都要去補助他那中部這個我跟委員報告一下我們7月1號到15號也就是在風災這段期間中區分歧的"},{"start":134.134,"end":160.426,"text":"健保IC卡的上傳件數還比去年113人成長11.5%表示他們的看診並沒有受到風災的影響所以這個我相信中部的醫院應該是不質疑因為可能停班你如果停班讓你去外面來就變成假班所以那可能有些"},{"start":161.627,"end":166.852,"text":"現在颱風天上班也不好,基層的醫護也是非常重視這個醫院也很重視安全,所以現在都有颱風天上班的規定所以我們在安全的經營之下"},{"start":179.813,"end":192.393,"text":"其實便宜也都只能在運作除了它真的被因為台灣現在風險也比較高隨時又有可能短時間內出現我們的大量傷患健保支付制度如果沒有妥善規劃的話影響到緊急狀況的"},{"start":195.537,"end":212.831,"text":"醫療量能的話這是民眾很擔心的事情請民眾安心我們的各位醫院總和現在運轉得很好而且也沒有發生人球的事件可是在此之前醫院個別總和制在南區就已經試辦大概實施了三年到今年一月中"},{"start":213.491,"end":229.269,"text":"一月在中区开始实施全国最晚实施的是台北区从今年的4月1号开始所以请问部长台北区最晚实施的原因是不是因为医学中心比别的地区多那需要更多的时间沟通是因为这个原因吗"},{"start":230.074,"end":256.768,"text":"是因為台北區的文化因為我在台北市也很久他們都覺得他們是要接受很嚴重的病人不能沒有後路了啦所以比較大的醫院包括台大籠總他會覺得說他們有先天的使命所以他們很擔心這樣的一個是不是影響到他們照顧病人結果我們溝通以後他們也發現說如果讓我們的這樣一個一定的"},{"start":258.318,"end":287.26,"text":"總而之下也根本也有一些剛性需求的話也不受影響需要的集中症那個都不受影響另外也可以把一些比較輕症的病人能夠盡量在分級醫療的理念之下放給那個比較屬於中小型或地區的醫院這樣反而形成一個良好的一個分級醫療而且有一點點財務的控制財務控制是其實不只醫院啦也是區域都在管那是不是我們也跟他"},{"start":288.001,"end":315.467,"text":"跟他溝通就是未來的方向也要讓民眾健康促進讓整個所有的健保也要朝向讓民眾更健康那這樣的話就變成一個分級醫療以此做對人民健康最好的一個模式那以到目前來講北區也得大家應做得相當好那用醫院個別總而治來控制健保經費支出這當然直接影響到醫院門診檢查手術甚至急救"},{"start":316.247,"end":336.014,"text":"等可以收治的病人數量我們擔心醫院為了健保點數不要超過總額發生拒收重症病患的狀況所以也要請教部長說那這樣子要怎麼去避免這種狀況發生好 謝謝委員我是不是請站派署署長簡調的跟大家報告一下"},{"start":336.494,"end":351.071,"text":"跟委員報告從我們的統計來看我們在疫情前國人就醫的次數每年是15次在所有的OECD國家是非常非常的高那麼到了疫後我們從去年的數字又再往上升已經逼近17次了"},{"start":351.892,"end":369.809,"text":"所以這中間一定可以有管理的地方所以我們希望透過醫院的個別總額來強化分級醫療那麼對於慢性病的管理也好跟病人的就醫能夠有適當的一些好的管理措施那也可以讓國人得到照顧"},{"start":370.53,"end":397.744,"text":"所以急重症的部分呢我們都是在個別總和裡面呢都是保障在中區的話他們是沒有限制只要你是急重症的他都是保障成長所以不會有斷頭的情形可是中區當然我覺得目前看起來不是太我寧願已經實施三年可是民眾普遍相信台北的醫院又多又好啦所以外縣市的急重症的病患經常都會到台北區的那個教學"},{"start":398.744,"end":417.2,"text":"醫學中心來所以從圖表上可以看到是說台北區的健保點子從前年到去年增加的幅度是非常明顯的可是病人總不能都擠到台北區所以應該是就近就醫才比較好所以如果說要盡可能讓他們就近就醫的話你們的對策是什麼"},{"start":417.78,"end":433.474,"text":"跟文包我們都有在監測流入跟流出所以從這幾年這幾個我們按季按月都在監測這個台北區的流入情形並沒有增加整個比例是沒有增加那當然各地區的醫院的數量"},{"start":434.355,"end":455.638,"text":"還有這個病床數確實也有變動所以像北區或台北區北區這幾年的醫院的加速是增加病床數也增加那當然他就會影響到這個分佈的情形所以並沒有讓台北區的就醫人數有明顯的增加所以我覺得後期可以觀察因為接下來台北也要執行"},{"start":458.019,"end":472.646,"text":"中的榮總因二零二五年第一劑的健保申報的點數就超出額度那遭健保署核三了三億元那另外張基也是光總院就核三掉一點二億元這凸顯醫院在個別總額"},{"start":474.987,"end":493.347,"text":"好的上邊來看的話馬上就會面對到一些困境那健保署的說法呢事實上是健保總額執行已經行之有年的話那現行的個別醫院的總額制的是南區實施的做法那南區的經驗現在是成功的那推行到全國"},{"start":494.608,"end":521.798,"text":"我剛講台北事件4月1號執行的話那後邊到底會怎麼樣不太確定因為南區只有兩家醫學中心而且健保點子都是比較高的那一樣的制度在台北區可能會不會面對到很多問題所以想問說對醫院來說要控制健保總額要避免虧損除了要減少病患以外就是從醫護人員的薪水下手這是我們最擔心的衛福部有沒有應對的措施去解決這種可能出現的"},{"start":522.998,"end":544.291,"text":"醫護減薪然後不賬薪或是預缺不補的問題跟委員報告我們第一劑今年的第一劑跟去年的第一劑相比所有的醫院的點值都是大幅的提升以台北區為例去年醫院的點值在沒有斷頭之前那麼大概不到0.9那今年呢已經是0.93"},{"start":547.453,"end":569.787,"text":"所以比去年都是提升的那醫院的營收也都是成長的那但是相對的醫院的病床的規模並沒有明顯的增加啦在台北區而言所以我們現在正在積極的希望呢醫院把這個增加的這個收入呢那麼能夠轉化成在人員的加薪上面我們在做這個努力"},{"start":570.547,"end":596.207,"text":"所以有再去促成這件事嗎因為我們最擔心的就是這個在這個總額被限制的制度裡面門診量跟手術量大的醫生聽起來也是會不會相對被變相被處罰因為事情卻做得越多跟報酬卻無法增加那要怎麼去避免這種狀況根文報告我們都有相關的這監測那麼我剛剛也提到有一些的門診的次數確實可以減少那麼醫療人員的"},{"start":601.251,"end":624.851,"text":"這個過勞情形其實也是蠻重的所以我們希望透過好的管理也讓這個醫護人員減壓啦那至於是剛性的需求這個在我們的總額裡面都是保障的而且在明年在談總額成長的時候個別醫院總額成長的時候也會看他的人力的投入情形有沒有增加薪資的這個署長剛剛也提到南區"},{"start":625.872,"end":649.671,"text":"事實上你覺得是成功經驗可是媒體有報導說在最早開始用這個制度的時候南區就已經開始有部分醫院用降薪限制醫生門診量跟手術量還有全力鼓吹病患自費等等的方式去控制不讓醫療點數超過每劑的總額所以想問說為了避免無效醫療當我們覺得浪費資源或過度控制手術量"},{"start":650.653,"end":662.597,"text":"門診量跟檢查量是需要的 必要的一個措施在可是如果醫院為了省錢讓手術量門診量跟檢查量下降就會傷害當地區的醫療量能這個問題你們要怎麼去應對"},{"start":664.592,"end":685.332,"text":"跟委員報告其實這個我們南區先實施之後高屏區然後北區就是陸陸續續大家還跟進也就是大家互相在學習一個制度剛上路的時候難免有需要調整的地方但是經過南區先行這幾年之後那麼發現了他其實大家都"},{"start":685.973,"end":711.589,"text":"都很滿意啦所以才持續擴大到其他的各區以現在第一劑為例南區的點值超過1.1塊錢了那麼高屏區也是差不多是0.99啦所以靠近這個1啦所以相對於這個沒有實施之前來講呢那麼其實這個對醫院的營收更穩定那它更能夠做比較中長期的規劃"},{"start":713.117,"end":728.395,"text":"好 疏解醫院門診壓力的解方就是弱勢分級醫療所以為了控制總額各醫院可能把重症的病人轉出去重症病人事實上是不會往送去診所而是到各大醫院"},{"start":729.256,"end":748.549,"text":"的那個診間去轉診踢來踢去最後把被送到不能再將病人轉出去的部立醫院或者醫學中心結果導致呢部立醫院跟醫學中心負擔更大醫護工作量更大所以部長想問說你們衛福怎麼去因應病人如果被當人球轉來轉去的問題"},{"start":751.091,"end":774.846,"text":"這個我們都有監測的指標在看就是病人的轉出轉入在我們的健保系統裡面都看得非常的清楚從哪邊轉來的比例有多少這個都很清楚的指標都在而且我們剛剛也提到說在急重症的部分他是剛性需求是被保障成長的那相對的呢你這個轉診的不當轉診呢那我們就會把你調降成為用"},{"start":775.586,"end":797.401,"text":"不保障點植的方式去處理所以對醫院我們也會有一些處罰的措施不過署長寫請教一下以南區為例在個別總額以下過去三年大醫院的輕症病轉回地區醫院或診所的成效怎麼樣因為你剛剛講說我不知道你有沒有掌握這個成效"},{"start":798.82,"end":826.269,"text":"就是轉診的部分那個南區的轉診成效都是蠻好的沒有什麼問題我們再提供詳細的數字給再麻煩那最後想問因為我覺得不管天災或平時台灣醫療體系的需求越來越大政府有餘裕應該是投入社會福利或醫療體系而不是普發現金這是我的看法所以請問部長因為的確我們現在隨著需求越大的時候"},{"start":827.509,"end":838.744,"text":"那大家很遺憾的是最近立法院通過的普發現金要把兩千三百五十億發出去而不是投入我們關心的社會福利或是醫療體系對此部長有什麼看法"},{"start":839.475,"end":859.686,"text":"我想醫療體系跟社福它是一個長久的一個規劃所以如果國家有財富比較盈利的時候應該把醫療的需求符合來醫療的需求跟社福的需求這應該是會比較能夠一本多利能夠有時候要看它的"},{"start":860.866,"end":884.755,"text":"效率也許能夠創造 創造人民更多的健康 更長遠穩定的事情會創造更多的健康跟幸福最後就請我們的衛福部應該要確保我們的醫療量能然後輕重症的病患都能夠受到妥善照顧還有就要保障醫護人員的一個權益 還有落實醫療分級 以上謝謝好 謝謝林委員謝謝林委員 謝謝部長"}]}}},"gazette":{"lineno":1122,"blocks":[["林委員月琴：（11時56分）主席，麻煩邱部長。"],["主席：請邱部長。"],["邱部長泰源：委員好。"],["林委員月琴：部長午安。"],["邱部長泰源：午安。"],["林委員月琴：上禮拜一的丹娜絲颱風造成中南部很嚴重的災情，台電人員到這週都還在搶救，到7月12號上週六的中午為止，急救的責任醫院，收治緊急傷病患總計大概713人，凸顯在緊急天災時維持醫療量能的重要性。可是有媒體報導颱風期間有很多中部醫院事實上是縮減服務，有的甚至停止門診，這個情形在過去不太明顯，不過本席認為，為了維護醫療人員的安全，颱風天醫院縮減服務是情有可原，但有醫界人士懷疑，今年的特例跟剛上路的醫院個別總額制的試辦計畫有關，對醫院來說，恐怕會擔心就診人數超過總額，導致點數打折，所以颱風天就乾脆停診了。想問部長，如果這個是事實的話，那就是一個很嚴重的警訊，請部長針對媒體提出來的疑問做回應。"],["邱部長泰源：謝謝委員的垂詢跟關心我們在颱風天或者一般時候的醫療運作。彰基總院陳穆寬院長所提：要信守對病人的承諾。我想所有醫院的院長都是懷抱這樣的情懷，幾乎不會因為颱風天而故意……除非像南部沒水、沒電，那當然就沒辦法，反而我們現在都要去補助他們。","我跟委員報告一下，7月1號到15號，也就是風災這段期間，中區分局健保IC卡上傳的件數還比去年113人成長11.5%，表示病患看診並沒有受到風災的影響，所以我相信中部的醫院應該是不至於……如果停班，護理人員來就變成加班，可能有些因為風大……現在颱風天上班也不太好，現在基層醫護也非常重視這個，醫院也很重視安全，所以現在都在研議颱風天上班的規定……"],["林委員月琴：對，因為颱風……"],["邱部長泰源：在安全的情形之下，其實醫院也都儘量在運作，除非它真的被停電、停水。"],["林委員月琴：因為臺灣天災風險也比較高，隨時又有可能短時間內出現大量傷患，健保支付制度如果沒有妥善規劃，影響到緊急狀況的醫療量能的話，這是民眾很擔心的事情。"],["邱部長泰源：請民眾安心，現在我們各個醫院都運轉得很好，而且也沒有發生人球的事件。"],["林委員月琴：可是在此之前，醫院個別總額制在南區大概就已經實施了3年，今年1月在中區開始實施，全國最晚實施的是臺北區，是從今年的4月1號開始。請問部長，臺北區最晚實施的原因是不是因為醫學中心比別的地區多，因此需要更多的時間溝通，是因為這個原因嗎？"],["邱部長泰源：是，因為臺北區的文化，我在臺北區也很久了，他們都覺得他們要接受很嚴重的病人，他們沒有後路了，所以比較大的醫院，像臺大、榮總會覺得有先天的使命在，因此很擔心這樣是不是會影響到他們照顧病人？溝通以後他們也發現，如果在一定的總額之下，即使有剛性需求、需要的急重症都不受影響。此外，在分級醫療的理念下，可以把一些比較輕症的病人放給中小型或地區醫院，這樣反而可以形成良好的分級醫療制度，且有一點點的財務控制。其實需要財務控制的不只醫院，整個區域都在管控範圍，所以我們也跟他們溝通，未來除了促進民眾健康外，健保也要朝讓民眾更健康的方向去改進，如此就可以形成分級醫療，這是對人民健康最好的模式。就目前來講，北區運作得相當順利。"],["林委員月琴：以醫院個別總額制來控制健保經費支出，當然會直接影響到醫院門診的檢查、手術，甚至急救等可以收治的病人數量。我們擔心醫院為了不讓健保點數超過總額，從而拒收重症病患，所以本席要請教部長，該如何避免這種狀況發生？"],["邱部長泰源：謝謝委員。是不是請健保署署長簡要向大家報告一下？"],["石署長崇良：跟委員報告，從我們的統計來看，疫情前國人就醫的次數每年是15次，這在OECD國家中來說非常非常的高。到了疫後，去年的數字又再往上升，已經逼近17次，所以中間一定有可以管理的地方。因此，我們希望透過醫院的個別總額來強化分級醫療，這樣不論對慢性病的管理或病人的就醫，都能有適當且好的管理措施，同時可以讓國人得到照顧。所以在急重症的部分，我們都在個別總額裡保障！至於中區是沒有限制的，只要是急重症的都保障成長，不會有斷頭的情形發生。"],["林委員月琴：目前看起來，中區不太有問題，因為已經實施三年。可是民眾普遍相信臺北的醫院又多又好，所以外縣市的急重症病患經常到臺北區的教學醫學中心就診，從圖表上可以看到，臺北區的健保點值從前年到去年所增加的幅度非常明顯，但總不能讓病人都擠到臺北區，應該是就近就醫比較好。如果要儘可能讓病人就近就醫的話，您的對策是什麼？"],["石署長崇良：跟委員報告，我們都有在監測流入跟流出。這幾年我們按季按月在監測，我們發現臺北區的流入情形並沒有增加，就整個比例來說並沒有增加。當然，各地區醫院的數量還有病床數確實有變動，像北區或臺北區來說，北區這幾年的醫院家數是增加的，病床數也增加，這就會影響到分布，不過臺北區的就醫人數並沒有明顯增加。"],["林委員月琴：我覺得後期可以再觀察，因為接下來臺北區也要執行了。臺中榮總在2025年第一季的健保申報點數就超出額度，遭健保署核刪了3億元；另外，彰基總院也核刪掉1.2億元，凸顯醫院在個別總額上會立即面臨困境。依據健保署的說法來看，健保總額執行已行之有年，而現行個別醫院總額制則是南區所實施的作法。現在南區的經驗是成功的，打算推行到全國。我剛剛有講，臺北市從4月1日開始執行，後續到底會怎麼樣？其實還不太確定。畢竟南區只有兩家醫學中心，且其健保點值都是比較高的，所以一樣的制度到了臺北區會不會面臨很多問題？為此本席想問，對醫院來說，要控制健保總額、避免虧損，除了減少病患外，就是從醫護人員的薪水下手，這是我們最擔心的！請問衛福部有沒有應對措施，以解決這種可能出現的醫護減薪、不漲薪或遇缺不補的問題？"],["石署長崇良：跟委員報告，我們今年的第一季跟去年第一季相比，所有醫院的點值都大幅提升！以臺北區為例，去年醫院點值在沒有斷頭之前大概不到0.9，但今年已經達到0.93，較去年提升，而醫院的營收也都是成長的。但相對來說，臺北區的醫院病床規模並沒有明顯增加，所以我們積極希望醫院能把所增加的收入轉化在人員的加薪上，我們正在做這個努力。"],["林委員月琴：所以有去促成這件事？"],["石署長崇良：有。"],["林委員月琴：這是我們最擔心的！再者，在限制總額的制度裡，門診量與手術量大的醫生會不會被變相處罰？因為事情做得越多，報酬卻無法增加，所以該怎麼去避免這種狀況？"],["石署長崇良：跟委員報告，我們都有做相關的監測。我剛剛也提到，有些門診次數確實可以減少。再者，醫療人員過勞其實也嚴重的，所以我們希望可以透過好的管理來讓醫護人員減壓。至於剛性需求，我們在總額裡面都有保障，且明年在總額成長，在個別醫院總額的成長上，也會看人力的投入有沒有增加薪資的……"],["林委員月琴：署長，我剛才有提到南區，署長覺得南區是成功的經驗，可是媒體卻報導說，最早開始實施該制度時，南區就已經有部分醫院降薪，並限制醫生的門診量跟手術量！還有，全力鼓吹病患自費等等的方式去控制，不讓醫療點數超過每季總額。所以我想請問，為了避免無效醫療，當然，減少浪費資源或控制手術量、門診量與檢查量是必要措施，但如果醫院為了省錢，讓手術量、門診量跟檢查量下降，就會傷害當地區的醫療量能！這個問題你們要怎麼去應對？"],["石署長崇良：跟委員報告，我們從南區先實施，之後是高屏區，然後北區，即陸陸續續跟進，大家互相學習。一個制度剛上路時，難免有需要調整的地方，但這幾年經過南區先行後，我們發現大家都很滿意，所以才持續擴大到其他各區。以第一季為例，南區的點值超過1.1元，高屏區則差不多是0.989，接近1元，相對於沒有實施之前，其實讓醫院的營收更穩定，也更能夠做比較中長期的規劃。"],["林委員月琴：我想紓解醫院門診壓力的解方就是落實分級醫療，為了控制總額，各醫院可能會把重症病人轉出去。但事實上，重症病人並不會送往診所，所以其實是在各大醫院的診間轉診，踢來踢去，最後送到不能再將病人轉出去的部立醫院或醫學中心，導致部立醫院跟醫學中心負擔更大，醫護工作量更大！請問部長，對於病人被當成人球轉來轉去，衛福部要怎麼因應？"],["石署長崇良：我們有在看監測指標，也就是病人的轉出轉入在健保系統裡都看得非常清楚，譬如從哪邊轉來的？比例有多少？這些都有很清楚的指標。而且剛剛也有提到，急重症部分屬剛性需求，是被保障成長的，但相對的，如果不當轉診，那麼我們就會調降成不保障點值的方式去處理，所以對醫院也會有一些處罰措施，不會讓病人成為人球。"],["林委員月琴：以南區為例，在個別總額底下，過去三年大醫院輕症病人轉回地區醫院或診所的成效怎麼樣？不知道你們有沒有掌握到成效？"],["石署長崇良：以轉診來說，南區轉診成效都蠻好的，沒有什麼問題，我們再提供詳細的數字給委員參考。"],["林委員月琴：再麻煩。最後想問，不管天災或平時，臺灣醫療體系的需求越來越大，若政府有餘裕，應該要投入社會福利或醫療體系，而不是普發現金，這是我的看法。在隨著需求越大之際，很遺憾的最近立法院通過普發現金，要把2,350億發出去，而不是投入我很關心的社會福利或醫療體系。對此，部長有什麼看法？"],["邱部長泰源：我想醫療體系跟社福是一個長久的規劃，所以國家財務如果比較盈餘的時候，能夠先照顧醫療的需求跟社福的需求，這應該是比較能夠一本多利，有時候要看它的效率，也許能夠創造人民更多的健康跟幸福……"],["林委員月琴：對，把錢財集中去做更長遠穩定的事情事實上是比較重要的。","最後，請衛福部應該要確保我們的醫療量能，讓輕重症病患都能夠受到妥善的照顧。還有，我覺得要保障醫護人員的權益以及落實醫療分級。以上，謝謝。"],["邱部長泰源：好，謝謝委員。"],["主席：謝謝林委員，謝謝部長及署長。","接續我們請許宇甄委員質詢。"]],"agenda":{"page_end":398,"meet_id":"委員會-11-3-26-21","speakers":["蘇清泉","陳昭姿","陳菁徽","王育敏","涂權吉","賴惠員","邱鎮軍","林淑芬","陳冠廷","劉建國","黃秀芳","林月琴","許宇甄","徐欣瑩","王正旭","陳瑩","陳永康","楊曜","廖偉翔","盧縣一"],"page_start":325,"meetingDate":["2025-07-17"],"gazette_id":"1146701","agenda_lcidc_ids":["1146701_00007"],"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21次全體委員會議紀錄","content":"邀請衛生福利部部長、勞動部部長、財政部部長、農業部針對「因應嚴重災情、緊急重大事件，\n醫療院所承擔救護量能困境及因應台美關稅談判對台灣食品安全相關影響」進行專題報告，並備\n質詢","agenda_id":"1146701_00006"}}}