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00:00:41,200\n部長這個議題其實我也非常的關心而且跟非洲豬瘟一樣非常嚴重很多人已經在新聞上看到最近為什麼大家又發現兒科醫師大出走是因為北榮直接說他們有四位總醫師都不願意留任那另外你也看到台大醫院的主任已經下海開始值班那我昨天有去請教了一些台大小兒科的前輩他們說像今年錄取例\n\n3\n00:00:43,241 --> 00:01:06,103\n1.5他們雖然把它做成一個網路上的笑話是苦中作樂啦但他說錄取率1.5已經持續三年了那為什麼今年才特別被人家注意是因為主任也必須要下海值班好你可能以為錄取率而科醫師1.5是單純台大問題我們攤開全國的各專科醫師最新住院醫師\n\n4\n00:01:07,464 --> 00:01:32,790\n招收率還有兒科住院醫師招收率等等這是平均就是五成不是只有台大醫院問題是全國的問題但為什麼你需要來搶救這件事情是因為醫學中心都已經淪陷了醫學中心是最後一線全國大家不懂的不會的就送到醫學中心台大榮總等等的\n\n5\n00:01:33,630 --> 00:01:58,358\n那連醫學中心都變成主任院長要下來值班那他們的教學怎麼辦研究怎麼辦行政怎麼辦所以這是一個惡性循環我知道您之前曾經提過說你要去培養急重症人才尤其是兒科急診專科醫師的人才這樣才可以舒緩兒科的人力嘛結果呢我跟您報告最近兩年全國就有\n\n6\n00:02:00,458 --> 00:02:27,584\n31個兒科的急診醫師離開醫院您是急診醫師你很懂啊那在基隆市新竹市像這樣子都會區兒科醫師平均一個人照顧是300到500個人宜蘭一個兒科醫師要照顧的是21820人遠超過全國平均1165人所以我認為您這個問題因為其實累積了多年那今年一口氣爆發\n\n7\n00:02:29,215 --> 00:02:45,455\n你可能需要更快的方式來處理你有沒有什麼想法跟委員說明確實我看了這個近五年的這個兒科的招收率我們現在兒科的容額大概在每年130個左右那麼兒科的招收率大概都在六成\n\n8\n00:02:46,236 --> 00:03:00,184\n去年才到七成勉強到七成所以換言之就是各位您的這個資料看到就七八十位啦所以以這樣的數目確實難以因應全國的需求您講的六成是他願意訓練還有留任問題\n\n9\n00:03:01,604 --> 00:03:25,456\n那就是后来训练完之后的流向流向的话目前大概三成八留在医院那另外有六成二就是在基层开业所以我们现在从去年开始第一步对于这个走儿科的住院医师有津贴就一年每个月有一万块的津贴给走儿科的住院医师以及他的fellow他比如说他是选儿童遗传\n\n10\n00:03:25,976 --> 00:03:48,923\n或者是這個兒童的一些次專科那重症的ICU急診次專科類似像這樣那如果是小兒外科的話每個月是津貼是3萬這去年開始我們再觀察後面那第二個是我們在總額的部分明年會特別匡列從0到6歲在總額的部分匡列249億這專門給兒科來調整支付標準\n\n11\n00:03:52,904 --> 00:04:11,957\n然后保障1.1块钱所以把所有的0到6岁儿童的住院的费用要全面性的调高那么让这个在医院里面做集中症的这个儿科医师的收入可以提高那这是第二个第三个在贫贱的部分我们过去贫贱是像一般性贫贱\n\n12\n00:04:12,597 --> 00:04:31,762\n那会特别融入呢在医学中心的部分都需要有儿科的专门评鉴过去我们是只有儿童医院有专门儿童的这个评鉴那我们是有四家儿童医院那明年开始我们的医学中心的儿科所有的医学儿科都是我们重点\n\n13\n00:04:32,242 --> 00:04:57,723\n要平的部分也把它融入在評鑑裡頭那同時的另外一個因為剛剛跟委員說明了大概有六成二的兒科醫師是在基層開業所以我們包含了0到3歲的幼兒專責醫師制度還有從這個兒童的核心醫院到責任醫院我們也結合這個開業的醫師大家一起來照顧\n\n14\n00:04:58,864 --> 00:05:25,806\n我先问一个问题刚刚那个住院医师fellow可以多拿一万很好但你看今年北荣的问题就是他们结束了住院医师他是之后的留任对啊对他就是训练的时候有然后之后要训练完之后有没有要留在医院所以我们才会把他再纳入在平健里头同时把儿科儿童的住院的给他拉高那保障一个总额那我刚刚提到的\n\n15\n00:05:26,710 --> 00:05:46,577\n急诊的专责儿童医师怎么办他流失很快没有人要做我们是一步一步来因为如果我们现在把所有的儿童到急诊都要儿科来看会雪上加霜所以我们现在先不要要求说所有的儿童到急诊来都要儿科医师来看\n\n16\n00:05:47,337 --> 00:06:13,477\n反而是應該先第一步的他需要只要做一些比較那個小baby就是我們比較小的確實是需要然後用區域聯防的方式兒科用照會的方式就好然後我們一步一步的在把這個兒童的照護強化在這個急診的部分所以我們另外有一個網絡就是兒童醫療網的部分那個是去強化兒童的急診的照護你這樣講急診醫師可能也會跳起來\n\n17\n00:06:14,602 --> 00:06:38,937\n不会啦我是急诊出生的我们过去的训练里头就包含处理儿童的问题啦因为急诊医师的流失现在跟儿科医师的流失是在比速度诶这个急诊的问题是另外一块那就是刚刚提到那个急诊的拥塞那个需要处理所以我们现在积极的在处理这个急诊拥塞的问题来降低急诊医师的负荷这样好这个\n\n18\n00:06:40,671 --> 00:07:00,053\n當然我們很贊成您做這個優化兒童醫療照護計畫但很多全國的兒童醫院院長他們完全不敢公開講所以我來幫他們講他們希望問你說優化兒童醫療照護計畫的錢已經11月了但是還沒有撥下來\n\n19\n00:07:00,914 --> 00:07:13,739\n是不是真的因為你每年都說明年會改善但現在要11月了還沒有給錢醫院要自己墊像你這樣子的效率你剛講很多啊0到6歲撥了一筆錢等等你這個效率是怎麼支持兒童醫療\n\n20\n00:07:16,039 --> 00:07:43,318\n預算是應該已經有在這裡現在是撥款您提的是撥款的速度嘛這個我再了解一下那個意思是在這個撥款的部分我會來注意這個撥款的速度一週你會告訴我我才可以告訴這些院長一週內另外也跟委員報告就是說今年另外還有一個這個叫做健康台灣生根計畫這個到明年底一共是160億那裡面對於\n\n21\n00:07:45,880 --> 00:08:10,817\n這個兒童的兒童醫院都拿到了這個每個醫院幾乎都是有1億的補助在給他們去發展依照不同醫院提出來的計畫好再來有一個是勞動部我質詢勞動部結果勞動部說要問你啊勞動部部長直接走到我前面說這個問題你要問的是衛福部部長好就是他們即將推出的看一下這張圖的右邊\n\n22\n00:08:12,298 --> 00:08:38,586\n勞動部說呢未來1月1號很快兩個月後就要開始了可以用日來申請育嬰留職停薪所以他在小孩子兩歲以內好像可以請30天最多那我們會遇到什麼問題因為醫事人員跟托育人員已經開始跟我陳情那你一定要盡快準備因為趕快找勞動部溝通你只剩下兩個月可以準備第一\n\n23\n00:08:39,706 --> 00:09:02,783\n這個我自己也有請過現在暈流停最少大概是一個月像我們這樣子醫事人員護理師醫師放射師等等的我們要跑兩個地方一個是工會嘛工會是辦你的職業登記你現在的這個有在做這個業務還是沒有在做這個業務這個是工會在管的那衛生局就是管你的職登就是說我現在在哪一個機構上班\n\n24\n00:09:04,124 --> 00:09:19,751\n好所以之前還沒有實施彈性暈流停的時候護理師就已經抱怨連連的因為他們要跑流程要跑工會要跑衛生局還要跟院方要停職證明復職證明這個我了解這就是那個這個\n\n25\n00:09:24,193 --> 00:09:50,267\n執停業登記啦就是說如果你是沒有執行業務要辦理這個這個停業登記嘛那這個是短期的不用這個在行政程序上我會請醫師私立課發文這種短期的這個育嬰留庭有的是長期啦你一次兩年的那你就要先去這個辦理這個沒有一個月的也要啊一個月兩個月三個月都要啊都要啊我們會把它處理這個程序上我們來談一下\n\n26\n00:09:51,708 --> 00:10:18,109\n現在很多護理師他其實是願意的他不一定想要請長期他覺得這樣一天一天請是很好但我不希望這些流程太過繁瑣到最後他就不想請了反而一口氣請久一點我們現在當然很在意的是護理師護理師也有一個護理師黃但其實醫師藥師檢驗師所有的醫事員你都必須要一起把他引你進去所以你多久內一個月內\n\n27\n00:10:20,211 --> 00:10:45,508\n一個月內可以給我們這個然後另外你也會發給全部各地的衛生局所有的衛生局跟醫院去遵循去簡化這個程序啦不需要這樣很繁複那第二個這也是您的業務範圍內就是托育人員托育人員他們有這樣子的一個系統可以看到這個機構他每一個托育人員目前的托育數規定是1比5嘛但是如果他做到1比4是可以有補助的\n\n28\n00:10:45,948 --> 00:11:06,788\n也是一样遇到一样的问题假使这位托育人员他要请弹性孕假就必须要把他移除移除就是停业停业就要把他的托育数放到别人的身上所以他也许一个机构他其实是很体恤他的同仁的所以他让他请弹性但却因为这样子影响到他拿补助的机会这样怎么办呢\n\n29\n00:11:08,759 --> 00:11:27,244\n就是说他没有额外的不是他让他请了弹性育婴可是他的就类似我们的护病笔1比4个小孩本来他可以达到被你补助的被你奖励的结果他就被迫变成1比5他就拿不到怎么办\n\n30\n00:11:29,338 --> 00:11:52,345\n因為這個還牽涉到那個這個托這個托育人員的loading所以如果馬上就說通通就他的loading也增加了他等於是這個機構沒有多餘的彈性能力像在在醫院的話他這個育嬰流停的時候就會有另外的護理人員不是因為之前當然因為之前育嬰流停比較久\n\n31\n00:11:54,145 --> 00:12:03,885\n比較長是月嘛以月為單位的嘛那當然就可以去儲備這些人物現在是1月1號改成以日為單位以日\n\n32\n00:12:05,393 --> 00:12:27,527\n你是不是要找社家署短期我是覺得還可以的但是如果是比較長的時間也不好這樣的話那個托育的品質也會下降我再找社家署討論一下第一個問題是這個主席第二個問題很快要結束第二個問題是我現在問了所有的托營機構還有地方政府的社會局現在地方政府社會局量能是不足的\n\n33\n00:12:27,947 --> 00:12:50,840\n所以對他們而言也是一樣的意思他們現在光是跑這個行政流程就是說他們要請一個月的暈假他們都是跑行政流程要辦理停業啊到職離職等等至少要三天以上比剛講到的衛生局還要久三天以上喔所以他們現在也無所適從他不知道說他請了他必須要等到這個流程跑完他才可以放這個假\n\n34\n00:12:51,660 --> 00:13:14,213\n還是說他可以先去照顧他小孩一天然後回來等這個流程跑完沒關係並且地方的社會局應該也沒有辦法應付這樣子的狀況跟我剛講到的一模一樣好這個行政程序的部分我也請社家署一起來討論行政程序跟照顧比這個也是一個月內可以拿到您的報告好謝謝謝謝部長好謝謝好謝謝陳偉謝謝部長\n\n35\n00:13:20,310 --> 00:13:21,854\n接下來請邱正軍委員來做懸檔\n\n","tsv":"start\tend\ttext\n2125\t9138\t謝謝主席 我想請石部長請石部長曾委員長\n12628\t41200\t部長這個議題其實我也非常的關心而且跟非洲豬瘟一樣非常嚴重很多人已經在新聞上看到最近為什麼大家又發現兒科醫師大出走是因為北榮直接說他們有四位總醫師都不願意留任那另外你也看到台大醫院的主任已經下海開始值班那我昨天有去請教了一些台大小兒科的前輩他們說像今年錄取例\n43241\t66103\t1.5他們雖然把它做成一個網路上的笑話是苦中作樂啦但他說錄取率1.5已經持續三年了那為什麼今年才特別被人家注意是因為主任也必須要下海值班好你可能以為錄取率而科醫師1.5是單純台大問題我們攤開全國的各專科醫師最新住院醫師\n67464\t92790\t招收率還有兒科住院醫師招收率等等這是平均就是五成不是只有台大醫院問題是全國的問題但為什麼你需要來搶救這件事情是因為醫學中心都已經淪陷了醫學中心是最後一線全國大家不懂的不會的就送到醫學中心台大榮總等等的\n93630\t118358\t那連醫學中心都變成主任院長要下來值班那他們的教學怎麼辦研究怎麼辦行政怎麼辦所以這是一個惡性循環我知道您之前曾經提過說你要去培養急重症人才尤其是兒科急診專科醫師的人才這樣才可以舒緩兒科的人力嘛結果呢我跟您報告最近兩年全國就有\n120458\t147584\t31個兒科的急診醫師離開醫院您是急診醫師你很懂啊那在基隆市新竹市像這樣子都會區兒科醫師平均一個人照顧是300到500個人宜蘭一個兒科醫師要照顧的是21820人遠超過全國平均1165人所以我認為您這個問題因為其實累積了多年那今年一口氣爆發\n149215\t165455\t你可能需要更快的方式來處理你有沒有什麼想法跟委員說明確實我看了這個近五年的這個兒科的招收率我們現在兒科的容額大概在每年130個左右那麼兒科的招收率大概都在六成\n166236\t180184\t去年才到七成勉強到七成所以換言之就是各位您的這個資料看到就七八十位啦所以以這樣的數目確實難以因應全國的需求您講的六成是他願意訓練還有留任問題\n181604\t205456\t那就是后来训练完之后的流向流向的话目前大概三成八留在医院那另外有六成二就是在基层开业所以我们现在从去年开始第一步对于这个走儿科的住院医师有津贴就一年每个月有一万块的津贴给走儿科的住院医师以及他的fellow他比如说他是选儿童遗传\n205976\t228923\t或者是這個兒童的一些次專科那重症的ICU急診次專科類似像這樣那如果是小兒外科的話每個月是津貼是3萬這去年開始我們再觀察後面那第二個是我們在總額的部分明年會特別匡列從0到6歲在總額的部分匡列249億這專門給兒科來調整支付標準\n232904\t251957\t然后保障1.1块钱所以把所有的0到6岁儿童的住院的费用要全面性的调高那么让这个在医院里面做集中症的这个儿科医师的收入可以提高那这是第二个第三个在贫贱的部分我们过去贫贱是像一般性贫贱\n252597\t271762\t那会特别融入呢在医学中心的部分都需要有儿科的专门评鉴过去我们是只有儿童医院有专门儿童的这个评鉴那我们是有四家儿童医院那明年开始我们的医学中心的儿科所有的医学儿科都是我们重点\n272242\t297723\t要平的部分也把它融入在評鑑裡頭那同時的另外一個因為剛剛跟委員說明了大概有六成二的兒科醫師是在基層開業所以我們包含了0到3歲的幼兒專責醫師制度還有從這個兒童的核心醫院到責任醫院我們也結合這個開業的醫師大家一起來照顧\n298864\t325806\t我先问一个问题刚刚那个住院医师fellow可以多拿一万很好但你看今年北荣的问题就是他们结束了住院医师他是之后的留任对啊对他就是训练的时候有然后之后要训练完之后有没有要留在医院所以我们才会把他再纳入在平健里头同时把儿科儿童的住院的给他拉高那保障一个总额那我刚刚提到的\n326710\t346577\t急诊的专责儿童医师怎么办他流失很快没有人要做我们是一步一步来因为如果我们现在把所有的儿童到急诊都要儿科来看会雪上加霜所以我们现在先不要要求说所有的儿童到急诊来都要儿科医师来看\n347337\t373477\t反而是應該先第一步的他需要只要做一些比較那個小baby就是我們比較小的確實是需要然後用區域聯防的方式兒科用照會的方式就好然後我們一步一步的在把這個兒童的照護強化在這個急診的部分所以我們另外有一個網絡就是兒童醫療網的部分那個是去強化兒童的急診的照護你這樣講急診醫師可能也會跳起來\n374602\t398937\t不会啦我是急诊出生的我们过去的训练里头就包含处理儿童的问题啦因为急诊医师的流失现在跟儿科医师的流失是在比速度诶这个急诊的问题是另外一块那就是刚刚提到那个急诊的拥塞那个需要处理所以我们现在积极的在处理这个急诊拥塞的问题来降低急诊医师的负荷这样好这个\n400671\t420053\t當然我們很贊成您做這個優化兒童醫療照護計畫但很多全國的兒童醫院院長他們完全不敢公開講所以我來幫他們講他們希望問你說優化兒童醫療照護計畫的錢已經11月了但是還沒有撥下來\n420914\t433739\t是不是真的因為你每年都說明年會改善但現在要11月了還沒有給錢醫院要自己墊像你這樣子的效率你剛講很多啊0到6歲撥了一筆錢等等你這個效率是怎麼支持兒童醫療\n436039\t463318\t預算是應該已經有在這裡現在是撥款您提的是撥款的速度嘛這個我再了解一下那個意思是在這個撥款的部分我會來注意這個撥款的速度一週你會告訴我我才可以告訴這些院長一週內另外也跟委員報告就是說今年另外還有一個這個叫做健康台灣生根計畫這個到明年底一共是160億那裡面對於\n465880\t490817\t這個兒童的 兒童醫院都拿到了這個每個醫院幾乎都是有1億的補助在給他們去發展依照不同醫院提出來的計畫好 再來有一個是勞動部 我質詢勞動部結果勞動部說要問你啊勞動部部長直接走到我前面說這個問題你要問的是衛福部部長好 就是他們即將推出的看一下這張圖的右邊\n492298\t518586\t勞動部說呢未來1月1號很快兩個月後就要開始了可以用日來申請育嬰留職停薪所以他在小孩子兩歲以內好像可以請30天最多那我們會遇到什麼問題因為醫事人員跟托育人員已經開始跟我陳情那你一定要盡快準備因為趕快找勞動部溝通你只剩下兩個月可以準備第一\n519706\t542783\t這個我自己也有請過 現在暈流停最少大概是一個月像我們這樣子醫事人員 護理師 醫師 放射師等等的我們要跑兩個地方 一個是工會嘛工會是辦你的職業登記 你現在的這個有在做這個業務 還是沒有在做這個業務這個是工會在管的 那衛生局就是管你的職登就是說我現在在哪一個機構上班\n544124\t559751\t好所以之前還沒有實施彈性暈流停的時候護理師就已經抱怨連連的因為他們要跑流程要跑工會要跑衛生局還要跟院方要停職證明復職證明這個我了解這就是那個這個\n564193\t590267\t執停業登記啦就是說如果你是沒有執行業務要辦理這個這個停業登記嘛那這個是短期的不用這個在行政程序上我會請醫師私立課發文這種短期的這個育嬰留庭有的是長期啦你一次兩年的那你就要先去這個辦理這個沒有一個月的也要啊一個月兩個月三個月都要啊都要啊我們會把它處理這個程序上我們來談一下\n591708\t618109\t現在很多護理師他其實是願意的他不一定想要請長期他覺得這樣一天一天請是很好但我不希望這些流程太過繁瑣到最後他就不想請了反而一口氣請久一點我們現在當然很在意的是護理師護理師也有一個護理師黃但其實醫師 藥師 檢驗師所有的醫事員你都必須要一起把他引你進去所以你多久內一個月內\n620211\t645508\t一個月內可以給我們這個然後另外你也會發給全部各地的衛生局所有的衛生局跟醫院去遵循去簡化這個程序啦不需要這樣很繁複那第二個這也是您的業務範圍內就是托育人員托育人員他們有這樣子的一個系統可以看到這個機構他每一個托育人員目前的托育數規定是1比5嘛但是如果他做到1比4是可以有補助的\n645948\t666788\t也是一样遇到一样的问题假使这位托育人员他要请弹性孕假就必须要把他移除移除就是停业停业就要把他的托育数放到别人的身上所以他也许一个机构他其实是很体恤他的同仁的所以他让他请弹性但却因为这样子影响到他拿补助的机会这样怎么办呢\n668759\t687244\t就是说他没有额外的不是他让他请了弹性育婴可是他的就类似我们的护病笔1比4个小孩本来他可以达到被你补助的被你奖励的结果他就被迫变成1比5他就拿不到怎么办\n689338\t712345\t因為這個還牽涉到那個這個托這個托育人員的loading所以如果馬上就說通通就他的loading也增加了他等於是這個機構沒有多餘的彈性能力像在在醫院的話他這個育嬰流停的時候就會有另外的護理人員不是因為之前當然因為之前育嬰流停比較久\n714145\t723885\t比較長是月嘛以月為單位的嘛那當然就可以去儲備這些人物現在是1月1號改成以日為單位以日\n725393\t747527\t你是不是要找社家署短期我是覺得還可以的但是如果是比較長的時間也不好這樣的話那個托育的品質也會下降我再找社家署討論一下第一個問題是這個主席第二個問題很快要結束第二個問題是我現在問了所有的托營機構還有地方政府的社會局現在地方政府社會局量能是不足的\n747947\t770840\t所以對他們而言也是一樣的意思他們現在光是跑這個行政流程就是說他們要請一個月的暈假他們都是跑行政流程要辦理停業啊到職離職等等至少要三天以上比剛講到的衛生局還要久三天以上喔所以他們現在也無所適從他不知道說他請了他必須要等到這個流程跑完他才可以放這個假\n771660\t794213\t還是說他可以先去照顧他小孩一天然後回來等這個流程跑完沒關係並且地方的社會局應該也沒有辦法應付這樣子的狀況跟我剛講到的一模一樣好 這個行政程序的部分我也請社家署一起來討論行政程序跟照顧比這個也是一個月內可以拿到您的報告好 謝謝 謝謝部長好 謝謝好 謝謝陳偉 謝謝部長\n800310\t801854\t接下來請邱正軍委員來做懸檔\n","txt":"謝謝主席 我想請石部長請石部長曾委員長\n部長這個議題其實我也非常的關心而且跟非洲豬瘟一樣非常嚴重很多人已經在新聞上看到最近為什麼大家又發現兒科醫師大出走是因為北榮直接說他們有四位總醫師都不願意留任那另外你也看到台大醫院的主任已經下海開始值班那我昨天有去請教了一些台大小兒科的前輩他們說像今年錄取例\n1.5他們雖然把它做成一個網路上的笑話是苦中作樂啦但他說錄取率1.5已經持續三年了那為什麼今年才特別被人家注意是因為主任也必須要下海值班好你可能以為錄取率而科醫師1.5是單純台大問題我們攤開全國的各專科醫師最新住院醫師\n招收率還有兒科住院醫師招收率等等這是平均就是五成不是只有台大醫院問題是全國的問題但為什麼你需要來搶救這件事情是因為醫學中心都已經淪陷了醫學中心是最後一線全國大家不懂的不會的就送到醫學中心台大榮總等等的\n那連醫學中心都變成主任院長要下來值班那他們的教學怎麼辦研究怎麼辦行政怎麼辦所以這是一個惡性循環我知道您之前曾經提過說你要去培養急重症人才尤其是兒科急診專科醫師的人才這樣才可以舒緩兒科的人力嘛結果呢我跟您報告最近兩年全國就有\n31個兒科的急診醫師離開醫院您是急診醫師你很懂啊那在基隆市新竹市像這樣子都會區兒科醫師平均一個人照顧是300到500個人宜蘭一個兒科醫師要照顧的是21820人遠超過全國平均1165人所以我認為您這個問題因為其實累積了多年那今年一口氣爆發\n你可能需要更快的方式來處理你有沒有什麼想法跟委員說明確實我看了這個近五年的這個兒科的招收率我們現在兒科的容額大概在每年130個左右那麼兒科的招收率大概都在六成\n去年才到七成勉強到七成所以換言之就是各位您的這個資料看到就七八十位啦所以以這樣的數目確實難以因應全國的需求您講的六成是他願意訓練還有留任問題\n那就是后来训练完之后的流向流向的话目前大概三成八留在医院那另外有六成二就是在基层开业所以我们现在从去年开始第一步对于这个走儿科的住院医师有津贴就一年每个月有一万块的津贴给走儿科的住院医师以及他的fellow他比如说他是选儿童遗传\n或者是這個兒童的一些次專科那重症的ICU急診次專科類似像這樣那如果是小兒外科的話每個月是津貼是3萬這去年開始我們再觀察後面那第二個是我們在總額的部分明年會特別匡列從0到6歲在總額的部分匡列249億這專門給兒科來調整支付標準\n然后保障1.1块钱所以把所有的0到6岁儿童的住院的费用要全面性的调高那么让这个在医院里面做集中症的这个儿科医师的收入可以提高那这是第二个第三个在贫贱的部分我们过去贫贱是像一般性贫贱\n那会特别融入呢在医学中心的部分都需要有儿科的专门评鉴过去我们是只有儿童医院有专门儿童的这个评鉴那我们是有四家儿童医院那明年开始我们的医学中心的儿科所有的医学儿科都是我们重点\n要平的部分也把它融入在評鑑裡頭那同時的另外一個因為剛剛跟委員說明了大概有六成二的兒科醫師是在基層開業所以我們包含了0到3歲的幼兒專責醫師制度還有從這個兒童的核心醫院到責任醫院我們也結合這個開業的醫師大家一起來照顧\n我先问一个问题刚刚那个住院医师fellow可以多拿一万很好但你看今年北荣的问题就是他们结束了住院医师他是之后的留任对啊对他就是训练的时候有然后之后要训练完之后有没有要留在医院所以我们才会把他再纳入在平健里头同时把儿科儿童的住院的给他拉高那保障一个总额那我刚刚提到的\n急诊的专责儿童医师怎么办他流失很快没有人要做我们是一步一步来因为如果我们现在把所有的儿童到急诊都要儿科来看会雪上加霜所以我们现在先不要要求说所有的儿童到急诊来都要儿科医师来看\n反而是應該先第一步的他需要只要做一些比較那個小baby就是我們比較小的確實是需要然後用區域聯防的方式兒科用照會的方式就好然後我們一步一步的在把這個兒童的照護強化在這個急診的部分所以我們另外有一個網絡就是兒童醫療網的部分那個是去強化兒童的急診的照護你這樣講急診醫師可能也會跳起來\n不会啦我是急诊出生的我们过去的训练里头就包含处理儿童的问题啦因为急诊医师的流失现在跟儿科医师的流失是在比速度诶这个急诊的问题是另外一块那就是刚刚提到那个急诊的拥塞那个需要处理所以我们现在积极的在处理这个急诊拥塞的问题来降低急诊医师的负荷这样好这个\n當然我們很贊成您做這個優化兒童醫療照護計畫但很多全國的兒童醫院院長他們完全不敢公開講所以我來幫他們講他們希望問你說優化兒童醫療照護計畫的錢已經11月了但是還沒有撥下來\n是不是真的因為你每年都說明年會改善但現在要11月了還沒有給錢醫院要自己墊像你這樣子的效率你剛講很多啊0到6歲撥了一筆錢等等你這個效率是怎麼支持兒童醫療\n預算是應該已經有在這裡現在是撥款您提的是撥款的速度嘛這個我再了解一下那個意思是在這個撥款的部分我會來注意這個撥款的速度一週你會告訴我我才可以告訴這些院長一週內另外也跟委員報告就是說今年另外還有一個這個叫做健康台灣生根計畫這個到明年底一共是160億那裡面對於\n這個兒童的 兒童醫院都拿到了這個每個醫院幾乎都是有1億的補助在給他們去發展依照不同醫院提出來的計畫好 再來有一個是勞動部 我質詢勞動部結果勞動部說要問你啊勞動部部長直接走到我前面說這個問題你要問的是衛福部部長好 就是他們即將推出的看一下這張圖的右邊\n勞動部說呢未來1月1號很快兩個月後就要開始了可以用日來申請育嬰留職停薪所以他在小孩子兩歲以內好像可以請30天最多那我們會遇到什麼問題因為醫事人員跟托育人員已經開始跟我陳情那你一定要盡快準備因為趕快找勞動部溝通你只剩下兩個月可以準備第一\n這個我自己也有請過 現在暈流停最少大概是一個月像我們這樣子醫事人員 護理師 醫師 放射師等等的我們要跑兩個地方 一個是工會嘛工會是辦你的職業登記 你現在的這個有在做這個業務 還是沒有在做這個業務這個是工會在管的 那衛生局就是管你的職登就是說我現在在哪一個機構上班\n好所以之前還沒有實施彈性暈流停的時候護理師就已經抱怨連連的因為他們要跑流程要跑工會要跑衛生局還要跟院方要停職證明復職證明這個我了解這就是那個這個\n執停業登記啦就是說如果你是沒有執行業務要辦理這個這個停業登記嘛那這個是短期的不用這個在行政程序上我會請醫師私立課發文這種短期的這個育嬰留庭有的是長期啦你一次兩年的那你就要先去這個辦理這個沒有一個月的也要啊一個月兩個月三個月都要啊都要啊我們會把它處理這個程序上我們來談一下\n現在很多護理師他其實是願意的他不一定想要請長期他覺得這樣一天一天請是很好但我不希望這些流程太過繁瑣到最後他就不想請了反而一口氣請久一點我們現在當然很在意的是護理師護理師也有一個護理師黃但其實醫師 藥師 檢驗師所有的醫事員你都必須要一起把他引你進去所以你多久內一個月內\n一個月內可以給我們這個然後另外你也會發給全部各地的衛生局所有的衛生局跟醫院去遵循去簡化這個程序啦不需要這樣很繁複那第二個這也是您的業務範圍內就是托育人員托育人員他們有這樣子的一個系統可以看到這個機構他每一個托育人員目前的托育數規定是1比5嘛但是如果他做到1比4是可以有補助的\n也是一样遇到一样的问题假使这位托育人员他要请弹性孕假就必须要把他移除移除就是停业停业就要把他的托育数放到别人的身上所以他也许一个机构他其实是很体恤他的同仁的所以他让他请弹性但却因为这样子影响到他拿补助的机会这样怎么办呢\n就是说他没有额外的不是他让他请了弹性育婴可是他的就类似我们的护病笔1比4个小孩本来他可以达到被你补助的被你奖励的结果他就被迫变成1比5他就拿不到怎么办\n因為這個還牽涉到那個這個托這個托育人員的loading所以如果馬上就說通通就他的loading也增加了他等於是這個機構沒有多餘的彈性能力像在在醫院的話他這個育嬰流停的時候就會有另外的護理人員不是因為之前當然因為之前育嬰流停比較久\n比較長是月嘛以月為單位的嘛那當然就可以去儲備這些人物現在是1月1號改成以日為單位以日\n你是不是要找社家署短期我是覺得還可以的但是如果是比較長的時間也不好這樣的話那個托育的品質也會下降我再找社家署討論一下第一個問題是這個主席第二個問題很快要結束第二個問題是我現在問了所有的托營機構還有地方政府的社會局現在地方政府社會局量能是不足的\n所以對他們而言也是一樣的意思他們現在光是跑這個行政流程就是說他們要請一個月的暈假他們都是跑行政流程要辦理停業啊到職離職等等至少要三天以上比剛講到的衛生局還要久三天以上喔所以他們現在也無所適從他不知道說他請了他必須要等到這個流程跑完他才可以放這個假\n還是說他可以先去照顧他小孩一天然後回來等這個流程跑完沒關係並且地方的社會局應該也沒有辦法應付這樣子的狀況跟我剛講到的一模一樣好 這個行政程序的部分我也請社家署一起來討論行政程序跟照顧比這個也是一個月內可以拿到您的報告好 謝謝 謝謝部長好 謝謝好 謝謝陳偉 謝謝部長\n接下來請邱正軍委員來做懸檔\n","vtt":"WEBVTT\n\n00:02.125 --> 00:09.138\n謝謝主席我想請石部長請石部長曾委員長\n\n00:12.628 --> 00:41.200\n部長這個議題其實我也非常的關心而且跟非洲豬瘟一樣非常嚴重很多人已經在新聞上看到最近為什麼大家又發現兒科醫師大出走是因為北榮直接說他們有四位總醫師都不願意留任那另外你也看到台大醫院的主任已經下海開始值班那我昨天有去請教了一些台大小兒科的前輩他們說像今年錄取例\n\n00:43.241 --> 01:06.103\n1.5他們雖然把它做成一個網路上的笑話是苦中作樂啦但他說錄取率1.5已經持續三年了那為什麼今年才特別被人家注意是因為主任也必須要下海值班好你可能以為錄取率而科醫師1.5是單純台大問題我們攤開全國的各專科醫師最新住院醫師\n\n01:07.464 --> 01:32.790\n招收率還有兒科住院醫師招收率等等這是平均就是五成不是只有台大醫院問題是全國的問題但為什麼你需要來搶救這件事情是因為醫學中心都已經淪陷了醫學中心是最後一線全國大家不懂的不會的就送到醫學中心台大榮總等等的\n\n01:33.630 --> 01:58.358\n那連醫學中心都變成主任院長要下來值班那他們的教學怎麼辦研究怎麼辦行政怎麼辦所以這是一個惡性循環我知道您之前曾經提過說你要去培養急重症人才尤其是兒科急診專科醫師的人才這樣才可以舒緩兒科的人力嘛結果呢我跟您報告最近兩年全國就有\n\n02:00.458 --> 02:27.584\n31個兒科的急診醫師離開醫院您是急診醫師你很懂啊那在基隆市新竹市像這樣子都會區兒科醫師平均一個人照顧是300到500個人宜蘭一個兒科醫師要照顧的是21820人遠超過全國平均1165人所以我認為您這個問題因為其實累積了多年那今年一口氣爆發\n\n02:29.215 --> 02:45.455\n你可能需要更快的方式來處理你有沒有什麼想法跟委員說明確實我看了這個近五年的這個兒科的招收率我們現在兒科的容額大概在每年130個左右那麼兒科的招收率大概都在六成\n\n02:46.236 --> 03:00.184\n去年才到七成勉強到七成所以換言之就是各位您的這個資料看到就七八十位啦所以以這樣的數目確實難以因應全國的需求您講的六成是他願意訓練還有留任問題\n\n03:01.604 --> 03:25.456\n那就是后来训练完之后的流向流向的话目前大概三成八留在医院那另外有六成二就是在基层开业所以我们现在从去年开始第一步对于这个走儿科的住院医师有津贴就一年每个月有一万块的津贴给走儿科的住院医师以及他的fellow他比如说他是选儿童遗传\n\n03:25.976 --> 03:48.923\n或者是這個兒童的一些次專科那重症的ICU急診次專科類似像這樣那如果是小兒外科的話每個月是津貼是3萬這去年開始我們再觀察後面那第二個是我們在總額的部分明年會特別匡列從0到6歲在總額的部分匡列249億這專門給兒科來調整支付標準\n\n03:52.904 --> 04:11.957\n然后保障1.1块钱所以把所有的0到6岁儿童的住院的费用要全面性的调高那么让这个在医院里面做集中症的这个儿科医师的收入可以提高那这是第二个第三个在贫贱的部分我们过去贫贱是像一般性贫贱\n\n04:12.597 --> 04:31.762\n那会特别融入呢在医学中心的部分都需要有儿科的专门评鉴过去我们是只有儿童医院有专门儿童的这个评鉴那我们是有四家儿童医院那明年开始我们的医学中心的儿科所有的医学儿科都是我们重点\n\n04:32.242 --> 04:57.723\n要平的部分也把它融入在評鑑裡頭那同時的另外一個因為剛剛跟委員說明了大概有六成二的兒科醫師是在基層開業所以我們包含了0到3歲的幼兒專責醫師制度還有從這個兒童的核心醫院到責任醫院我們也結合這個開業的醫師大家一起來照顧\n\n04:58.864 --> 05:25.806\n我先问一个问题刚刚那个住院医师fellow可以多拿一万很好但你看今年北荣的问题就是他们结束了住院医师他是之后的留任对啊对他就是训练的时候有然后之后要训练完之后有没有要留在医院所以我们才会把他再纳入在平健里头同时把儿科儿童的住院的给他拉高那保障一个总额那我刚刚提到的\n\n05:26.710 --> 05:46.577\n急诊的专责儿童医师怎么办他流失很快没有人要做我们是一步一步来因为如果我们现在把所有的儿童到急诊都要儿科来看会雪上加霜所以我们现在先不要要求说所有的儿童到急诊来都要儿科医师来看\n\n05:47.337 --> 06:13.477\n反而是應該先第一步的他需要只要做一些比較那個小baby就是我們比較小的確實是需要然後用區域聯防的方式兒科用照會的方式就好然後我們一步一步的在把這個兒童的照護強化在這個急診的部分所以我們另外有一個網絡就是兒童醫療網的部分那個是去強化兒童的急診的照護你這樣講急診醫師可能也會跳起來\n\n06:14.602 --> 06:38.937\n不会啦我是急诊出生的我们过去的训练里头就包含处理儿童的问题啦因为急诊医师的流失现在跟儿科医师的流失是在比速度诶这个急诊的问题是另外一块那就是刚刚提到那个急诊的拥塞那个需要处理所以我们现在积极的在处理这个急诊拥塞的问题来降低急诊医师的负荷这样好这个\n\n06:40.671 --> 07:00.053\n當然我們很贊成您做這個優化兒童醫療照護計畫但很多全國的兒童醫院院長他們完全不敢公開講所以我來幫他們講他們希望問你說優化兒童醫療照護計畫的錢已經11月了但是還沒有撥下來\n\n07:00.914 --> 07:13.739\n是不是真的因為你每年都說明年會改善但現在要11月了還沒有給錢醫院要自己墊像你這樣子的效率你剛講很多啊0到6歲撥了一筆錢等等你這個效率是怎麼支持兒童醫療\n\n07:16.039 --> 07:43.318\n預算是應該已經有在這裡現在是撥款您提的是撥款的速度嘛這個我再了解一下那個意思是在這個撥款的部分我會來注意這個撥款的速度一週你會告訴我我才可以告訴這些院長一週內另外也跟委員報告就是說今年另外還有一個這個叫做健康台灣生根計畫這個到明年底一共是160億那裡面對於\n\n07:45.880 --> 08:10.817\n這個兒童的兒童醫院都拿到了這個每個醫院幾乎都是有1億的補助在給他們去發展依照不同醫院提出來的計畫好再來有一個是勞動部我質詢勞動部結果勞動部說要問你啊勞動部部長直接走到我前面說這個問題你要問的是衛福部部長好就是他們即將推出的看一下這張圖的右邊\n\n08:12.298 --> 08:38.586\n勞動部說呢未來1月1號很快兩個月後就要開始了可以用日來申請育嬰留職停薪所以他在小孩子兩歲以內好像可以請30天最多那我們會遇到什麼問題因為醫事人員跟托育人員已經開始跟我陳情那你一定要盡快準備因為趕快找勞動部溝通你只剩下兩個月可以準備第一\n\n08:39.706 --> 09:02.783\n這個我自己也有請過現在暈流停最少大概是一個月像我們這樣子醫事人員護理師醫師放射師等等的我們要跑兩個地方一個是工會嘛工會是辦你的職業登記你現在的這個有在做這個業務還是沒有在做這個業務這個是工會在管的那衛生局就是管你的職登就是說我現在在哪一個機構上班\n\n09:04.124 --> 09:19.751\n好所以之前還沒有實施彈性暈流停的時候護理師就已經抱怨連連的因為他們要跑流程要跑工會要跑衛生局還要跟院方要停職證明復職證明這個我了解這就是那個這個\n\n09:24.193 --> 09:50.267\n執停業登記啦就是說如果你是沒有執行業務要辦理這個這個停業登記嘛那這個是短期的不用這個在行政程序上我會請醫師私立課發文這種短期的這個育嬰留庭有的是長期啦你一次兩年的那你就要先去這個辦理這個沒有一個月的也要啊一個月兩個月三個月都要啊都要啊我們會把它處理這個程序上我們來談一下\n\n09:51.708 --> 10:18.109\n現在很多護理師他其實是願意的他不一定想要請長期他覺得這樣一天一天請是很好但我不希望這些流程太過繁瑣到最後他就不想請了反而一口氣請久一點我們現在當然很在意的是護理師護理師也有一個護理師黃但其實醫師藥師檢驗師所有的醫事員你都必須要一起把他引你進去所以你多久內一個月內\n\n10:20.211 --> 10:45.508\n一個月內可以給我們這個然後另外你也會發給全部各地的衛生局所有的衛生局跟醫院去遵循去簡化這個程序啦不需要這樣很繁複那第二個這也是您的業務範圍內就是托育人員托育人員他們有這樣子的一個系統可以看到這個機構他每一個托育人員目前的托育數規定是1比5嘛但是如果他做到1比4是可以有補助的\n\n10:45.948 --> 11:06.788\n也是一样遇到一样的问题假使这位托育人员他要请弹性孕假就必须要把他移除移除就是停业停业就要把他的托育数放到别人的身上所以他也许一个机构他其实是很体恤他的同仁的所以他让他请弹性但却因为这样子影响到他拿补助的机会这样怎么办呢\n\n11:08.759 --> 11:27.244\n就是说他没有额外的不是他让他请了弹性育婴可是他的就类似我们的护病笔1比4个小孩本来他可以达到被你补助的被你奖励的结果他就被迫变成1比5他就拿不到怎么办\n\n11:29.338 --> 11:52.345\n因為這個還牽涉到那個這個托這個托育人員的loading所以如果馬上就說通通就他的loading也增加了他等於是這個機構沒有多餘的彈性能力像在在醫院的話他這個育嬰流停的時候就會有另外的護理人員不是因為之前當然因為之前育嬰流停比較久\n\n11:54.145 --> 12:03.885\n比較長是月嘛以月為單位的嘛那當然就可以去儲備這些人物現在是1月1號改成以日為單位以日\n\n12:05.393 --> 12:27.527\n你是不是要找社家署短期我是覺得還可以的但是如果是比較長的時間也不好這樣的話那個托育的品質也會下降我再找社家署討論一下第一個問題是這個主席第二個問題很快要結束第二個問題是我現在問了所有的托營機構還有地方政府的社會局現在地方政府社會局量能是不足的\n\n12:27.947 --> 12:50.840\n所以對他們而言也是一樣的意思他們現在光是跑這個行政流程就是說他們要請一個月的暈假他們都是跑行政流程要辦理停業啊到職離職等等至少要三天以上比剛講到的衛生局還要久三天以上喔所以他們現在也無所適從他不知道說他請了他必須要等到這個流程跑完他才可以放這個假\n\n12:51.660 --> 13:14.213\n還是說他可以先去照顧他小孩一天然後回來等這個流程跑完沒關係並且地方的社會局應該也沒有辦法應付這樣子的狀況跟我剛講到的一模一樣好這個行政程序的部分我也請社家署一起來討論行政程序跟照顧比這個也是一個月內可以拿到您的報告好謝謝謝謝部長好謝謝好謝謝陳偉謝謝部長\n\n13:20.310 --> 13:21.854\n接下來請邱正軍委員來做懸檔\n\n","segments":[{"start":2.125,"end":9.138,"text":"謝謝主席 我想請石部長請石部長曾委員長"},{"start":12.628,"end":41.2,"text":"部長這個議題其實我也非常的關心而且跟非洲豬瘟一樣非常嚴重很多人已經在新聞上看到最近為什麼大家又發現兒科醫師大出走是因為北榮直接說他們有四位總醫師都不願意留任那另外你也看到台大醫院的主任已經下海開始值班那我昨天有去請教了一些台大小兒科的前輩他們說像今年錄取例"},{"start":43.241,"end":66.103,"text":"1.5他們雖然把它做成一個網路上的笑話是苦中作樂啦但他說錄取率1.5已經持續三年了那為什麼今年才特別被人家注意是因為主任也必須要下海值班好你可能以為錄取率而科醫師1.5是單純台大問題我們攤開全國的各專科醫師最新住院醫師"},{"start":67.464,"end":92.79,"text":"招收率還有兒科住院醫師招收率等等這是平均就是五成不是只有台大醫院問題是全國的問題但為什麼你需要來搶救這件事情是因為醫學中心都已經淪陷了醫學中心是最後一線全國大家不懂的不會的就送到醫學中心台大榮總等等的"},{"start":93.63,"end":118.358,"text":"那連醫學中心都變成主任院長要下來值班那他們的教學怎麼辦研究怎麼辦行政怎麼辦所以這是一個惡性循環我知道您之前曾經提過說你要去培養急重症人才尤其是兒科急診專科醫師的人才這樣才可以舒緩兒科的人力嘛結果呢我跟您報告最近兩年全國就有"},{"start":120.458,"end":147.584,"text":"31個兒科的急診醫師離開醫院您是急診醫師你很懂啊那在基隆市新竹市像這樣子都會區兒科醫師平均一個人照顧是300到500個人宜蘭一個兒科醫師要照顧的是21820人遠超過全國平均1165人所以我認為您這個問題因為其實累積了多年那今年一口氣爆發"},{"start":149.215,"end":165.455,"text":"你可能需要更快的方式來處理你有沒有什麼想法跟委員說明確實我看了這個近五年的這個兒科的招收率我們現在兒科的容額大概在每年130個左右那麼兒科的招收率大概都在六成"},{"start":166.236,"end":180.184,"text":"去年才到七成勉強到七成所以換言之就是各位您的這個資料看到就七八十位啦所以以這樣的數目確實難以因應全國的需求您講的六成是他願意訓練還有留任問題"},{"start":181.604,"end":205.456,"text":"那就是后来训练完之后的流向流向的话目前大概三成八留在医院那另外有六成二就是在基层开业所以我们现在从去年开始第一步对于这个走儿科的住院医师有津贴就一年每个月有一万块的津贴给走儿科的住院医师以及他的fellow他比如说他是选儿童遗传"},{"start":205.976,"end":228.923,"text":"或者是這個兒童的一些次專科那重症的ICU急診次專科類似像這樣那如果是小兒外科的話每個月是津貼是3萬這去年開始我們再觀察後面那第二個是我們在總額的部分明年會特別匡列從0到6歲在總額的部分匡列249億這專門給兒科來調整支付標準"},{"start":232.904,"end":251.957,"text":"然后保障1.1块钱所以把所有的0到6岁儿童的住院的费用要全面性的调高那么让这个在医院里面做集中症的这个儿科医师的收入可以提高那这是第二个第三个在贫贱的部分我们过去贫贱是像一般性贫贱"},{"start":252.597,"end":271.762,"text":"那会特别融入呢在医学中心的部分都需要有儿科的专门评鉴过去我们是只有儿童医院有专门儿童的这个评鉴那我们是有四家儿童医院那明年开始我们的医学中心的儿科所有的医学儿科都是我们重点"},{"start":272.242,"end":297.723,"text":"要平的部分也把它融入在評鑑裡頭那同時的另外一個因為剛剛跟委員說明了大概有六成二的兒科醫師是在基層開業所以我們包含了0到3歲的幼兒專責醫師制度還有從這個兒童的核心醫院到責任醫院我們也結合這個開業的醫師大家一起來照顧"},{"start":298.864,"end":325.806,"text":"我先问一个问题刚刚那个住院医师fellow可以多拿一万很好但你看今年北荣的问题就是他们结束了住院医师他是之后的留任对啊对他就是训练的时候有然后之后要训练完之后有没有要留在医院所以我们才会把他再纳入在平健里头同时把儿科儿童的住院的给他拉高那保障一个总额那我刚刚提到的"},{"start":326.71,"end":346.577,"text":"急诊的专责儿童医师怎么办他流失很快没有人要做我们是一步一步来因为如果我们现在把所有的儿童到急诊都要儿科来看会雪上加霜所以我们现在先不要要求说所有的儿童到急诊来都要儿科医师来看"},{"start":347.337,"end":373.477,"text":"反而是應該先第一步的他需要只要做一些比較那個小baby就是我們比較小的確實是需要然後用區域聯防的方式兒科用照會的方式就好然後我們一步一步的在把這個兒童的照護強化在這個急診的部分所以我們另外有一個網絡就是兒童醫療網的部分那個是去強化兒童的急診的照護你這樣講急診醫師可能也會跳起來"},{"start":374.602,"end":398.937,"text":"不会啦我是急诊出生的我们过去的训练里头就包含处理儿童的问题啦因为急诊医师的流失现在跟儿科医师的流失是在比速度诶这个急诊的问题是另外一块那就是刚刚提到那个急诊的拥塞那个需要处理所以我们现在积极的在处理这个急诊拥塞的问题来降低急诊医师的负荷这样好这个"},{"start":400.671,"end":420.053,"text":"當然我們很贊成您做這個優化兒童醫療照護計畫但很多全國的兒童醫院院長他們完全不敢公開講所以我來幫他們講他們希望問你說優化兒童醫療照護計畫的錢已經11月了但是還沒有撥下來"},{"start":420.914,"end":433.739,"text":"是不是真的因為你每年都說明年會改善但現在要11月了還沒有給錢醫院要自己墊像你這樣子的效率你剛講很多啊0到6歲撥了一筆錢等等你這個效率是怎麼支持兒童醫療"},{"start":436.039,"end":463.318,"text":"預算是應該已經有在這裡現在是撥款您提的是撥款的速度嘛這個我再了解一下那個意思是在這個撥款的部分我會來注意這個撥款的速度一週你會告訴我我才可以告訴這些院長一週內另外也跟委員報告就是說今年另外還有一個這個叫做健康台灣生根計畫這個到明年底一共是160億那裡面對於"},{"start":465.88,"end":490.817,"text":"這個兒童的 兒童醫院都拿到了這個每個醫院幾乎都是有1億的補助在給他們去發展依照不同醫院提出來的計畫好 再來有一個是勞動部 我質詢勞動部結果勞動部說要問你啊勞動部部長直接走到我前面說這個問題你要問的是衛福部部長好 就是他們即將推出的看一下這張圖的右邊"},{"start":492.298,"end":518.586,"text":"勞動部說呢未來1月1號很快兩個月後就要開始了可以用日來申請育嬰留職停薪所以他在小孩子兩歲以內好像可以請30天最多那我們會遇到什麼問題因為醫事人員跟托育人員已經開始跟我陳情那你一定要盡快準備因為趕快找勞動部溝通你只剩下兩個月可以準備第一"},{"start":519.706,"end":542.783,"text":"這個我自己也有請過 現在暈流停最少大概是一個月像我們這樣子醫事人員 護理師 醫師 放射師等等的我們要跑兩個地方 一個是工會嘛工會是辦你的職業登記 你現在的這個有在做這個業務 還是沒有在做這個業務這個是工會在管的 那衛生局就是管你的職登就是說我現在在哪一個機構上班"},{"start":544.124,"end":559.751,"text":"好所以之前還沒有實施彈性暈流停的時候護理師就已經抱怨連連的因為他們要跑流程要跑工會要跑衛生局還要跟院方要停職證明復職證明這個我了解這就是那個這個"},{"start":564.193,"end":590.267,"text":"執停業登記啦就是說如果你是沒有執行業務要辦理這個這個停業登記嘛那這個是短期的不用這個在行政程序上我會請醫師私立課發文這種短期的這個育嬰留庭有的是長期啦你一次兩年的那你就要先去這個辦理這個沒有一個月的也要啊一個月兩個月三個月都要啊都要啊我們會把它處理這個程序上我們來談一下"},{"start":591.708,"end":618.109,"text":"現在很多護理師他其實是願意的他不一定想要請長期他覺得這樣一天一天請是很好但我不希望這些流程太過繁瑣到最後他就不想請了反而一口氣請久一點我們現在當然很在意的是護理師護理師也有一個護理師黃但其實醫師 藥師 檢驗師所有的醫事員你都必須要一起把他引你進去所以你多久內一個月內"},{"start":620.211,"end":645.508,"text":"一個月內可以給我們這個然後另外你也會發給全部各地的衛生局所有的衛生局跟醫院去遵循去簡化這個程序啦不需要這樣很繁複那第二個這也是您的業務範圍內就是托育人員托育人員他們有這樣子的一個系統可以看到這個機構他每一個托育人員目前的托育數規定是1比5嘛但是如果他做到1比4是可以有補助的"},{"start":645.948,"end":666.788,"text":"也是一样遇到一样的问题假使这位托育人员他要请弹性孕假就必须要把他移除移除就是停业停业就要把他的托育数放到别人的身上所以他也许一个机构他其实是很体恤他的同仁的所以他让他请弹性但却因为这样子影响到他拿补助的机会这样怎么办呢"},{"start":668.759,"end":687.244,"text":"就是说他没有额外的不是他让他请了弹性育婴可是他的就类似我们的护病笔1比4个小孩本来他可以达到被你补助的被你奖励的结果他就被迫变成1比5他就拿不到怎么办"},{"start":689.338,"end":712.345,"text":"因為這個還牽涉到那個這個托這個托育人員的loading所以如果馬上就說通通就他的loading也增加了他等於是這個機構沒有多餘的彈性能力像在在醫院的話他這個育嬰流停的時候就會有另外的護理人員不是因為之前當然因為之前育嬰流停比較久"},{"start":714.145,"end":723.885,"text":"比較長是月嘛以月為單位的嘛那當然就可以去儲備這些人物現在是1月1號改成以日為單位以日"},{"start":725.393,"end":747.527,"text":"你是不是要找社家署短期我是覺得還可以的但是如果是比較長的時間也不好這樣的話那個托育的品質也會下降我再找社家署討論一下第一個問題是這個主席第二個問題很快要結束第二個問題是我現在問了所有的托營機構還有地方政府的社會局現在地方政府社會局量能是不足的"},{"start":747.947,"end":770.84,"text":"所以對他們而言也是一樣的意思他們現在光是跑這個行政流程就是說他們要請一個月的暈假他們都是跑行政流程要辦理停業啊到職離職等等至少要三天以上比剛講到的衛生局還要久三天以上喔所以他們現在也無所適從他不知道說他請了他必須要等到這個流程跑完他才可以放這個假"},{"start":771.66,"end":794.213,"text":"還是說他可以先去照顧他小孩一天然後回來等這個流程跑完沒關係並且地方的社會局應該也沒有辦法應付這樣子的狀況跟我剛講到的一模一樣好 這個行政程序的部分我也請社家署一起來討論行政程序跟照顧比這個也是一個月內可以拿到您的報告好 謝謝 謝謝部長好 謝謝好 謝謝陳偉 謝謝部長"},{"start":800.31,"end":801.854,"text":"接下來請邱正軍委員來做懸檔"}]}}},"gazette":{"lineno":339,"blocks":[["陳委員菁徽：（9時29分）謝謝主席。我想請石部長。"],["主席：請石部長。"],["石部長崇良：陳委員早。"],["陳委員菁徽：部長好。這個議題其實我也非常的關心，而且跟非洲豬瘟一樣，非常嚴重！很多人已經在新聞上看到，最近為什麼大家又發現兒科醫師大出走？是因為北榮直接說他們有4位總醫師都不願意留任。另外你也看到臺大醫院的主任已經下海開始值班，我昨天有去請教了一些臺大小兒科的前輩，他們說今年錄取率1.5%，他們雖然把它作成一個網路上的笑話，是苦中作樂，但是他說錄取率1.5%已經持續3年了，為什麼今年才特別被人家注意？是因為主任也必須要下海值班。","你可能以為兒科醫師錄取率1.5%是單純臺大的問題，我們攤開全國各專科醫師最新住院醫師招收率，還有兒科住院醫師招收率等等，平均就是五成，不是只有臺大醫院的問題，而是全國的問題，但為什麼你需要來搶救這件事情？是因為醫學中心都已經淪陷了，醫學中心是最後一線，全國大家不懂的、不會的就送到醫學中心，包括臺大、榮總等等，連醫學中心都變成主任、院長要下海值班，那麼他們的教學怎麼辦、研究怎麼辦、行政怎麼辦？所以這是一個惡性循環。我知道你之前曾經提過你要去培養急重症人才，尤其是兒科急診專科醫師的人才，這樣才可以紓緩兒科的人力。結果我跟您報告，最近兩年全國就有31位兒科的急診醫師離開醫院，您是急診醫師，你很懂啊！在基隆市、新竹市像這樣子的都會區，兒科醫師平均1人是照顧300人到500人；宜蘭1位兒科醫師要照顧的是2萬1,820人，遠超過全國平均1,165人，所以我認為這個問題其實累積了多年，今年一口氣爆發，你可能需要以更快的方式來處理，你有沒有什麼想法？"],["石部長崇良：跟委員說明，確實，我看了近5年兒科的招收率，現在兒科的容額大概在每年130位左右，那麼兒科的招收率大概都在六成，去年才勉強到七成，所以換言之，就是您的資料看到的，就是七、八十位，所以以這樣的數目確實難以因應全國的需求。"],["陳委員菁徽：你講的六成是他願意訓練，還有留任的問題。"],["石部長崇良：對，那就是後來訓練完之後的流向。關於流向，目前大概三成八留在醫院，另外有六成二就是在基層開業。所以我們從去年開始，第一步，對於走兒科的住院醫師有津貼，一年每個月有1萬塊的津貼給走兒科的住院醫師以及他的fellow，比如他是選兒童遺傳，或者是兒童的一些次專科、重症的ICU、急診次專科，類似像這樣，如果是小兒外科，每個月津貼是3萬，這是去年開始的，我們再觀察後面。第二個，我們在總額的部分，明年會特別匡列，從0到6歲，在總額的部分匡列249億，這專門給兒科來調整支付標準，然後保障1點1元，所以把所有的0到6歲兒童的住院費用要全面性的調高，那麼讓在醫院裡面做急重症的兒科醫師收入可以提高，這是第二個。第三個，在評鑑的部分，我們過去評鑑是這樣，一般性評鑑會特別融入在醫學中心的部分，都需要有兒科的專門評鑑，過去我們是只有兒童醫院有專門兒童的評鑑，我們是有4家兒童醫院，明年開始，所有醫學中心的兒科都是我們重點要評的部分，也把它融入在評鑑裡頭。","同時，另外一個，因為剛剛跟委員說明了，大概有六成二的兒科醫師是在基層開業，所以我們包含了0到3歲的幼兒專責醫師制度，還有從兒童的核心醫院到責任醫院，我們也結合開業的醫師，大家一起來照顧，我們一步一步在進行。"],["陳委員菁徽：我先問你一個問題，剛剛提到住院醫師fellow可以多拿1萬？"],["石部長崇良：對。"],["陳委員菁徽：很好！但你看今年北榮的問題，他們結束了住院醫師……"],["石部長崇良：他是之後的留任。"],["陳委員菁徽：對啊！"],["石部長崇良：他就是訓練的時候有，但之後訓練完之後有沒有要留在醫院？所以我們才會把它再納入在評鑑裡頭，同時把兒童的住院給付拉高，保障一個總額。"],["陳委員菁徽：我剛剛提到的急診專責兒童醫師怎麼辦？流失很快，沒有人要做。"],["石部長崇良：我們是一步一步來，因為如果我們現在把所有的兒童到急診都要兒科來看，會雪上加霜。"],["陳委員菁徽：對。"],["石部長崇良：所以我們現在先不要求所有兒童到急診來都要兒科醫師來看，反而應該是第一步他只要先做一些比較小的baby，因為比較小的確實是需要，然後用區域聯防的方式，兒科用照會的方式就好，我們一步一步再把兒童的照護強化在急診的部分，所以我們另外有一個網絡，就是兒童醫療網的部分，那個是去強化兒童的急診照護。"],["陳委員菁徽：你這樣講，急診醫師可能也會跳起來。"],["石部長崇良：不會啦，我是急診出身的，我們過去的訓練裡頭就包含處理兒童的問題。"],["陳委員菁徽：因為現在急診醫師的流失跟兒科醫師的流失是在比速度。"],["石部長崇良：急診的問題是另外一塊，就是剛剛提到的急診壅塞那個部分需要處理，所以我們現在也積極在處理急診壅塞的問題，以降低急診醫師的負荷。"],["陳委員菁徽：好，當然我們很贊成你做優化兒童醫療照護計畫，但很多全國的兒童醫院院長他們完全不敢公開講，所以我來幫他們講，他們希望問你優化兒童醫療照護計畫的錢，已經11月了，但是還沒有撥下來，是不是真的？因為你每年都說明年會改善，但現在要11月了，還沒有給錢，醫院要自己墊，像你這樣子的效率，你剛剛講很多，0到6歲撥了一筆錢等等，你這個效率是怎麼支持兒童醫療？"],["石部長崇良：預算是應該已經有在這裡……"],["陳委員菁徽：你什麼時候會撥？"],["石部長崇良：現在是撥款，您提的是撥款的速度嘛！"],["陳委員菁徽：對啊！"],["石部長崇良：這個部分我再了解一下醫事司在撥款的部分，我會注意撥款的速度。"],["陳委員菁徽：所以一週內，你會告訴我？我才可以告訴這些院長。"],["石部長崇良：對、對。一週內。"],["陳委員菁徽：一週內？好，一週內。"],["石部長崇良：另外也跟委員報告，今年還有一個叫做「健康臺灣深耕計畫」，到明年底一共是160億，裡面對於兒童醫院，每個醫院幾乎都是有1億的補助，給他們去發展。"],["陳委員菁徽：依照不同醫院提出來的計畫？"],["石部長崇良：對。"],["陳委員菁徽：好。再來是勞動部，我質詢勞動部，結果勞動部說要問你，勞動部部長直接走到我前面說這個問題要問的是衛福部部長。","這是他們即將推出的，看一下這張圖的右邊，勞動部說未來1月1日，很快，兩個月後就要開始了，可以用「日」來申請育嬰留職停薪，所以在小孩子兩歲以內好像最多可以請30天。我們會遇到什麼問題？因為醫事人員跟托育人員已經開始跟我陳情，您一定要儘快準備，趕快找勞動部溝通，你只剩下兩個月可以準備。第一，我自己也有請過，現在育嬰留停最少大概是一個月，像我們這樣子的醫事人員、護理師、醫師、放射師等等，我們要跑兩個地方，一個是工會，工會是辦理你的執業登記，你現在有在做這個業務還是沒有在做這個業務，這個是工會在管的，衛生局就是管你的執登，就是我現在在哪一個機構上班。之前還沒有實施彈性育嬰留停的時候，護理師就已經抱怨連連了，因為他們要跑流程、要跑工會，還要跑衛生局，還要跟院方要停職證明、復職證明。"],["石部長崇良：委員，我了解，這個就是執業停業登記，如果是沒有執行業務，要辦理停業登記，這個是短期的，不用，這個在行政程序上，我會請醫事司立刻發文，這種是短期的育嬰留停，但有的是長期，一次兩年的就要先去辦理……"],["陳委員菁徽：沒有，一個月的也要啊！一個月、兩個月、三個月都要啊！"],["石部長崇良：對，我們把它放寬，我們會處理。這個程序上，我們來盤點。"],["陳委員菁徽：現在很多護理師其實是願意的，他不一定想要請長期，他覺得這樣一天一天請是很好。"],["石部長崇良：對。"],["陳委員菁徽：但我不希望這些流程太過繁瑣，到最後他就不想請了，反而一口氣請久一點。我們現在當然很在意的是護理師，護理師也有護理師荒，但其實醫師、藥師、檢驗師所有的醫事人員，你都必須要一起把他研擬進去。"],["石部長崇良：好。"],["陳委員菁徽：所以你多久內？"],["石部長崇良：一個月內。"],["陳委員菁徽：一個月內可以給我們這個？"],["石部長崇良：對、對。"],["陳委員菁徽：然後，另外你也會發給全部各地的衛生局？"],["石部長崇良：對，我們會給所有的衛生局跟醫院去遵循並簡化這個程序，不需要這樣很繁複。"],["陳委員菁徽：第二個也是您的業務範圍內，就是托育人員，托育人員有這樣子的一個系統可以看到這個機構每一個托育人員目前的托育數，規定是一比五，但如果機構做到一比四是可以有補助的，也是遇到一樣的問題，假使這位托育人員要請彈性育嬰假，就必須要把他移除，移除就是停業，停業就要把他的托育數放到別人的身上，所以也許一個機構其實是很體恤同仁，所以讓他請彈性，但卻因為這樣子影響到機構拿補助的機會，這樣怎麼辦呢？"],["石部長崇良：就是說它沒有額外的這個……"],["陳委員菁徽：不是，機構讓他請了彈性育嬰，可是就類似我們的護病比，一比四個小孩，本來機構可以達到被你補助及獎勵的標準，結果它被迫變成一比五就拿不到補助，怎麼辦？"],["石部長崇良：因為這個還牽涉到托育人員的loading，所以如果馬上就通通……他的loading也增加了，等於是這個機構沒有多餘的彈性能力，像在醫院育嬰留停的時候就會有另外的護理人員來照顧。"],["陳委員菁徽：當然，因為之前的育嬰留停比較久、比較長，是以月為單位的，他當然就可以去儲備這些人力。"],["石部長崇良：對啊！"],["陳委員菁徽：現在是1月1號要改成以日為單位，你是不是要找社家署？"],["石部長崇良：如果是短期，我是覺得還可以啦，但是如果是比較長的時間也不好，這樣的話，托育品質也會下降，我再找社家署討論一下。"],["陳委員菁徽：對，社家署，第一個問題是這個。","主席，第二個問題很快就結束。","第二個問題是，我現在問了所有的托嬰機構和地方政府的社會局，現在地方政府社會局的量能是不足的，所以對他們而言也是一樣的意思，他們現在如果要請一個月的育嬰假，光是跑行政流程要辦理停業、到職、離職等等至少要三天以上，比剛剛講到的衛生局還要久，三天以上喔！所以他們現在也無所適從，他不知道說他請了，還必須要等到流程跑完才可以放這個假，還是說他可以先去照顧他小孩一天，然後回來等這個流程跑完也沒關係？並且地方的社會局應該也沒有辦法應付這樣子的狀況，跟我剛剛講到的一模一樣。"],["石部長崇良：好，這個行政程序的部分，我也請社家署一起來討論。"],["陳委員菁徽：好，行政程序跟照顧比也是一個月內可以拿到您的報告？"],["石部長崇良：好，可以。"],["陳委員菁徽：謝謝部長。"],["石部長崇良：好，謝謝。"],["主席：謝謝陳委員、謝謝部長。","接下來請邱鎮軍委員做詢答。"]],"agenda":{"page_end":486,"meet_id":"委員會-11-4-26-7","speakers":["劉建國","盧縣一","陳昭姿","陳菁徽","邱鎮軍","王育敏","廖偉翔","林淑芬","黃秀芳","林月琴","王正旭","楊曜","葉元之","陳瑩","蘇清泉","范雲"],"page_start":373,"meetingDate":["2025-10-30"],"gazette_id":"1149002","agenda_lcidc_ids":["1149002_00003"],"meet_name":"立法院第11屆第4會期社會福利及衛生環境委員會第7次全體委員會議紀錄","content":"一、邀請衛生福利部部長、農業部、財政部、交通部、經濟部、數位發展部、海洋委員會海巡署\n就「如何精進海外小型包裹夾帶肉品之查緝與防堵，持續強化阻絕疫情於國門，同時優化國內後\n續對於非洲豬瘟防疫」提出專題報告，並備質詢；二、繼續審查(一)行政院函請審議「職業安全\n衛生法部分條文修正草案」案、(二)委員廖先翔等18人擬具「職業安全衛生法第三十五條條文修\n正草案」案、(三)委員牛煦庭等18人擬具「職業安全衛生法第四十九條條文修正草案」案、(四)\n委員李昆澤等26人擬具「職業安全衛生法第三十九條及第四十九條條文修正草案」案、(五)委員\n魯明哲等16人擬具「職業安全衛生法第四十條條文修正草案」案、(六)台灣民眾黨黨團擬具「職\n業安全衛生法部分條文修正草案」案、(七)委員林淑芬等19人擬具「職業安全衛生法第四十三條\n條文修正草案」案、(八)委員楊曜等22人擬具「職業安全衛生法第六條條文修正草案」案、(九)\n委員李昆澤等27 人擬具「職業安全衛生法部分條文修正草案」案、( 十) 委員黃秀芳等21 人擬具\n「職業安全衛生法部分條文修正草案」案、(十一)委員翁曉玲等23人擬具「職業安全衛生法第三\n十五條、第三十九條及第四十九條條文修正草案」案、(十二)委員范雲等18人擬具「職業安全衛\n生法部分條文修正草案」案、( 十三) 委員劉建國等17 人擬具「職業安全衛生法部分條文修正草\n案」案、(十四)委員吳琪銘等18人擬具「職業安全衛生法第六條條文修正草案」案、(十五)委員\n沈發惠等18人擬具「職業安全衛生法部分條文修正草案」案、(十六)委員王育敏等19人擬具「職\n業安全衛生法部分條文修正草案」案、(十七)委員王育敏等25人擬具「職業安全衛生法部分條文\n修正草案」案、(十八)委員郭國文等17人擬具「職業安全衛生法部分條文修正草案」案、(十九)\n委員王鴻薇等19人擬具「職業安全衛生法第四條條文修正草案」案、(二十)委員郭昱晴等17人擬\n具「職業安全衛生法部分條文修正草案」案、(二十一)委員羅廷瑋等18人擬具「職業安全衛生法\n部分條文修正草案」案；三、審查(一)委員王正旭等23人擬具「職業安全衛生法部分條文修正草\n案」案、(二)委員吳沛憶等19人擬具「職業安全衛生法部分條文修正草案」案、(三)委員莊瑞雄\n等16人擬具「職業安全衛生法第九條條文修正草案」案、(四)委員林月琴等21人擬具「職業安全\n衛生法部分條文修正草案」案、 ( 五) 委員林淑芬等21 人擬具「職業安全衛生法部分條文修正草\n案」案、(六)委員邱鎮軍等22人擬具「職業安全衛生法部分條文修正草案」案、(七)委員徐富癸\n等16人擬具「職業安全衛生法部分條文修正草案」案、(八)委員黃捷等16人擬具「職業安全衛生\n法部分條文修正草案」案、( 九) 委員蔡易餘等17 人擬具「職業安全衛生法部分條文修正草案」\n案、(十)委員陳亭妃等16人擬具「職業安全衛生法部分條文修正草案」案","agenda_id":"1149002_00002"}}}