{"error":false,"id":["149446"],"data":{"IVOD_ID":149446,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/149446","日期":"2024-03-07","會議資料":{"會議代碼":"委員會-11-1-26-4","會議代碼:str":"第11屆第1會期社會福利及衛生環境委員會第4次全體委員會議","屆":11,"會期":1,"會次":4,"臨時會會次":null,"種類":"委員會","委員會代碼":[26],"委員會代碼:str":["社會福利及衛生環境委員會"],"標題":"第11屆第1會期社會福利及衛生環境委員會第4次全體委員會議"},"影片種類":"Clip","開始時間":"2024-03-07T09:08:46+08:00","結束時間":"2024-03-07T09:18:43+08:00","影片長度":"00:09:57","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/1441ba9c2015bdbe82be5d8640f7b643dc62c46c87ca327ff8ba9b0039caa7a6cba6a9359c3954295ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"陳昭姿","委員發言時間":"09:08:46 - 09:18:43","會議時間":"2024-03-07T09:00:00+08:00","會議名稱":"立法院第11屆第1會期社會福利及衛生環境委員會第4次全體委員會議（事由：邀請衛生福利部部長、中央健康保險署、食品藥物管理署就「健保藥價調整，藥廠停產慢性病用藥之因應作為」進行專題報告，並備質詢。）","gazette":{"lineno":106,"blocks":[["陳委員昭姿：（9時8分）有請薛部長。"],["主席：有請部長。"],["薛部長瑞元：委員好。"],["陳委員昭姿：部長，我想請教，分級醫療還在嗎？"],["薛部長瑞元：分級醫療當然還在啊！"],["陳委員昭姿：健保開辦29年前就開始規劃分級醫療，到今天健保署的網站上還有這些宣傳，如「分級醫療，厝邊好醫師X社區好醫院」，但是分級醫療離事實越來越遠，甚至遙不可及。我想部長你也心知肚明，只是不知道部長你是無心去改變，還是無力去改變？"],["薛部長瑞元：這個分級醫療本來就是在、就是還在。"],["陳委員昭姿：部長，我為什麼告訴你「它還在嗎？」，部長，請你看這個示意圖，健保開辦是1995年，醫學中心13家，區域48家，地區568家，這是一個正三角形，非常健康的醫療結構；25年後醫學中心增加兩倍，區域醫院增加一倍半，地區醫院腰斬了，這是什麼形狀？請部長來預測，部長，在10年、20年後，你覺得我們會走向哪一部分？"],["薛部長瑞元：委員，你的分級醫療少了最底層的基層診所。"],["陳委員昭姿：針對醫院分級……"],["薛部長瑞元：基層診所是越來越多。"],["陳委員昭姿：根據醫院評鑑，我等一下會根據你的醫院評鑑……"],["薛部長瑞元：這是醫院評鑑……"],["陳委員昭姿：這是個事實。部長，我要說……"],["薛部長瑞元：不能因為地區醫院家數減少就說分級醫療沒有了。"],["陳委員昭姿：我認為健保制度帶動、造成了今天的狀況，為什麼呢？因為健保制度的設計會誘引醫療行為，也會改變民眾的就醫行為。部長，你嫌醫學中心還不夠多嗎？"],["薛部長瑞元：醫學中心……"],["陳委員昭姿：這一次你一口氣增加了3家醫學中心，引起很大的爭議。"],["薛部長瑞元：醫學中心是根據評鑑的結果，家數是不是要限制是可以討論的。"],["陳委員昭姿：部長，你不知道醫療網的設計是200萬人1家醫學中心嗎？"],["薛部長瑞元：從一開始就沒有按照這樣子。"],["陳委員昭姿：你這次有很多的爭議，請你概括承受。"],["薛部長瑞元：從一開始臺北區就超過了。"],["陳委員昭姿：這不是理由！延宕公布時間……"],["薛部長瑞元：為什麼不是理由？"],["陳委員昭姿：本來在去年年底就應該公布，後來到大選後公布。第二個，你改變了遊戲規則，說沒有鑑別度、有差距，你沒考過聯考嗎？聯考同分的時候是比其他科，這還有差距耶！再來……"],["薛部長瑞元：聯考是電腦閱卷，標準是一致的。"],["陳委員昭姿：你增加了3家醫學中心，弱化了分級醫療，讓民眾負擔增加，讓健保點值下降，讓已經不足的護理人員惡向地重新分配。"],["薛部長瑞元：沒有這種事情！健保點值下降不是這個原因，護理人員的缺少也不是這個原因。"],["陳委員昭姿：部長，請幾位系出同門前後任的重要人物捫心自問究竟受益者是誰？"],["薛部長瑞元：問什麼？"],["陳委員昭姿：一下子增加3家醫學中心，台灣醫務管理學會洪理事長說，衛福部此舉是模糊了排名概念，是為了某些醫院、某些體系，怕他們太沒面子了。"],["薛部長瑞元：這是臆測之詞。"],["陳委員昭姿：藥價調整是有法源依據的，應該根據市場的交易情形合理調整，但是我要請問交易情形是議價能力都一樣嗎？臺灣四百多家醫院的議價能力都一樣嗎？"],["薛部長瑞元：當然不一樣。"],["陳委員昭姿：大者恆大、強者恆強、弱者恆弱，什麼叫合理地調整價格呢？對於罹患高血壓的患者，每位醫師都會開脈優，脈優15年來降了只剩下兩成藥價。萬物皆漲，唯有藥品該跌。"],["薛部長瑞元：所以委員的意思是藥價就不要調低嗎？"],["陳委員昭姿：各行各業營業額增加都是喜事，唯有整體藥費增加的時候註定是悲劇。藥價調整的目的達標了，我們先來看藥價差的問題，曾經在2016年、8年前監察院有過糾正案，指出藥價差未釐訂明確合理藥價差比率，藥品核價機制不足，執行全民健保藥價調查機制效能不彰，這也是監察院的文字，以藥養醫扭曲醫療生態。"],["薛部長瑞元：委員，你到底是要做藥價調降，還是……"],["陳委員昭姿：石署長說過藥品供應因素很多，不只是價格……"],["薛部長瑞元：這是矛盾的。"],["陳委員昭姿：但是我也要告訴你們，藥費成長也不能單方面歸因於價格，藥費成長因素還有人口老化，癌重症病人增加，通貨膨脹，原物料成本提高，研發成本提高，研發的規格也提高了，所以這幾年的藥價調降造成很嚴重的後果，包括缺藥、影響供藥的穩定性，第一線不斷地換藥，品質堪慮。"],["薛部長瑞元：這是不對的說法，為什麼品質堪慮？"],["陳委員昭姿：藥價一直調降能夠維持品質嗎？"],["薛部長瑞元：委員是專家，你跟我講哪一個藥品質堪慮？"],["陳委員昭姿：請問部長，如果我年年砍你的薪水，你還能維持你原來的生活品質嗎？"],["薛部長瑞元：跟那個無關，你跟我講說哪一個藥的品質堪慮？你是專家啊！"],["陳委員昭姿：我們來看藥價調整的目的有沒有達標，第一個，縮小藥價差距，部長知道每年的藥價差有多少錢嗎？你能回答嗎？"],["薛部長瑞元：差不多在四、五百億左右。"],["陳委員昭姿：部長，不錯！你還講出了一個數字，我本來想問你是400億，還是500億，還是600億，還是700億，你大概知道我講話不是沒有根據的。第一個，它達到縮小藥價差的目的嗎？沒有！這個沒達標！"],["薛部長瑞元：有！有下來。"],["陳委員昭姿：第二個，將節省的藥費作為給付新藥及放寬藥品給付之財源，抱歉！全臺灣只有我有這個完整的數字，我們的新藥等待期越來越長，而我們的藥品給付是越限越嚴重、越限縮，只有臺灣發明這個給付方法，癌藥只能用幾個月、幾個療程，全世界沒有人這樣做的，都用到病情惡化，為什麼？因為錢不夠，我知道是錢不夠。"],["薛部長瑞元：對，錢不夠，所以委員的主張到底是什麼？我實在是聽不出來，你是不要調藥價，還是要調藥價？"],["陳委員昭姿：我在第一張投影片其實有答案了。大家都說臺灣人愛吃藥，我不認為，大家都在看那個百分比是25%、26%、27%、28%，臺灣人真的愛吃藥嗎？不要比那個，而是整個專業服務費用太低了，一個扭曲數字的分母那麼低，讓藥品好像占率很高，結果是以藥養醫。其實回到藥品的GDP占比，我們才1.1%，日本1.6%、南韓1.3%，如果再把藥價差扣掉的話，當然實際上不會有這麼理想的狀況，只剩下0.7%……"],["薛部長瑞元：沒有這樣子算的。"],["陳委員昭姿：部長，以藥養醫是挖東牆補西牆，東牆要倒了，西牆還能撐住嗎？部長能不能讓醫師正正當當好好地賺錢，讓他們賺他們應該賺的醫療費，不要逼著醫院跟醫師去以藥養醫，可以嗎？以藥養醫還能撐多久呢？這個牆已經快倒了。"],["薛部長瑞元：以藥養醫這個部分過去是比較多的，目前的藥價差是有在下降了。"],["陳委員昭姿：我已經告訴你藥價差了，你講的400億大概是10年前的藥價差。"],["薛部長瑞元：藥價差仍然存在是沒有錯，但是不能這樣子就叫以藥養醫。"],["陳委員昭姿：這兩張圖我要問衛福部，我一直在追蹤這兩張圖，為什麼在去年之前，臺灣的醫療衛生支出占GDP都是六點多，現在突然間變成7.5，這麼巧？"],["薛部長瑞元：因為把長照算進去。"],["陳委員昭姿：這麼巧！在去年大選有在野的總統候選人要求我們要把健康投資提高，提高到8%，結果算出來剛好就是7.5%，這麼多年都是6%，然後還來一個校正回歸……"],["薛部長瑞元：那個本來沒有算長照，各國都有算長照。"],["陳委員昭姿：96年到110年全部校正回歸，它已經放了這麼久，你們突然間去做修正，好一個校正回歸啊！部長，我知道你把長照放進去，如果你認為把長照放進去可以呈現醫療的健康投資，那我請問你，為什麼在算新藥新科技的財務衝擊時，不能夠把新藥新科技可能帶來的長照費用減少也扣除呢？這是兩個標準、雙標啊！"],["薛部長瑞元：請問委員，這兩個……"],["陳委員昭姿：你這邊要算，這邊就要算。部長，你不要跟我爭辯，我在那個委員會29年。我們看最後一張，所以我要告訴部長……"],["薛部長瑞元：29年錯的都還是錯。"],["陳委員昭姿：部長，整個醫療支出的占比，你要算6.1%或要改成7.5%都沒關係，我只是要告訴你，還是輸人家很多。"],["薛部長瑞元：這當然是可以努力的。"],["陳委員昭姿：當你是7.5%的時候，南韓是9.7%；你是6.1%的時候，韓國是8%，所以這是健康投資的不足，我認為部長以上都要負這個責任，好嗎？健康投資是不足的，但是政府從來不承認健康投資不足。"],["薛部長瑞元：這是我們努力的方向。"],["陳委員昭姿：我們再看管理有沒有失當，醫院評鑑內幕重重，分級醫療蕩然無存，藥價調整慘不忍睹！"],["薛部長瑞元：管理的不當要指出事實出來。"],["陳委員昭姿：我已經點出所有的診斷了。"],["薛部長瑞元：要指出事實出來。"],["陳委員昭姿：部長可能要根據這個診斷去參考未來怎麼治療、怎麼進行。健康投資不足、醫療管理不當，請別把藥品當作祭品！謝謝部長。"],["薛部長瑞元：謝謝。"],["主席：謝謝陳昭姿委員的發言。","接下來請陳菁徽委員進行質詢。"]],"agenda":{"page_end":210,"meet_id":"委員會-11-1-26-4","speakers":["王育敏","陳昭姿","陳菁徽","林月琴","盧縣一","邱鎮軍","廖偉翔","黃秀芳","蘇清泉","涂權吉","王正旭","林德福","王鴻薇","羅廷瑋","李彥秀","林淑芬","黃健豪","謝衣鳯","鍾佳濱","林憶君","劉建國","陳瑩","楊曜","楊瓊瓔"],"page_start":133,"meetingDate":["2024-03-07"],"gazette_id":"1130901","agenda_lcidc_ids":["1130901_00003"],"meet_name":"立法院第11屆第1會期社會福利及衛生環境委員會第4次全體委員會議紀錄","content":"邀請衛生福利部部長、中央健康保險署、食品藥物管理署就「健保藥價調整，藥廠停產慢性病用\n藥之因應作為」進行專題報告，並備質詢","agenda_id":"1130901_00002"}},"transcript":{"pyannote":[{"speaker":"SPEAKER_00","start":0.03096875,"end":1.39784375},{"speaker":"SPEAKER_00","start":4.654718750000001,"end":5.8697187500000005},{"speaker":"SPEAKER_00","start":8.654093750000001,"end":9.869093750000001},{"speaker":"SPEAKER_01","start":14.661593750000002,"end":15.117218750000003},{"speaker":"SPEAKER_00","start":16.29846875,"end":16.66971875},{"speaker":"SPEAKER_00","start":17.04096875,"end":17.918468750000002},{"speaker":"SPEAKER_00","start":18.812843750000003,"end":20.65221875},{"speaker":"SPEAKER_00","start":21.22596875,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事長說外服部此舉是模糊的排名概念是為了某些醫院某些體系的怕他們太沒面子了"},{"start":205.933,"end":231.521,"text":"藥價調整是有法源依據的它是應該根據市場的交易情形合理調整但是我要請問交易情形交易情形都是能力都一樣嗎?溢價能力都一樣嗎?臺灣400多家醫院的溢價能力都一樣嗎?當然不一樣大者恆大、強者恆強、弱者恆弱什麼叫合理的調整價格呢?每位醫師要是罹患高血壓都會吃麥優麥優15年來降了實現了兩成的藥價"},{"start":236.056,"end":246.401,"text":"問物皆長,唯有藥品該點。各行各業營業額增加,各行各業營業額增加,都是喜事。唯有藥費,整體藥費增加,說注定是悲劇。好,我們來看,藥價調整的目的達標了嗎?我們先來看藥價差這個問題。曾經在2016年,8年了。"},{"start":260.277,"end":286.992,"text":"監察院有過糾正案藥價差為離地明確的合理藥價差比率藥品核加機制不足執行全民健保藥價調整機制效能不彰這個造成這個也是監察院的文字以藥養育扭曲了醫療生態你到底是要做這個藥價調漲還是實質組長說過這個藥品供應因素很多這個是矛盾的但是我也要告訴"},{"start":287.992,"end":288.112,"text":"這是不對的說法"},{"start":310.854,"end":319.622,"text":"你藥價一直調降,能夠維持品質嗎?你跟我講一下哪一個藥品質看力?我請問你,如果我年年砍你的薪水,你還能維持你原來的生活品質嗎?你跟我講說哪一個藥品質看力?你是專家我們來看藥價調整,下一個我們來看目的,藥價調整的目的有沒有達標第一個,縮小藥價差距,部長你知道每年的藥價差有多少錢嗎?"},{"start":338.244,"end":353.307,"text":"差不多在四五百億左右啦部長不錯你還講出了一個數字我本來想問你是400億還是500億還是600億還是700億你大概知道我講話不是沒有根據的第一個他達到縮小要加他的目的嗎"},{"start":354.451,"end":359.233,"text":"沒有,好,這個沒達標,那個目的有下來,有下來節省了藥費作為給付新藥跟販快藥品給付的財源抱歉,全臺灣只有我有這個完整的數字我們的新藥等待其實越來越長我們的藥品給付是越限越嚴重、越限縮臺灣只有臺灣發明這個給付方法癌藥只能用幾個月幾個療程,全世界沒有人這樣做的"},{"start":377.06,"end":399.013,"text":"全世界都用到這個藥病情惡化為什麼呢?因為錢不夠我知道錢不夠錢不夠那12委員的主張到底是什麼我實在是聽不出來下一張你是不要調藥價還是要調藥價我在第一張投影片其實有答案了但是來來跑這裡大家都說台灣人愛吃藥我不認為欸大家都在看那個百分比百分之25、26、27、28台灣人真的愛吃藥嗎不要比那個好不好整個專業費用服務太低了"},{"start":405.297,"end":425.423,"text":"一個扭曲數字分母那麼低然後藥品好像佔率很高結果是以藥養醫其實如果我們回到GDP藥品的GDP佔我們才1.1日本1.6南韓1.3如果我再把藥價差再扣掉的話當然實際上不會有這麼理想的話只是那0.7以藥養醫部長這個挖東牆補西牆東牆要倒了西牆還能撐住嗎"},{"start":435.011,"end":435.151,"text":"陳昭姿"},{"start":450.271,"end":459.68,"text":"這個以藥養醫是過去的這一個部分是比較多的那目前的藥價差是有在下降我已經告訴你藥價差啦你講的414大概是10年前的藥價差是有藥價差,仍然存在是沒有錯這兩張圖我要問衛福部我要問衛福部我一直在追蹤這兩張圖為什麼在去年之前臺灣的醫療衛生支出佔GDP都是6點多"},{"start":473.752,"end":480.695,"text":"突然間現在變成7.5這麼巧這麼巧在去年的大選有在野的總統候選人他要求我們把投資健康投資要提高提高到8%剛好你算出來就是7.5這麼多年都是6然後還來一個校正回歸96年到110年全部校正回歸你放了他這麼久你突然間去做修正好一個校正回歸啊"},{"start":504.684,"end":522.686,"text":"部長如果你認為長照我知道你把長照放進去對啊如果你認為把長照放進去可以呈現這個醫療的健康投資那我請問你為什麼在算新藥新科技的財務衝擊時不能夠把這個新藥新科技帶來的可能的長照的費用減少也扣除呢"},{"start":523.667,"end":549.895,"text":"這是兩標標準啊 雙標啊請問你這個這兩個的你這邊要算 這邊就要算好 部長你不要跟我爭辯 我在那個委員會29年好 我們看最後一張所以我要告訴部長有29年錯的都還是錯啦告訴部長齁 這個整個醫療支出的占比齁你要算6.1齁 你要改成7.5都沒關係 我只是要告訴你還是輸人家很多"},{"start":551.694,"end":552.697,"text":"你7.5,人家南韓是9.7你算6.1,總韓國是8%"},{"start":558.686,"end":582.392,"text":"所以這個是健康投資整個不足健康投資不足我知道部長是部長以上都要去負這個責任好嗎健康投資是不足但是政府從來不承認健康投資不足好我們再看右邊管理呢管理有沒有適當醫院評鑑內幕重重分級醫療蕩然無存藥價調整慘不忍睹管理的不當這個要指出事實出來部長可能要根據這個診斷去參考未來怎麼治療怎麼進行好"},{"start":588.715,"end":588.735,"text":"謝謝部長謝謝"}]}},"supported_relations":[],"relations":[]}