{"error":false,"id":["149459"],"data":{"IVOD_ID":149459,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/149459","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":"2024-03-07T09:38:11+08:00","結束時間":"2024-03-07T09:47:20+08:00","影片長度":"00:09:09","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/1441ba9c2015bdbeaae95c9e81b4df24dc62c46c87ca327ff8ba9b0039caa7a6f072a55b25eb6c425ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"盧縣一","委員發言時間":"09:38:11 - 09:47:20","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":257,"blocks":[["盧委員縣一：（9時38分）有請部長。"],["主席：有請部長。"],["薛部長瑞元：委員好。"],["盧委員縣一：部長好。因為我來自偏鄉，所以我來這裡每次都會提到偏鄉的問題。記得我離開衛生所大概一年多，不過屏東衛生所缺醫師的情況一直並沒有改善，更何況是有些像新竹、苗栗比較偏鄉但不是屬於原鄉的地區也是缺醫師，部長今天能不能給我一個答案，或者說你們有沒有在考慮要怎麼樣來招募醫師進駐我們偏鄉地區？"],["薛部長瑞元：跟委員報告，大概是這樣子啦，以所謂的偏鄉來講是包括像山地原鄉，其實根據我們的調查，山地原鄉現在缺醫師的情況是比較少，最缺的是所謂那種不山不市的……"],["盧委員縣一：對，沒錯。"],["薛部長瑞元：就是非都會區、也不是山區的那些地區，那些地方的問題是比較大的，我們現在有提出一個偏鄉醫療計畫，已經在行政院那邊，應該快……"],["盧委員縣一：我想知道他們的薪水有沒有調漲？調漲多少？就針對不山不市的地區。"],["薛部長瑞元：這個部分，第一個，我們先要找到人力……"],["盧委員縣一：可是你沒有先提供一個待遇可以支撐他們去那個地區生活，我想他們最主要的考量應該是在這裡。"],["薛部長瑞元：我們……"],["盧委員縣一：如果一般市區是七萬多塊的本俸，是不是用14萬來招募他們，馬上就會有很多人來應徵，不是嗎？"],["薛部長瑞元：這個部分，我想委員應該也知道，衛生所醫師的俸給跟獎勵金其實是在縣市政府手上……"],["盧委員縣一：沒有錯，可是我們是不是可以特別編列預算，再從衛福部這裡給他們？"],["薛部長瑞元：我們是可以考慮，但主要還是要看人從哪裡來。"],["盧委員縣一：是，所以你可以編預算，然後我們這邊想辦法同意，不然永遠都缺啊！"],["薛部長瑞元：我們來研議看看要怎麼樣……"],["盧委員縣一：像我知道的屏東，枋山永遠都沒有，不然就是調來調去。"],["薛部長瑞元：對啦！"],["盧委員縣一：然後東港、潮州也沒有，東港跟潮州行政相驗的量那麼大，要靠誰來服務？都是靠鄰近的醫生來幫忙，然後鄰近的醫生還有他自己的工作也要做，不是嗎？"],["薛部長瑞元：東港有很多是拜託蘇委員……"],["盧委員縣一：我覺得不能把問題一直放在那裡，要想辦法解決。我在替我們偏鄉的……不只原鄉而已，對不對？"],["薛部長瑞元：不過剛剛委員提到的，像東港或潮州這一種，大概是因為當地有一些醫療院所，所以他們的衛生所醫療業務本來就少。"],["盧委員縣一：沒錯啊！可是還是有地方可以作為，像我本來在部屏，後來到枋寮，剛去的時候申報也不到50萬，可是我離開的時候，已經超過一倍，就是要看你怎麼去經營，不是嗎？"],["薛部長瑞元：對啦！對啦！當然是這樣。"],["盧委員縣一：好，我們回到今天的主題。我們用藥占保險的比率從26%到現在大概是28%左右，我想知道你們這次調整的主要目的是什麼？"],["薛部長瑞元：委員現在講的調整，應該是第一梯的調整，第一梯的調整主要目的就是讓這些專利剛剛過期的藥，它的藥價可以壓下來。"],["盧委員縣一：是，像我們常常在偏鄉或是老人家比較多的地方服務，其實在改藥或用藥選擇上，如果一改再改，光叫長者認這個藥都非常困難，有些藥廠也不會考慮說原來的藥是什麼顏色就改顏色，那病人就不敢吃了，可能都是因為這樣，他們會認為怎麼藥又改了。"],["薛部長瑞元：這個醫師本來就有這個……"],["盧委員縣一：我的意思是頻率不要那麼頻繁，尤其是慢性病藥……"],["薛部長瑞元：這個應該不會頻繁，但是你說原廠藥通通都不保障它也不對啦！"],["盧委員縣一：當然，我知道……"],["薛部長瑞元：對啊！"],["盧委員縣一：我的意思是如果以後國內有生產原廠藥的話，儘量它的形狀跟顏色要一樣，就是幾乎要一致，不然常常會……"],["薛部長瑞元：這個會有困難。"],["盧委員縣一：沒有錯，可是儘量，因為老人家就是認那個顏色、認那個大小啊！"],["薛部長瑞元：但是藥廠在製造這個藥的時候……"],["盧委員縣一：我是說你要替一些山上、偏鄉的老人家……"],["薛部長瑞元：對啦！對啦！但是藥廠在出的時候，通常都是同一個系列會有他們一個普遍的……"],["盧委員縣一：是啦！我是說你要請他們列入考量，好不好？"],["薛部長瑞元：這個要做的話，是有一點困難。"],["盧委員縣一：剛才那張表格顯示我們臺灣整個藥費的比率是在28%左右，可是OECD國家的平均是17%而已，那我們努力的方向是越來越高，還是越來越低？"],["薛部長瑞元：當然不是啊！"],["盧委員縣一：所以我們是希望朝正常，我是說健康的方向來想，對不對？"],["薛部長瑞元：對，而且跟委員報告，現在有一些新藥是蠻貴的，但是我們也必須把它納進來。"],["盧委員縣一：我知道啊！也有一針1億的，我也知道啊！我的意思是說我們目前的水準大概跟土耳其差不多，按照這個藥費比率，是土耳其，然後墨西哥，如果要跟美國比，美國是12%，英國12%，韓國是23%，如果我們的方向以後是越來越低的話，那你是不是要有一個配套措施？你要怎麼去教育民眾？你有一系列的教育計畫嗎？"],["薛部長瑞元：這差異是在母數，母數。"],["盧委員縣一：是嗎？這個不是母數。"],["薛部長瑞元：美國那個母數就大，整個醫療費用的base非常大。"],["盧委員縣一：OK，那我們不要看美國，我們就看墨西哥就好了，或是看土耳其，是不是？我的意思是，如果以後是越來越低，你要相對花很大的成本在教育民眾上。"],["薛部長瑞元：用這個比率來看是不準的。"],["盧委員縣一：當然是。"],["薛部長瑞元：土耳其它可能整個醫療費用很少……"],["盧委員縣一：這個是很多國家啦！"],["薛部長瑞元：但藥費的比率就高啦！"],["盧委員縣一：是，我們是期待往健康的方向走，而不是支出越來越多的方向，不是嗎？"],["薛部長瑞元：我的意思是藥費占GDP的比率，這種比較是不很恰當的。"],["盧委員縣一：我們的GDP是占1.1%……"],["薛部長瑞元：我們應該是自己跟自己比。"],["盧委員縣一：我手邊資料是1.1%，藥費比率占1.1%，也就是我們是這裡面的倒數第六名。"],["薛部長瑞元：這個比較沒有太大意義，我剛剛講嘛，那個base不一樣，GDP是不同的。"],["盧委員縣一：OK。"],["薛部長瑞元：你說GDP很少的，它藥費就那麼多，當然比率就高啊！"],["盧委員縣一：占整體醫療的話，右手邊這邊是整體醫療的費用支出，這邊是占GDP的費用支出，那我們臺灣占GDP比率大概就是倒數第六名，費用則是在前面。"],["薛部長瑞元：整體醫療費用占GDP比率，這個比較有其基準，但用藥費去比的話，沒有什麼意義。"],["盧委員縣一：沒有關係，我們就是讓國人理解我們目前的狀況在哪裡，如果國家的政策以後是越來越少的話，你們應該想辦法有個十年計畫，看要如何來教育全國的民眾，好不好？"],["薛部長瑞元：基本上，如果我們的base沒有辦法擴大，那這個藥費所占比率就會越來越高。"],["盧委員縣一：其實我們在診間花最多時間就是在解釋藥品，尤其在改藥的時候……"],["薛部長瑞元：對、對，非常瞭解。"],["盧委員縣一：2年前我在枋寮的時候，他們就缺了一個藥叫Adalat或者氧化鎂，氧化鎂甚至缺了半年之久，我想知道的是，當初缺藥跟後來進藥，那個窗口是怎麼運作的？"],["薛部長瑞元：氧化鎂的部分，的確是因為健保價已經殺到很低，所以廠商要退出……"],["盧委員縣一：就沒有人要做啦！"],["薛部長瑞元：後來我們就給他一個地板的保障價，廠商就恢復供應了，這是氧化鎂的部分。"],["盧委員縣一：好，請問部長知道怎麼定價格是最合理的嗎？"],["薛部長瑞元：這個沒有一個公式是最合理的。"],["盧委員縣一：OK，那我告訴你一個方向，好不好？再給我1分鐘。這叫Value-Based Pricing，也就是你先教育，先讓人理解，讓消費者理解這個產品的價值在哪裡，這是對長期價格取向一個最好的指標，希望你能夠上網看一下。謝謝。"],["薛部長瑞元：好，謝謝委員。"],["主席：好，我們謝謝盧縣一委員的質詢。","接下來我們請邱鎮軍委員進行質詢。"]],"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_02","start":8.02971875,"end":8.83971875},{"speaker":"SPEAKER_01","start":10.375343750000003,"end":11.286593750000002},{"speaker":"SPEAKER_02","start":14.712218750000002,"end":15.218468750000003},{"speaker":"SPEAKER_02","start":16.83846875,"end":17.496593750000002},{"speaker":"SPEAKER_01","start":34.72596875,"end":35.43471875},{"speaker":"SPEAKER_01","start":36.43034375,"end":37.22346875},{"speaker":"SPEAKER_01","start":38.96159375,"end":39.26534375},{"speaker":"SPEAKER_02","start":40.345343750000005,"end":45.12096875},{"speaker":"SPEAKER_02","start":46.16721875,"end":48.765968750000006},{"speaker":"SPEAKER_02","start":48.95159375,"end":50.75721875},{"speaker":"SPEAKER_02","start":51.28034375,"end":70.09596875},{"speaker":"SPEAKER_00","start":70.65284375,"end":99.18846875000001},{"speaker":"SPEAKER_01","start":86.39721875000001,"end":86.85284375},{"speaker":"SPEAKER_02","start":98.04096875,"end":101.58471875000001},{"speaker":"SPEAKER_02","start":101.83784375,"end":102.02346875},{"speaker":"SPEAKER_00","start":102.02346875,"end":102.24284375},{"speaker":"SPEAKER_02","start":102.24284375,"end":103.96409375},{"speaker":"SPEAKER_00","start":103.96409375,"end":103.99784375},{"speaker":"SPEAKER_02","start":103.99784375,"end":104.01471875},{"speaker":"SPEAKER_00","start":104.01471875,"end":104.18346875},{"speaker":"SPEAKER_02","start":104.18346875,"end":104.20034375},{"speaker":"SPEAKER_00","start":104.47034375000001,"end":107.54159375},{"speaker":"SPEAKER_02","start":107.54159375,"end":127.04909375000001},{"speaker":"SPEAKER_00","start":108.13221875,"end":108.35159375},{"speaker":"SPEAKER_00","start":115.11846875,"end":115.30409375},{"speaker":"SPEAKER_00","start":117.36284375000001,"end":118.17284375000001},{"speaker":"SPEAKER_00","start":121.21034375,"end":121.53096875000001},{"speaker":"SPEAKER_00","start":127.04909375000001,"end":127.08284375000001},{"speaker":"SPEAKER_00","start":127.09971875000001,"end":139.24971875},{"speaker":"SPEAKER_02","start":136.39784375000002,"end":136.61721875},{"speaker":"SPEAKER_02","start":138.81096875,"end":143.38409375},{"speaker":"SPEAKER_00","start":142.18596875,"end":142.21971875},{"speaker":"SPEAKER_00","start":142.67534375,"end":147.75471875000002},{"speaker":"SPEAKER_02","start":144.49784375000002,"end":144.91971875000002},{"speaker":"SPEAKER_02","start":147.36659375000002,"end":147.82221875000002},{"speaker":"SPEAKER_00","start":147.82221875000002,"end":148.12596875},{"speaker":"SPEAKER_02","start":148.31159375000001,"end":151.33221875},{"speaker":"SPEAKER_02","start":151.56846875000002,"end":152.76659375},{"speaker":"SPEAKER_00","start":151.63596875000002,"end":152.19284375},{"speaker":"SPEAKER_00","start":152.76659375,"end":156.31034375000002},{"speaker":"SPEAKER_02","start":154.57221875000002,"end":158.23409375},{"speaker":"SPEAKER_01","start":158.23409375,"end":158.30159375000002},{"speaker":"SPEAKER_00","start":158.30159375000002,"end":158.31846875000002},{"speaker":"SPEAKER_01","start":158.31846875000002,"end":158.35221875000002},{"speaker":"SPEAKER_02","start":158.35221875000002,"end":160.10721875000002},{"speaker":"SPEAKER_02","start":160.42784375000002,"end":162.33471875},{"speaker":"SPEAKER_01","start":162.28409375,"end":162.57096875000002},{"speaker":"SPEAKER_02","start":162.46971875,"end":166.50284375},{"speaker":"SPEAKER_02","start":166.90784375,"end":168.78096875},{"speaker":"SPEAKER_02","start":169.11846875,"end":172.39221875},{"speaker":"SPEAKER_00","start":172.39221875,"end":175.12596875},{"speaker":"SPEAKER_02","start":174.34971875000002,"end":180.44159375},{"speaker":"SPEAKER_00","start":178.34909375,"end":178.65284375000002},{"speaker":"SPEAKER_02","start":180.47534375,"end":183.66471875000002},{"speaker":"SPEAKER_00","start":183.34409375,"end":183.54659375},{"speaker":"SPEAKER_00","start":184.32284375,"end":196.99596875},{"speaker":"SPEAKER_01","start":191.89971875,"end":191.93346875},{"speaker":"SPEAKER_02","start":191.93346875,"end":192.22034375},{"speaker":"SPEAKER_02","start":195.84846875000002,"end":208.08284375000002},{"speaker":"SPEAKER_02","start":208.40346875,"end":211.17096875000001},{"speaker":"SPEAKER_01","start":209.80409375000002,"end":211.59284375000001},{"speaker":"SPEAKER_02","start":211.59284375000001,"end":214.64721875},{"speaker":"SPEAKER_02","start":216.48659375000003,"end":216.82409375},{"speak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土耳其可能整個醫療費用很少藥費的比例就高了我們期待是往健康的方向走 而不是支出越來越多的一個方向不是嗎所以我的意思是說藥費去佔GDP的這個比例的話這種比較的話是不很恰當我們的GDP是佔1.1"},{"start":414.998,"end":431.339,"text":"我們應該是自己跟自己比的左手邊是1.1藥費這樣1.1也就是說我們是在這裡面的倒數第6名這個比較沒有太大的意義我剛剛講嘛那個base是不一樣GDP是不同的你說GDP很少的那大家藥費就是那麼多那是這樣整體醫療的話這邊就有一個"},{"start":433.221,"end":454.779,"text":"右手邊這邊是整體醫療的費用支出這邊是佔GDP的費用支出那我們台灣大概就是倒數第6名那個GDP的比例費用的話是在前面整體醫療費用去佔GDP的比例這個比較有它的基礎但是用醫療費去比的話讓國務院理解說目前的狀況是在哪裡"},{"start":455.439,"end":475.896,"text":"那如果國家的政策以後是越來越少的話,你們應該要有個想辦法10年的一個計畫,怎麼來教育我們全國的民眾好不好?基本上如果我們的BASE沒有辦法擴大的話,那我們這一個藥費所佔的比例會越來越高了。其實我們在整間,其實花最多的時間就是在解釋藥的部分,尤其在改藥的時候。"},{"start":477.358,"end":501.221,"text":"我曾經在兩年前在訪聊的時候他們常常就缺了一個藥叫Adalat或者說氧化酶然後氧化酶甚至缺了半年之久那我想知道當初缺藥跟後來進了藥的時候那樣的一個窗口是怎麼樣來運作的氧化酶的部分的話事實上是因為的確啦這個健保價是已經殺到很低所以那個廠商要推出啦"},{"start":501.641,"end":525.877,"text":"那後來我們就給他一個保障價,地板的保障價,那他廠商就恢復供應了,所以這是氧化煤的部分。好,我想知道,部長知道怎麼樣來定價格是最合理的嗎?這個沒有一個公式是最合理的。那我告訴你一個方向好不好,下一張,下一張,再給我一分鐘。"},{"start":527.864,"end":531.866,"text":"這是對長期價格取向的一個最好的指標,希望你能夠上網看一下,謝謝。"}]}},"supported_relations":[],"relations":[]}