{"error":false,"id":["149486"],"data":{"IVOD_ID":149486,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/149486","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":"2024-03-07T10:23:54+08:00","結束時間":"2024-03-07T10:35:17+08:00","影片長度":"00:11:23","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/1441ba9c2015bdbef23c92ae51bdd2a1dc62c46c87ca327ff8ba9b0039caa7a60226e946d5867dbe5ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"蘇清泉","委員發言時間":"10:23:54 - 10:35:17","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":589,"blocks":[["蘇委員清泉：（10時24分）謝謝主席。部長，我讓你休息啦！我看你都沒有聲音了。我們請石崇良署長，還有我們吳署長。"],["主席：好，請兩位署長。"],["石署長崇良：委員早。"],["蘇委員清泉：我讓吳署長先回答一個問題，這個是媒體要知道的。"],["吳署長秀梅：委員好。"],["蘇委員清泉：今天早上都談很多了，即蘇丹紅辣椒粉，前幾天部長就講這次出包是辣椒粉，是蘇丹紅摻在辣椒粉裡面，對不對？源頭是大陸嘛！"],["吳署長秀梅：對！"],["蘇委員清泉：所以它進來後就一級、二級，一直分裝、一直出去。我上次跟部長請教，聽說已經進來十幾萬公斤了，部長說沒有那麼多，結果你看現在越爆越多了，原來3家，我請問今天又查出來幾家？"],["吳署長秀梅：因為我們那時候查了59批。"],["蘇委員清泉：對。"],["吳署長秀梅：59批在檢驗的時候有發現有11批，但事實上製造的業者在中國那邊一樣是三禾藥業，還有另外一家就是Kavin Shipping，所以製造廠有一點集中了，目前的階段就是他們這兩家。"],["蘇委員清泉：另外一個，有媒體說這個東西已經進來3年了，真的那麼久嗎？還是10年了？"],["吳署長秀梅：我們過去一直都有在驗，像我們這一次針對的21家業者全部都是進它的，不管是農藥啊，或者是曾經有驗出蘇丹紅的，我們就全部都禁止它再輸入。"],["蘇委員清泉：問題在這裡，這次是雲林查出來，雲林是人家檢舉嘛。"],["吳署長秀梅：是！"],["蘇委員清泉：所以你說在邊境海關要進來，這幾年都有驗嗎？這是第一個問題。第二個問題，要是沒有人檢舉，這件事情又沒有人提出來，就繼續吃？"],["吳署長秀梅：確實是需要全民監督，因為我們的檢驗在邊境不可能百分之百，我們再怎麼做都沒有辦法到百分之百。"],["蘇委員清泉：你們是不是完全沒有驗呢？我這樣問。"],["吳署長秀梅：有，我們有在檢驗，我們每一年都有驗，像去年我們驗的就有87件。"],["蘇委員清泉：所以去年就有驗到辣椒粉摻蘇丹紅？"],["吳署長秀梅：對，所以我們才改變在邊境的抽批比例，去年是驗到了7批，我們在邊境就一直提高整個抽批的比例。"],["蘇委員清泉：所以你們看歐盟、美國禁，我們就禁，但是中央這邊不太積極。我們現在各縣市政府都非常地努力，一些年輕的稽核員大家都很認真，這要給予他們鼓勵及獎勵。"],["吳署長秀梅：好，有。"],["蘇委員清泉：要鼓勵他們，像部長講的中央、地方要合作，所以這個不能互相在那邊推託、閃躲責任，這是完全不行喔！有嗎？"],["吳署長秀梅：有！"],["蘇委員清泉：明天是38婦女節，這是很快樂的日子，孩子是很快樂的，結果營養午餐什麼有200萬的孩子都在吃這些東西，部長說的我聽得下去，他說孩子比較少吃辣的東西，所以有可能比較沒有污染，但還是要小心，不要婦女節後明天就變樣了，好不好？"],["吳署長秀梅：好。"],["蘇委員清泉：這個很重要喔！我看食藥署不夠認真喔！","再來請崇良兄。"],["石署長崇良：蘇委員好。"],["蘇委員清泉：DET就是上次第8屆的時候，由康照洲擔任署長，以前叫作PVS，這個是根據健保法第四十六條衍生出來的藥價。DET做到現在差不多10年了，國產藥廠也在批評、進口也不滿意、藥界也不滿意、醫界也不滿意，百姓有600萬人沒藥可以吃，越做越多批評，這個辦法是不是該廢止，或者是要重新檢討？玩得差不多了啦！"],["石署長崇良：跟委員報告，DET是從102年開始實施，當時最主要提出來是要解決第一個是藥價差，當時初步啟動這個機制的時候，一年的藥價差大概有30%，為了要解決這個藥價差，同時也不要每年調動的幅度太大，所以才訂出一個目標制，讓它調整的幅度不要那麼大。幾年下來，現在大概藥價差已經縮小到差不多24%、25%，那麼也到了需要整個進行檢討的時候。所以委員的指教，我們從去年就開始跟大家在討論，應該今年上半年我們會提出一些法規的修訂。"],["蘇委員清泉：我在這裡要說明一下，我是做第一線的重症醫師，什麼以藥養醫啦！什麼藥價差很多啦！我跟大家報告，我是第一線做重症的，我們現在的藥價差搞不好連10%、15%都很難了，現在每年被砍藥，一直砍、一直砍，我們現在根本不會去care藥價差這一塊。我想大的醫院，或許像長庚體系、北醫體系的進量非常大，可以用價量來制衡，或許他們的藥價差會多一點，但是你說基層診所，這裡要替他們講講話，基層診所要去買藥，跟健保價的核價是一樣的，甚至於比健保價的核價還高，像一個心律不整藥Mexitil，署長你知道嘛？"],["石署長崇良：我知道。"],["蘇委員清泉：那個藥健保核價核一點點，然後他們要買得比它高，所以不要污名化我們醫界，這裡我要替他們講話。","再來我們一天到晚說停藥、Covid的關係、打仗的關係，所以有些藥都進不來，我這裡要跟署長講，用學名藥（Generic）我們也同意，學名藥進來，有本國的學名藥、有進口的學名藥，我們對於本國的學名藥有沒有信心？這第一個。第二個，如果有信心的話，要如何保障學名藥？第三個，我們學名藥的原料，臺灣有沒有在開發？如果有開發的話，我們更要保護，不然的話真的打起仗來或封鎖起來，我們現在很多原料都從中國大陸跟印度進來的，所以如果到時候一停怎麼辦？"],["石署長崇良：跟委員報告，我們已經在研議中，接下來會修訂支付標準，在定價的時候，如果用到的是臺灣製造的原料藥，可以加到20%最高的價格，另外如果是在臺灣製造的學名藥，我們會看它藥證的張數還有臨床使用缺口，最高可以加到15%。"],["蘇委員清泉：所以你有保護的機制？"],["石署長崇良：對。"],["蘇委員清泉：不要一天到晚停藥、一天到晚沒有藥用，這個是很糟糕，我去年給它統計一下，我們那個體系的藥就缺了21種，就真的是藥廠缺藥，所以我們對這個非常敏感。","另外一個問題就是以前用PVS，就是用price-volume survey，那你現在用DET，這差不多大同小異，這還要再改嗎？我剛才說了，我今天有一個提案要把它廢止、要重來。"],["石署長崇良：不過跟委員報告，這個是牽涉到整個健保的總額，因為每年的健保總額有一定的成長，那麼DET是它的目標，就藥費支出的成長是跟著總額的成長浮動，所以如果藥費的DET制度目標沒有的時候，那怎麼樣去適當地管控藥費的成長，避免排擠到醫療費用，這個也是需要來一併思考的。"],["蘇委員清泉：還有這裡我要跟署長報告的就是說，我跟你請教，我們一直講說藥費占了我們健保費用的25%，差不多25、26。"],["石署長崇良：如果沒有調整前的話是到28%。"],["蘇委員清泉：為什麼我們藥費的比例占比會那麼高？是因為我們其他的醫療行為的價格太低了，就是點數太低，你在國外，在美國、在日本，他們不太去care藥費所占的比例，因為臺灣便宜，每樣都很便宜，開刀便宜，醫生也便宜，包括你也很便宜，所以這樣是不對的，你要讓這些醫生做醫生要做的，藥師做藥師要做的，把價格抬高，你的藥費的比例就不會那麼顯眼，然後你現在要去把藥價砍到底、砍到見骨、砍到沒有價差，這個我都同意，但是你這邊要把它拉起來，部長，這樣講有沒有道理？"],["薛部長瑞元：的確這就是我剛剛在跟陳昭姿委員argue的這件事情，你的base是不一樣的，我們整體的醫療費用的 base就是比較低，所以你不能用這樣去算。"],["蘇委員清泉：所以部長你也是臨床醫師轉過來的，我們的署長你也是臨床醫師、急診醫師，所以要如何讓醫界有價量同等，所以這塊要往上加，我完全不反對你這個藥品的DET什麼要重新檢討，但是這個地方一定要讓它volume增加，這個很重要，不然你當臨床醫師，對臨床醫療這樣是不行的。"],["薛部長瑞元：所以這目前我們也是在想辦法改善當中，整個健保的基金，我們看能不能適度地予以擴充，大概是這樣。"],["蘇委員清泉：不行的就用公務預算來挹注。"],["薛部長瑞元：公務預算也是挹注到健保，所以我剛剛講的是健保，基金不是健保。"],["蘇委員清泉：不夠就是整個volume要增加，不用怕啦！大家一起努力，好不好？謝謝。"],["薛部長瑞元：謝謝。"],["主席：好，我們謝謝蘇清泉委員的質詢。"],["主席（蘇委員清泉代）：接續我們請王育敏委員質詢。"]],"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_01","start":6.13971875,"end":7.371593750000001},{"speaker":"SPEAKER_01","start":7.9790937500000005,"end":14.84721875},{"speaker":"SPEAKER_03","start":14.982218750000001,"end":16.28159375},{"speaker":"SPEAKER_01","start":18.91409375,"end":19.42034375},{"speaker":"SPEAKER_01","start":20.95596875,"end":24.55034375},{"speaker":"SPEAKER_01","start":25.81596875,"end":27.79034375},{"speaker":"SPEAKER_03","start":27.68909375,"end":28.414718750000002},{"speaker":"SPEAKER_01","start":28.00971875,"end":29.528468750000002},{"speaker":"SPEAKER_01","start":30.034718750000003,"end":38.18534375},{"speaker":"SPEAKER_01","start":38.38784375,"end":44.69909375},{"speaker":"SPEAKER_00","start":44.10846875,"end":44.445968750000006},{"speaker":"SPEAKER_01","start":44.783468750000004,"end":53.13659375},{"speaker":"SPEAKER_01","start":53.37284375,"end":58.705343750000004},{"speaker":"SPEAKER_01","start":59.835968750000006,"end":60.679718750000006},{"speaker":"SPEAKER_01","start":60.93284375,"end":63.767843750000004},{"speaker":"SPEAKER_03","start":64.32471875,"end":67.27784375},{"speaker":"SPEAKER_01","start":67.27784375,"end":67.59846875000001},{"speaker":"SPEAKER_03","start":67.32846875,"end":67.37909375000001},{"speaker":"SPEAKER_03","start":67.49721875,"end":71.37846875000001},{"speaker":"SPEAKER_02","start":67.59846875000001,"end":67.61534375000001},{"speaker":"SPEAKER_03","start":71.56409375,"end":76.72784375},{"speaker":"SPEAKER_03","start":76.94721875,"end":78.80346875000001},{"speaker":"SPEAKER_03","start":79.15784375,"end":83.42721875000001},{"speaker":"SPEAKER_03","start":83.79846875000001,"end":85.11471875000001},{"speaker":"SPEAKER_01","start":85.30034375000001,"end":86.22846875},{"speaker":"SPEAKER_01","start":86.56596875000001,"end":90.10971875},{"speaker":"SPEAKER_01","start":91.02096875000001,"end":94.00784375},{"speaker":"SPEAKER_03","start":93.07971875000001,"end":93.26534375},{"speaker":"SPEAKER_03","start":94.37909375000001,"end":96.65721875000001},{"speaker":"SPEAKER_03","start":96.92721875000001,"end":108.94221875000001},{"speaker":"SPEAKER_01","start":108.45284375000001,"end":110.54534375},{"speaker":"SPEAKER_03","start":109.53284375000001,"end":109.95471875000001},{"speaker":"SPEAKER_01","start":110.88284375,"end":112.28346875000001},{"speaker":"SPEAKER_03","start":112.33409375000001,"end":112.72221875000001},{"speaker":"SPEAKER_01","start":112.67159375000001,"end":114.51096875},{"speaker":"SPEAKER_03","start":114.51096875,"end":114.98346875},{"speaker":"SPEAKER_01","start":115.08471875000001,"end":118.54409375},{"speaker":"SPEAKER_01","start":118.84784375000001,"end":126.91409375},{"speaker":"SPEAKER_03","start":125.46284375,"end":130.77846875},{"speaker":"SPEAKER_03","start":131.18346875,"end":133.32659375},{"speaker":"SPEAKER_01","start":132.65159375000002,"end":134.94659375},{"speaker":"SPEAKER_03","start":134.18721875,"end":139.68846875},{"speaker":"SPEAKER_03","start":140.07659375,"end":140.29596875000001},{"speaker":"SPEAKER_01","start":140.66721875000002,"end":146.62409375000001},{"speaker":"SPEAKER_03","start":144.90284375000002,"end":149.12159375000002},{"speaker":"SPEAKER_03","start":149.79659375,"end":156.51284375},{"speaker":"SPEAKER_03","start":156.64784375000002,"end":157.00221875},{"speaker":"SPEAKER_01","start":157.72784375,"end":158.70659375},{"speaker":"SPEAKER_01","start":160.03971875000002,"end":164.98409375},{"speaker":"SPEAKER_01","start":165.43971875,"end":175.71659375000002},{"speaker":"SPEAKER_01","start":175.98659375,"end":181.52159375000002},{"speaker":"SPEAKER_01","start":181.69034375,"end":187.39409375000002},{"speaker":"SPEAKER_01","start":188.54159375,"end":189.70596875},{"speaker":"SPEAKER_01","start":190.00971875000002,"end":191.03909375},{"speaker":"SPEAKER_00","start":190.70159375,"end":190.95471875},{"speaker":"SPEAKER_01","start":191.51159375,"end":207.40784375},{"speaker":"SPEAKER_01","start":208.08284375000002,"end":210.02346875},{"speaker":"SPEAKER_01","start":211.06971875000002,"end":213.55034375000002},{"speaker":"SPEAKER_03","start":213.95534375000003,"end":214.00596875000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那再來請蘇 崇良兄蘇委員好這個第一梯齁就是上次第8屆的時候那個康照桌 康照桌這署長的孫就以前叫做PVS嘛這個是根據健保法46條衍生出來 藥價那這個第一梯做到現在10年齁 差不多了齁10年齁"},{"start":250.503,"end":267.976,"text":"國產藥藥廠在趕走進口也沒問題藥借也沒問題醫感也沒問題賠償六百萬人沒辦法吃還要走這個方法是不是該廢止或者是要重新檢討可以玩得差不多了啦"},{"start":269.811,"end":294.564,"text":"跟委員報告 這個第一梯是從102年開始實施的它最主要當時候提出來是要解決第一個是藥價差當時候初步的剛啟動這個機制的時候一年的藥價差大概有30%為了要解決這個藥價差同時也不要每年的調動的幅度太大所以才訂出一個目標制讓它調整的幅度不要那麼大"},{"start":295.624,"end":317.237,"text":"幾年下來大概現在藥價差已經縮小到差不多24、25%那麼也需要到整個要來檢討的時候所以委員的指教我們從去年就開始跟大家在討論應該今年上半年我會提出一些法規的修訂我要這裡要說明一下我是做第一線的重症醫師"},{"start":319.946,"end":329.82,"text":"什麼以藥養醫啦什麼藥價差很多啦我跟大家報告我第一線我才做重症我們現在的藥價差搞不好連10%、15%都很難"},{"start":334.105,"end":358.016,"text":"現在每年被砍藥一直砍一直砍我們現在根本不會去care藥價差這一塊我想大的醫院或許像長庚體系像北醫體系他的進量非常大可以用價量來製衡或許他們的藥價才會多一點但是你說基層診所這裡要替他們講講話基層診所要去買藥"},{"start":361.755,"end":371.26,"text":"跟健保價的合價是一樣的,甚至於比健保價的合價還高,這樣一個心力不整藥,要健保合價合一點點,然後他們要買要買,比他高,所以不要汙名化我們醫界,這裡我要替他們講話"},{"start":384.844,"end":396.051,"text":"那再來我們一天到晚說停藥啦、COVID的關係啦、打仗的關係所以有些藥都進不來那我要這裡要跟署長講"},{"start":397.625,"end":418.033,"text":"我們的用賢明藥我們也同意那賢明藥進來有本國的賢明藥有進口的賢明藥那我們對本國的賢明藥有沒有信心的第一個第二個如果有信心的話要如何保障賢明藥第三個我們的"},{"start":419.508,"end":432.715,"text":"學民要的原料台灣有沒有在開發如果開發的話我們真的要保護不然的話真的打起仗來或是封鎖起來我們現在很多原料都從中國大陸跟印度進來的"},{"start":434.016,"end":461.648,"text":"所以如果到時候一停那怎麼辦跟委員報告我們已經在研議中接下來會修訂這個支付標準那在定價的時候如果用到的是臺灣製造的原料藥可以加到20%最高的價格那另外如果是在臺灣製造的學民藥那我們會看他的那個藥證的章數還有他的這個臨床使用缺口最高可以加到15%"},{"start":466.603,"end":478.011,"text":"所以你有保護的機制啦不要一天到晚停藥一天到晚沒有藥用這個是很糟糕我去年給大家統計一下我們那個體系的藥就缺了21種"},{"start":480.869,"end":495.059,"text":"21種就真的是藥廠缺藥所以我們對這個非常敏感那這另外一個問題就是以前用PVS就是用Price Volume Survey那你現在用DET這差不多都大同小異啦那這個還要改變嗎我剛才說我今天有一個提案要廢止我們重來"},{"start":502.711,"end":524.636,"text":"不過跟委員報告這個是牽涉到整個健保的總額因為每年的健保的總額有一定的成長那麼第一梯是它的目標藥費支出的成長是跟著總額的成長浮動所以如果說這個藥費的第一梯制度"},{"start":525.296,"end":526.377,"text":"如果沒有這個調整前的話是到28%"},{"start":553.525,"end":561.904,"text":"為什麼我們的藥費的比例、佔比會那麼高是因為我們其他的醫療行為的價格太低啦"},{"start":562.796,"end":583.316,"text":"就是說點數太低。在國外、在美國、在日本,他們不太去care藥費所佔的比例。因為臺灣很便宜,每個都很便宜,開刀也很便宜、醫生也很便宜,包括你也很便宜。所以這樣是不對的,你一定要讓醫生做醫生要做的,有時候做有時候要做的。"},{"start":585.018,"end":585.098,"text":"蘇清泉"},{"start":605.626,"end":634.19,"text":"的確啦這就是我剛剛在跟那個應該是陳昭智委員在argue的就是這件事情嘛就是說你的base是不一樣的那我們整體的醫療費用的base就是比較低所以你不能用這樣去所以保陵你也是臨床醫師轉過來我們的署長你也是臨床醫師、急診醫師所以要如何讓這個醫界的可以"},{"start":635.716,"end":652.088,"text":"有價量要同等所以這塊要往上加我完全不反對你這個藥品的第一梯什麼要重新檢討但是這個地方的一定要當然volume增加這個很重要耶不然你當臨床醫師這裡追臨床醫療這樣是"},{"start":656.498,"end":680.563,"text":"這目前我們也是在想辦法改善當中那整個健保的基金我們看能不能適度的予以擴充他還是這位不行的就用公務預算來挹注公務預算也是挹注到健保所以我剛剛講是健保基金不夠就是整個玻璃要增加嘛不用怕啦大家一起努力好不好謝謝"}]}},"supported_relations":[],"relations":[]}