{"error":false,"id":["150414"],"data":{"IVOD_ID":150414,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/150414","日期":"2024-03-26","會議資料":{"會議代碼":"院會-11-1-6","會議代碼:str":"第11屆第1會期第6次會議","屆":11,"會期":1,"會次":6,"臨時會會次":null,"種類":"院會","標題":"立法院第11屆第1會期第6次會議"},"影片種類":"Clip","開始時間":"2024-03-26T10:48:49+08:00","結束時間":"2024-03-26T11:04:36+08:00","影片長度":"00:15:47","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/f45bf982c29023ee7228642423d5278f8ac1d636ef3e2fe8f8ba9b0039caa7a652976c251cd3d18d5ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"劉建國","委員發言時間":"10:48:49 - 11:04:36","會議時間":"2024-03-26T09:00:00+08:00","會議名稱":"第11屆第1會期第6次會議（事由：一、對行政院院長提出施政方針及施政報告繼續質詢。\n二、3月22日上午9時至10時為國是論壇時間。\n三、3月26日下午1時50分至2時30分為處理臨時提案時間。）","gazette":{"lineno":391,"blocks":[["劉委員建國：（10時48分）謝謝主席，有請院長還有衛福部薛部長。"],["主席：麻煩再請陳院長備詢、請衛福部。"],["陳院長建仁：劉委員早。"],["劉委員建國：院長早，辛苦了。這可能是最後一次在院會跟你探討國家的事情，我還是肯定院長這段時間的辛苦跟努力。"],["陳院長建仁：謝謝。"],["劉委員建國：這種辛苦跟努力還是為了要給下一個團隊打下更好的基礎，照顧更多的臺灣人民，所以院長的決策還有整體的方向跟好的方法，絕對攸關福國利民，是一個非常重要的事情。我今天因為時間真的很有限15分鐘，所以針對幾個面向要特別來跟院長、部長提醒跟討論。第一個，當然是長照基金，臺灣明年就邁入超高齡，我個人看法可能是今年年底或明年初就要到了，因為在7年前曾經講是2026，而3年前就講再提早1年，我覺得還會再提更早一點，這是我個人的淺見啦！","事實上，臺灣有22個縣市，現在已經有6個縣市早就進到超高齡社會，有嘉義、臺北、南投、基隆、屏東，還有我的母縣雲林，已經占了四分之一的縣市，這速度真的會越來越快，而且人口結構的快速改變，基本上所有面向通通會變，我在這邊也講了不下N次，從經濟、教育、文化、產業等等，我們看到蔡政府執政之後，也要回推到馬政府時，當時的長照預算每年平均不足50億，我們都講50億，但真的是不足。"],["陳院長建仁：是。"],["劉委員建國：一路到今年達到八百多億，這是非常恐怖的成長。請部長、院長看這張衛福部106到115年的10年長照推估表，110年支出推估是396.3億，實際上決算是454億，相差57.9億；111年的推估是415.9億，和決算559億又相差了143.1億；112年是428億，和決算679億相差251億。這3年幾乎是百分之一百、兩百在成長的，不曉得我們的因應之道在什麼地方？113年，我們現在的預算是抓828億，實際上最後執行是多少還不知道？但推估是436億，如果照預算去算，誤差將近400億，這推估表是不是要更正了？這是第一點。","第二點，薛部長曾經對外說，長照基金剩餘將近一千多億。"],["陳院長建仁：對。"],["劉委員建國：主要是房地合一、菸稅、遺產、遺贈，還有所得稅，認為5年內長照基金的財源是沒有問題的，這是部長講的，真的有這麼樂觀嗎？","我簡單講一些背景資料再給院長和部長答復，內政部在111年的12月統計，65歲的失智人口是30.8萬，國發會預估120年，等於不到10年的時間，失智人口會達到46萬，有50%成長，所以未來這個面向的照顧會更多。我們的準總統賴清德特別提出長照3.0，其中針對住宿式機構服務使用者的補助方案，整個預算規模要從78億調高到118億，再增加40億，還有要強化重度失能者的照顧，新增居家、社區晚間到宅照顧，建立24小時重度失能者的支持服務，這可能又需要幾十億的預算規模，而且長照給支付7年都沒檢討，到現在沒提升過，所以3.0的時候勢必要檢討。關於這幾個面向，我想實質上要進入3.0，可能我們明年的長照預算就會破千億、一定會破千億。","院長、部長再看一下，針對過去長照基金的收入來源，112年是七百多億，111年到112年確實也有高達九百多億，如果以我們的長照基金來源預估，也就是推估表，113年如果是776.6億，今年實際上執行數是828億，已經相差51.4億，以此類推，114年、115年、116年各差了兩百多億。不到5年，誠如部長講的，賸餘一千多億元的長照基金就會不足，這是我個人的推估，不曉得院長跟部長怎麼看待這個事情？"],["陳院長建仁：好，我請部長來回答。"],["薛部長瑞元：跟委員報告，因為我們的支出是根據收入的預算，收入的預算是由財政部給的資料，因為財政部在一些像是房地合一稅、遺產稅等是比較不確定的，所以通常會比較低估，在年度結算時，我們的收入通常比原來收入的預算高很多。目前來講，已經累積到1,500億的基金結餘在那個地方……"],["劉委員建國：對、對、對。從我的簡報第二張表格可以看到，112年你們的結餘是1,072億，對不對？"],["薛部長瑞元：對。"],["劉委員建國：我還是照部長所講的金額去算。"],["薛部長瑞元：以去年整個結餘算起來，現在total差不多是1,500億。"],["劉委員建國：1,500億？"],["薛部長瑞元：對，所以收入比原來的預算多很多。"],["劉委員建國：如果誠如部長所答復我的，院長就可以看到我們長照基金的支出推估表跟財源收入表，坦白講，這兩張表是假的，差太多了！"],["薛部長瑞元：沒辦法，因為我們支出的預算，只能根據收入的預算來處理……"],["陳院長建仁：因為收入的部分包括贈與稅、菸稅還有房地合一稅，那是浮動的……"],["劉委員建國：沒有錯！"],["陳院長建仁：一般來說，政府在說收入的時候，財政部都會比較保守，就是會說少一點，但實際上會比較多。至於我們的支出，要跟委員報告，重要的是我們要以量入微出的方式來進行我們的長照，但是你說的那些居住型長照等等，就是長照3.0，清德總統未來要推動的，這個我們有估計，實際上到了118年的預算，應該都還不會像委員這個表所提的這個樣子，但是我們當然還是要認真地增加收入，支出也是一定要很審慎地來控制。"],["劉委員建國：我知道院長答復我的一定是朝這樣的方向，在推估、預估時，基本上抓得比較靈活一些，我都可以接受，但是坦白講這些稅在專家學者的看待裡面，他們認為這是機會稅。"],["陳院長建仁：我懂你的意思。"],["劉委員建國：所以它的穩定性，尤其房地合一的稅，因為一直在打房，這兩年可以比較高，明年、後年、大後年，或許會急遽下降也不一定。"],["陳院長建仁：我們會來盤點。"],["劉委員建國：所以我希望可能要有相關的一些應變的措施，因為過去打出所謂的長照就是看得到，找得到、用得到，我們現在更要顧得好，對不對？就是要顧得好，才從2.0變成3.0，相關的預算增加，實際上你的來源、收入穩定還是要更確定才行。"],["薛部長瑞元：對，有關支出的部分，委員剛剛提到3.0將來要做的事情也是滿多的，不過有一點會有一點差異，就是我們投入到資源布建的成本會減少，因為差不多都有了。"],["陳院長建仁：要蓋的都蓋好了。"],["劉委員建國：是啊！是啊！請院長跟部長在短時間內，是不是可以再重新盤點一下？包括支出來源預估表、推估表，可能要再詳細地做一些修正，好不好？"],["陳院長建仁：好。"],["劉委員建國：時間的關係，抱歉，不能讓兩位答復很久。","第二個就是百億新藥基金，上屆最後一個會期，我也在這邊特別……"],["陳院長建仁：極力推動。"],["劉委員建國：我也是第一個在本院提出修法的委員，當時院長跟部長都有答復我要一步一步來，我當然可以接受，但是現在已經3月了，今年已經3月了，我知道衛福部今年有成立健康政策與醫療科技評估中心，這個要肯定啦！因為協助健保進行新醫療技術、藥品及醫材給付的審定，但是跟賴副、準總統要建置獨立的百億癌症新藥基金，顯然落差很大，因為我們的目標就是國家的癌症防治計畫，目標是在2031年，讓臺灣癌症死亡人可以減少到三分之一，要達到這個目標，很多的面向必須處理，而這個新藥的百億基金，我覺得是重中之重。"],["薛部長瑞元：跟委員報告，目前的作法是在健保的總額預算之內，我們利用公務預算來補助，像去年240億、今年200億，今年的兩百億裡面我們有安排了差不多60億，其中24億左右是做暫時性支付，其他有三十幾億是做新藥的納入，所以現在嚴格來講有60億癌症新藥的錢……"],["劉委員建國：現在有60億，對不對？"],["薛部長瑞元：今年。"],["劉委員建國：那明年呢？"],["薛部長瑞元：明年我們會來爭取，看看是否能夠繼續有公務預算可以進來。"],["劉委員建國：當時院長跟部長答復我，要從制度面一步一步來，對不對？"],["陳院長建仁：是。"],["劉委員建國：我覺得在制度面是不是請院長、部長在短時間內可以趕快去確定？不然你今年年底就要準備爭取明年度的預算……"],["陳院長建仁：對，5月……"],["薛部長瑞元：5月我們的概算就要送出去了。"],["劉委員建國：就要處理了嘛！"],["陳院長建仁：他們概算送來後，我們這邊會增加。"],["劉委員建國：好啊！OK！但是癌症百億新藥基金到底什麼時候可以成立？"],["薛部長瑞元：我們目前就是先用這種方式來處理，因為這種方式才能與健保掛勾。跟委員報告，新藥基金並不是所有新藥就統統一直給，是有過渡期的，從暫時性支付到納入健保裡變成常規性給付，再過來就移到總額去，所以是一個階段、一個階段，不然老實講，100億撐不了幾天，癌症藥品就不夠用了。"],["陳院長建仁：這是以暫時性支付為主。"],["劉委員建國：部長的說法我瞭解，但調放基金是應該打拚的目標，這是沒有錯的事，現在所用的方式則是為了支應這段時間，說得粗魯一點，就是讓你可以方便調度，我怎麼會不懂這個意思，但這是院長在院會答復我說要建立的制度，現在在準總統的政策下，健康臺灣論壇已經啟動了，這是他重要的政見之一，現在要成為政策。所以為下一個團隊打下好的基礎還是要靠兩位吧？"],["薛部長瑞元：就機制來說，如果採用健保機制的話是可行的，問題在於如何確保其財源是穩定的。"],["劉委員建國：是不是一個月內給我未來的正確方向與處理方式，還有目標要如何去達成的報告，好不好？謝謝院長、部長。","再來，去年10月在這邊討論到護理人力荒問題，這也是院長任內與部長非常重視、非常絞盡腦汁的事情。當時我在這邊特別提到，要就要全部照顧到，因為這不是大夜班、小夜班的問題，也不能搞成區域醫院與醫學中心彼此對抗！還好，之前的抗爭處理得宜，提出可接受的方案讓大家沒有走上街頭。不過當時我們就特別提到，針對所謂含日班急慢性病床及急診這部分要一併思考，既然對大小夜班有獎勵，為什麼對這些就沒有獎勵？"],["薛部長瑞元：對。"],["劉委員建國：這好像在分階級，不對啦！"],["薛部長瑞元：跟委員報告，我們目前正在規劃這一塊，已經開始在做討論。我們內部先做討論，先把草案弄出來，然後再跟醫界或其他各界來做討論。"],["劉委員建國：草案什麼時候會出來？"],["薛部長瑞元：應該是上半年會有草案出來……"],["劉委員建國：上半年？"],["薛部長瑞元：因為我們必須爭取預算，所以上半年應該就會有草案……"],["劉委員建國：院長，我覺得可以加緊腳步。"],["薛部長瑞元：包括預算規模多少……"],["劉委員建國：在這個會期結束前就可以把草案……"],["薛部長瑞元：我們儘量。"],["陳院長建仁：應該是。"],["劉委員建國：應該可以吧，院長？部長說儘量，院長可以說這個會期結束前完成，好不好？謝謝。","最後是有關偏鄉醫療，時間只剩下一分鐘而已，院長跟部長可以看一下。牙痛不是病，病起來要人命！給人民基本醫療─牙醫資源是政府責無旁貸的。監察院在110年8月18日的調查報告中提到，雲林口湖鄉無牙醫診所。同時報告中也提到，雲林縣部分鄉鎮僅有一家牙醫診所，故要求衛福部與雲林縣政府必須檢討。其實不僅雲林如此，112年10月底前，全臺牙醫醫療資源不足的鄉鎮還有153個。再來，弱勢還有身障朋友可能需要牙醫到宅口腔照護或診治，但全國有1萬6,000名牙醫師，卻只有160位投入到宅，不到1%！偏鄉醫療計畫第一期已經結束，請問第二期什麼時候啟動？院長可不可以這邊做具體承諾？"],["陳院長建仁：我想我們儘快。"],["薛部長瑞元：這個案子，也就是優化偏鄉醫療計畫第二期已經在行政院，國發會、主計總處大概已經溝通過……"],["劉委員建國：何時可以核定？簡單答復一下。"],["陳院長建仁：最近就會核定。"],["劉委員建國：最近就會核定？請在一個禮拜內核定好嗎，院長？最近一個禮拜差不多，謝謝。"],["主席：謝謝劉委員建國的質詢，也謝謝陳院長的備詢。","接下來我們請登記第6位的吳委員春城質詢。"]],"agenda":{"page_end":219,"meet_id":"院會-11-1-6","speakers":["韓國瑜","吳宗憲","廖偉翔","陳昭姿","林憶君","賴士葆","劉建國","吳春城","王世堅","李彥秀","謝龍介","黃捷","游顥","蘇清泉","李坤城","蘇巧慧","王正旭","邱議瑩","洪申翰","鄭正鈐","涂權吉","徐巧芯"],"page_start":133,"meetingDate":["2024-03-26"],"gazette_id":"1131401","agenda_lcidc_ids":["1131401_00004","1131401_00005"],"meet_name":"立法院第11屆第1會期第6次會議紀錄","content":"施政質詢\n對行政院院長提出施政方針及施政報告繼續質詢─ 詢答完畢─","agenda_id":"1131401_00004"}},"transcript":{"pyannote":[{"speaker":"SPEAKER_03","start":1.29659375,"end":2.91659375},{"speaker":"SPEAKER_03","start":3.03471875,"end":4.3678437500000005},{"speaker":"SPEAKER_02","start":4.705343750000001,"end":6.7809687499999995},{"speaker":"SPEAKER_03","start":10.67909375,"end":11.387843750000002},{"speaker":"SPEAKER_02","start":11.809718750000002,"end":12.062843750000003},{"speaker":"SPEAKER_03","start":12.282218750000002,"end":14.00346875},{"speaker":"SPEAKER_03","start":14.695343750000003,"end":22.37346875},{"speaker":"SPEAKER_03","start":22.42409375,"end":25.984718750000003},{"speaker":"SPEAKER_00","start":22.47471875,"end":22.930343750000002},{"speaker":"SPEAKER_03","start":26.23784375,"end":34.81034375},{"speaker":"SPEAKER_03","start":34.962218750000005,"end":37.15596875},{"speaker":"SPEAKER_03","start":37.45971875,"end":40.63221875},{"speaker":"SPEAKER_03","start":40.986593750000004,"end":44.867843750000006},{"speaker":"SPEAKER_03","start":45.205343750000004,"end":49.01909375},{"speaker":"SPEAKER_03","start":49.27221875,"end":50.75721875},{"speaker":"SPEAKER_03","start":51.14534375,"end":61.57409375},{"speaker":"SPEAKER_03","start":62.063468750000006,"end":66.02909375},{"speaker":"SPEAKER_00","start":64.66221875000001,"end":64.67909375},{"speaker":"SPEAKER_03","start":66.33284375000001,"end":83.56221875},{"speaker":"SPEAKER_03","start":83.76471875,"end":86.66721875},{"speaker":"SPEAKER_03","start":87.12284375,"end":93.51846875000001},{"speaker":"SPEAKER_03","start":94.10909375,"end":96.58971875},{"speaker":"SPEAKER_03","start":96.92721875000001,"end":110.25846875},{"speaker":"SPEAKER_03","start":110.84909375000001,"end":117.34596875000001},{"speaker":"SPEAKER_03","start":117.68346875,"end":119.99534375},{"speaker":"SPEAKER_03","start":120.33284375000001,"end":129.54659375},{"speaker":"SPEAKER_03","start":129.88409375,"end":134.13659375},{"speaker":"SPEAKER_03","start":134.27159375000002,"end":145.10534375},{"speaker":"SPEAKER_03","start":145.56096875,"end":146.23596875},{"speaker":"SPEAKER_03","start":146.70846875,"end":148.90221875},{"speaker":"SPEAKER_03","start":149.39159375,"end":150.37034375000002},{"speaker":"SPEAKER_03","start":150.40409375000002,"end":161.59221875},{"speaker":"SPEAKER_03","start":162.52034375000002,"end":164.05596875},{"speaker":"SPEAKER_03","start":164.41034375,"end":166.70534375},{"speaker":"SPEAKER_03","start":167.32971875,"end":181.58909375000002},{"speaker":"SPEAKER_00","start":176.22284375,"end":176.57721875000001},{"speaker":"SPEAKER_03","start":181.70721875,"end":185.57159375},{"speaker":"SPEAKER_00","start":185.89221875,"end":186.06096875},{"speaker":"SPEAKER_03","start":186.06096875,"end":192.49034375000002},{"speaker":"SPEAKER_03","start":192.84471875,"end":203.00346875000002},{"speaker":"SPEAKER_03","start":203.20596875,"end":205.95659375000002},{"speaker":"SPEAKER_03","start":206.17596875,"end":208.87596875000003},{"speaker":"SPEAKER_03","start":209.28096875,"end":212.28471875000002},{"speaker":"SPEAKER_03","start":212.58846875,"end":213.68534375000002},{"speaker":"SPEAKER_03","start":213.83721875,"end":216.60471875000002},{"speaker":"SPEAKER_03","start":216.80721875,"end":220.70534375000003},{"speaker":"SPEAKER_03","start":220.89096875,"end":225.44721875000002},{"speaker":"SPEAKER_03","start":225.90284375000002,"end":234.35721875000002},{"speaker":"SPEAKER_03","start":234.69471875000002,"end":236.38221875000002},{"speaker":"SPEAKER_03","start":236.71971875000003,"end":238.77846875},{"speaker":"SPEAKER_03","start":239.55471875,"end":246.92909375000002},{"speaker":"SPEAKER_03","start":247.57034375,"end":247.65471875000003},{"speaker":"SPEAKER_03","start":247.92471875,"end":249.03846875000002},{"speaker":"SPEAKER_03","start":249.52784375000002,"end":250.28721875000002},{"speaker":"SPEAKER_03","start":250.59096875,"end":251.35034375},{"speaker":"SPEAKER_03","start":251.73846875,"end":252.93659375000001},{"speaker":"SPEAKER_03","start":253.22346875000002,"end":253.66221875000002},{"speaker":"SPEAKER_03","start":253.91534375,"end":255.36659375000002},{"speaker":"SPEAKER_03","start":255.48471875,"end":256.22721875},{"speaker":"SPEAKER_03","start":257.03721875,"end":257.79659375},{"speaker":"SPEAKER_03","start":257.94846875,"end":258.55596875000003},{"speaker":"SPEAKER_03","start":258.92721875,"end":260.42909375},{"speaker":"SPEAKER_03","start":260.85096875,"end":264.04034375000003},{"speaker":"SPEAKER_03","start":264.10784375000003,"end":270.46971875},{"speaker":"SPEAKER_03","start":270.87471875,"end":286.24784375},{"speaker":"SPEAKER_03","start":286.53471875,"end":291.56346875},{"speaker":"SPEAKER_03","start":291.78284375000004,"end":294.51659375},{"speaker":"SPEAKER_03","start":295.39409375,"end":298.54971875},{"speaker":"SPEAKER_00","start":298.54971875,"end":300.97971875},{"speaker":"SPEAKER_01","start":300.97971875,"end":302.81909375000004},{"speaker":"SPEAKER_01","start":303.37596875,"end":306.51471875000004},{"speaker":"SPEAKER_01","start":307.22346875,"end":311.56034375},{"speaker":"SPEAKER_01","start":311.64471875000004,"end":315.05346875000004},{"speaker":"SPEAKER_01","start":315.23909375,"end":322.24221875},{"speaker":"SPEAKER_01","start":322.68096875000003,"end":326.83221875000004},{"speaker":"SPEAKER_01","start":327.13596875,"end":330.20721875000004},{"speaker":"SPEAKER_01","start":330.32534375,"end":333.29534375000003},{"speaker":"SPEAKER_01","start":333.91971875,"end":342.44159375000004},{"speaker":"SPEAKER_03","start":340.53471875,"end":341.54721875},{"speaker":"SPEAKER_01","start":342.77909375,"end":343.47096875},{"speaker":"SPEAKER_03","start":342.86346875000004,"end":352.31346875},{"speaker":"SPEAKER_01","start":344.51721875000004,"end":345.37784375},{"speaker":"SPEAKER_01","start":352.60034375000004,"end":356.02596875},{"speaker":"SPEAKER_01","start":356.36346875000004,"end":360.31221875},{"speaker":"SPEAKER_03","start":359.08034375,"end":359.13096875},{"speaker":"SPEAKER_00","start":359.13096875,"end":359.43471875},{"speaker":"SPEAKER_03","start":359.43471875,"end":359.45159375000003},{"speaker":"SPEAKER_00","start":359.45159375000003,"end":359.48534375},{"speaker":"SPEAKER_00","start":360.31221875,"end":361.12221875},{"speaker":"SPEAKER_01","start":360.58221875000004,"end":365.94846875},{"speaker":"SPEAKER_03","start":366.25221875,"end":370.09971875},{"speaker":"SPEAKER_03","start":370.36971875,"end":372.32721875000004},{"speaker":"SPEAKER_03","start":372.71534375000005,"end":375.29721875},{"speaker":"SPEAKER_01","start":375.29721875,"end":376.59659375},{"speaker":"SPEAKER_03","start":376.05659375000005,"end":376.90034375000005},{"speaker":"SPEAKER_00","start":376.90034375000005,"end":376.98471875},{"speaker":"SPEAKER_01","start":376.98471875,"end":377.00159375000004},{"speaker":"SPEAKER_01","start":377.05221875,"end":381.57471875000005},{"speaker":"SPEAKER_00","start":379.66784375000003,"end":434.14034375000006},{"speaker":"SPEAKER_01","start":388.72971875,"end":388.76346875},{"speaker":"SPEAKER_03","start":389.91096875000005,"end":390.45096875},{"speaker":"SPEAKER_03","start":396.03659375,"end":396.15471875000003},{"speaker":"SPEAKER_00","start":434.44409375000004,"end":436.67159375000006},{"speaker":"SPEAKER_03","start":435.49034375,"end":446.67846875000004},{"speaker":"SPEAKER_00","start":444.78846875000005,"end":445.04159375},{"speaker":"SPEAKER_03","start":447.28596875000005,"end":463.36784375},{"speaker":"SPEAKER_00","start":451.60596875000005,"end":452.04471875},{"speaker":"SPEAKER_01","start":452.04471875,"end":452.34846875000005},{"speaker":"SPEAKER_00","start":452.34846875000005,"end":452.56784375},{"speaker":"SPEAKER_03","start":463.95846875,"end":483.28034375000004},{"speaker":"SPEAKER_00","start":464.09346875000006,"end":464.21159375},{"speaker":"SPEAKER_03","start":483.60096875000005,"end":484.68096875000003},{"speaker":"SPEAKER_01","start":484.91721875,"end":485.11971875},{"speaker":"SPEAKER_01","start":485.18721875000006,"end":494.53596875000005},{"speaker":"SPEAKER_01","start":494.83971875000003,"end":500.74596875000003},{"speaker":"SPEAKER_01","start":501.13409375000003,"end":502.58534375000005},{"speaker":"SPEAKER_03","start":502.38284375,"end":502.56846875},{"speaker":"SPEAKER_03","start":502.58534375000005,"end":543.06846875},{"speaker":"SPEAKER_00","start":509.95971875000004,"end":510.38159375000004},{"speaker":"SPEAKER_00","start":512.0522187500001,"end":512.27159375},{"speaker":"SPEAKER_00","start":526.75034375,"end":527.22284375},{"speaker":"SPEAKER_03","start":543.6084687499999,"end":553.5647187500001},{"speaker":"SPEAKER_03","start":554.07096875,"end":554.61096875},{"speaker":"SPEAKER_03","start":554.8134687500001,"end":555.2859687499999},{"speaker":"SPEAKER_03","start":555.57284375,"end":562.81221875},{"speaker":"SPEAKER_03","start":563.0147187499999,"end":565.84971875},{"speaker":"SPEAKER_03","start":566.45721875,"end":570.79409375},{"speaker":"SPEAKER_03","start":571.3003437500001,"end":574.84409375},{"speaker":"SPEAKER_03","start":575.2490937499999,"end":577.9153437500001},{"speaker":"SPEAKER_01","start":578.38784375,"end":593.03534375},{"speaker":"SPEAKER_01","start":593.42346875,"end":608.2397187500001},{"speaker":"SPEAKER_00","start":604.24034375,"end":604.5947187500001},{"speaker":"SPEAKER_01","start":608.3915937500001,"end":617.4365937499999},{"speaker":"SPEAKER_03","start":615.2765937500001,"end":619.15784375},{"speaker":"SPEAKER_01","start":617.7234687499999,"end":618.2634687500001},{"speaker":"SPEAKER_01","start":619.15784375,"end":624.7434687500001},{"speaker":"SPEAKER_03","start":624.06846875,"end":633.2822187500001},{"speaker":"SPEAKER_03","start":633.67034375,"end":634.07534375},{"speaker":"SPEAKER_03","start":634.49721875,"end":636.9272187500001},{"speaker":"SPEAKER_03","start":636.9440937500001,"end":638.32784375},{"speaker":"SPEAKER_03","start":638.86784375,"end":643.39034375},{"speaker":"SPEAKER_01","start":642.1753437500001,"end":647.74409375},{"speaker":"SPEAKER_00","start":643.39034375,"end":643.4240937500001},{"speaker":"SPEAKER_00","start":645.9722187500001,"end":651.0178437500001},{"speaker":"SPEAKER_03","start":650.96721875,"end":654.6965937500001},{"speaker":"SPEAKER_03","start":655.28721875,"end":655.8103437500001},{"speaker":"SPEAKER_00","start":656.58659375,"end":656.6540937500001},{"speaker":"SPEAKER_03","start":656.6540937500001,"end":658.27409375},{"speaker":"SPEAKER_00","start":656.97471875,"end":657.16034375},{"speaker":"SPEAKER_01","start":657.16034375,"end":657.1772187500001},{"speaker":"SPEAKER_00","start":657.1772187500001,"end":657.2278437500001},{"speaker":"SPEAKER_03","start":658.4597187500001,"end":659.9109687499999},{"speaker":"SPEAKER_01","start":658.56096875,"end":675.3178437500001},{"speaker":"SPEAKER_01","start":675.7734687500001,"end":686.23596875},{"speaker":"SPEAKER_01","start":686.4553437500001,"end":689.6615937500001},{"speaker":"SPEAKER_01","start":690.16784375,"end":690.20159375},{"speaker":"SPEAKER_01","start":690.5390937500001,"end":693.12096875},{"speaker":"SPEAKER_00","start":692.26034375,"end":692.32784375},{"speaker":"SPEAKER_03","start":692.32784375,"end":692.88471875},{"speaker":"SPEAKER_00","start":692.88471875,"end":692.96909375},{"speaker":"SPEAKER_01","start":693.54284375,"end":696.25971875},{"speaker":"SPEAKER_03","start":695.66909375,"end":701.0522187500001},{"speaker":"SPEAKER_01","start":696.4115937500001,"end":697.06971875},{"speaker":"SPEAKER_03","start":701.45721875,"end":710.31659375},{"speaker":"SPEAKER_02","start":706.92471875,"end":707.02596875},{"speaker":"SPEAKER_00","start":707.02596875,"end":707.05971875},{"speaker":"SPEAKER_02","start":707.05971875,"end":707.1103437500001},{"speaker":"SPEAKER_00","start":707.1103437500001,"end":707.19471875},{"speaker":"SPEAKER_03","start":711.0759687500001,"end":719.27721875},{"speaker":"SPEAKER_01","start":711.3290937500001,"end":711.7678437500001},{"speaker":"SPEAKER_00","start":711.7678437500001,"end":711.85221875},{"speaker":"SPEAKER_01","start":719.27721875,"end":719.9015937500001},{"speaker":"SPEAKER_03","start":719.9015937500001,"end":734.88659375},{"speaker":"SPEAKER_01","start":734.6672187500001,"end":734.76846875},{"speaker":"SPEAKER_01","start":734.88659375,"end":746.98596875},{"speaker":"SPEAKER_03","start":746.98596875,"end":749.7365937500001},{"speaker":"SPEAKER_03","start":750.20909375,"end":763.60784375},{"speaker":"SPEAKER_00","start":763.60784375,"end":763.6753437500001},{"speaker":"SPEAKER_03","start":763.6753437500001,"end":764.0972187500001},{"speaker":"SPEAKER_00","start":763.72596875,"end":763.86096875},{"speaker":"SPEAKER_03","start":764.56971875,"end":770.2903437500001},{"speaker":"SPEAKER_03","start":771.1340937500001,"end":773.6147187500001},{"speaker":"SPEAKER_03","start":773.71596875,"end":774.82971875},{"speaker":"SPEAKER_03","start":774.99846875,"end":778.62659375},{"speaker":"SPEAKER_03","start":779.08221875,"end":781.05659375},{"speaker":"SPEAKER_03","start":781.32659375,"end":786.38909375},{"speaker":"SPEAKER_03","start":786.77721875,"end":790.5403437500001},{"speaker":"SPEAKER_03","start":791.2322187500001,"end":795.90659375},{"speaker":"SPEAKER_03","start":796.37909375,"end":800.29409375},{"speaker":"SPEAKER_03","start":800.56409375,"end":802.28534375},{"speaker":"SPEAKER_03","start":802.70721875,"end":804.52971875},{"speaker":"SPEAKER_03","start":805.1540937500001,"end":805.8797187500002},{"speaker":"SPEAKER_03","start":806.5547187500001,"end":807.02721875},{"speaker":"SPEAKER_01","start":807.02721875,"end":807.1115937500001},{"speaker":"SPEAKER_01","start":807.21284375,"end":820.7465937500001},{"speaker":"SPEAKER_03","start":820.27409375,"end":821.3372187500001},{"speaker":"SPEAKER_01","start":821.80971875,"end":830.6015937500001},{"speaker":"SPEAKER_03","start":825.7078437500002,"end":826.16346875},{"speaker":"SPEAKER_03","start":826.46721875,"end":827.46284375},{"speaker":"SPEAKER_03","start":830.53409375,"end":830.5678437500001},{"speaker":"SPEAKER_03","start":830.6015937500001,"end":830.95596875},{"speaker":"SPEAKER_01","start":830.95596875,"end":838.0772187500002},{"speaker":"SPEAKER_03","start":830.9897187500001,"end":831.1415937500001},{"speaker":"SPEAKER_03","start":831.24284375,"end":831.47909375},{"speaker":"SPEAKER_03","start":834.43221875,"end":835.9509687500001},{"speaker":"SPEAKER_03","start":837.2334687500002,"end":840.49034375},{"speaker":"SPEAKER_01","start":839.8828437500001,"end":840.8784687500001},{"speaker":"SPEAKER_03","start":840.8784687500001,"end":849.19784375},{"speaker":"SPEAKER_00","start":843.6797187500001,"end":847.0378437500001},{"speaker":"SPEAKER_01","start":847.0378437500001,"end":848.0165937500001},{"speaker":"SPEAKER_00","start":848.0165937500001,"end":848.08409375},{"speaker":"SPEAKER_01","start":849.19784375,"end":849.4509687500001},{"speaker":"SPEAKER_03","start":849.4509687500001,"end":849.7040937500001},{"speaker":"SPEAKER_03","start":849.90659375,"end":852.7078437500002},{"speaker":"SPEAKER_03","start":852.9778437500001,"end":853.8047187500001},{"speaker":"SPEAKER_03","start":854.2434687500001,"end":856.3022187500001},{"speaker":"SPEAKER_03","start":856.7578437500001,"end":860.03159375},{"speaker":"SPEAKER_03","start":860.5547187500001,"end":867.8447187500001},{"speaker":"SPEAKER_03","start":868.2834687500001,"end":879.18471875},{"speaker":"SPEAKER_03","start":879.48846875,"end":883.84221875},{"speaker":"SPEAKER_03","start":884.11221875,"end":886.93034375},{"speaker":"SPEAKER_03","start":886.9978437500001,"end":892.54971875},{"speaker":"SPEAKER_03","start":893.07284375,"end":897.2240937500001},{"speaker":"SPEAKER_03","start":897.61221875,"end":898.20284375},{"speaker":"SPEAKER_03","start":898.9453437500001,"end":899.58659375},{"speaker":"SPEAKER_03","start":900.6497187500001,"end":902.10096875},{"speaker":"SPEAKER_03","start":902.64096875,"end":905.5265937500001},{"speaker":"SPEAKER_03","start":905.88096875,"end":906.5053437500001},{"speaker":"SPEAKER_03","start":906.91034375,"end":909.01971875},{"speaker":"SPEAKER_00","start":909.42471875,"end":910.23471875},{"speaker":"SPEAKER_01","start":910.23471875,"end":918.43596875},{"speaker":"SPEAKER_03","start":912.7490937500002,"end":912.78284375},{"speaker":"SPEAKER_00","start":912.78284375,"end":912.9853437500001},{"speaker":"SPEAKER_00","start":917.0522187500001,"end":917.71034375},{"speaker":"SPEAKER_02","start":930.38346875,"end":932.93159375},{"speaker":"SPEAKER_02","start":933.9440937500001,"end":937.0322187500001},{"speaker":"SPEAKER_02","start":938.8715937500001,"end":941.8415937500001},{"speaker":"SPEAKER_02","start":942.1115937500001,"end":943.6809687500001}],"whisperx":[{"start":1.651,"end":29.431,"text":"謝謝主席,有請院長,還有衛福部,薛部長麻煩再請陳院長備詢衛福部委員長,謝謝,辛苦了可能最後一百日,因為跟你談到國家事情那我還是肯定院長這段時間的辛苦跟努力那這種辛苦跟努力還是為了要給下一個團隊打下更好的基礎照顧更多的臺灣的人民、百姓"},{"start":30.273,"end":58.442,"text":"所以院長的決策還有這個整體的這個方向跟這個好的一個方法絕對是對於胡國立民是一個非常攸關重要的事情那我今天因為時間真的很有限15分鐘所以針對幾個面向要特別來跟院長跟部長來做一個提醒跟討論那第一個當然就長照基金那台灣邁入超高齡明年就到我個人看可能是今年年底明年初就要到了因為在七年前曾經講是2026"},{"start":59.83,"end":86.396,"text":"三年前就講說再提早一年我覺得還會再提更早一點點這我個人的淺見那事實上臺灣的22個縣市現在已經有6個縣市早就進到超高齡社會有嘉義、臺北、南投、基隆、屏東還有我的母縣雲林已經代表的已經佔了四分之一的縣市所以我覺得速度真的會越來越快而且人口結構的快速改變基本上"},{"start":87.208,"end":109.256,"text":"所有的面相通通會變,這個我在這邊也講了不下N次以上,從經濟、教育、文化、產業等等等。所以我們看到蔡政府執政之後,也要回歸回推到馬政府的時候,對長照的預算當時是平均是不足每年50億啦。我們都講50億啦,其實真的是不足啦,不足。一路一直到今年已經拿到800多億。"},{"start":111.042,"end":119.451,"text":"這是非常恐怖的一個成長。那部長、院長看這張圖就是說,這是我們為何不得106到115年的10年的長照推估表。當時是110年的支出,我們推估是396.36億。那實際上決算是來到454。那你看相差。"},{"start":131.28,"end":131.3,"text":"韓國瑜"},{"start":150.632,"end":165.983,"text":"我不曉得我們的因應知道在什麼地方。那11、3年當然我們現在的預算是抓8和8了。實際上最後的執行是多少還不知道。但是推估是4、3、6。如果照預算去算又誤差了300多、將近400億。"},{"start":168.15,"end":192.188,"text":"這個推估表是不是要更正了,這第一點。第二點,徐部長曾經對我講說長照基金剩餘將近一千多億,那主要是黃帝合一、菸稅遺產遺證還有所得稅,認為五年內長照基金的裁員是沒有問題,這是部長講的。那真的有這麼樂觀嗎?我要簡單講一些背景資料再給院長跟部長做答覆。"},{"start":192.932,"end":199.837,"text":"內政部在110年的12月統計65歲的失智人口是30.8萬那國安會預估120年等於不到10年時間失智人口會達到46萬百分之50的成長所以未來這個面向照顧會更多我們的總總統賴清德特別提出長照3.0"},{"start":212.657,"end":237.423,"text":"那其中又針對住宿式的服務機構使用者補助方案從整個預算規模要從78億調高到118億就要再增加40億嘛還有要強化重度失能者的照顧新增居家或社區的晚間倒載照顧然後建立24小時的重度失能者支持服務這可能又要需要幾十億的預算的規模嘛對不對好而且我們長照幾支戶7年"},{"start":239.608,"end":242.59,"text":"這幾個面向我想從要進到實質上進到3.0可能明年我們的長照預算就會破千億。"},{"start":257.076,"end":277.1,"text":"一定會破千例。那院長跟部長再看一下嘛從過去長道基金的收入來源110億是700多億但是111到12它確實有高達將近900多億但是如果以我們的長道基金來源的預估就是推估表113如果是776.6億那今年實際上執行數是828的話那這均相差了50幾億以此類推114"},{"start":283.137,"end":283.537,"text":"因為我們的收入的預算"},{"start":307.55,"end":313.858,"text":"我們的支出的預算是根據收入的預算來。那收入的預算是由財政部這邊給的資料。"},{"start":315.662,"end":337.16,"text":"財政部在這個因為有一些像說房地利合一稅等等遺產稅這些因為他是比較不確定的所以通常會比較低估所以在年度結算的時候我們的收入通常比原來收入的預算高很多所以目前來講的話已經累計到1500億的這個基金的結餘在那個地方"},{"start":343.098,"end":372.111,"text":"所以我第二張表格對不起我抄一下第二張表格你可以看嘛你的結語是1120的時候是1072嘛對不對我還是照部長所講的金額去算沒有去年去年後來整個的結語算起來的話total現在已經差不多1500億對所以收入有比原來的預算多很多如果陳理部長所答覆我這樣院長你可以看到我們長照基金的支出推估表"},{"start":372.776,"end":394.131,"text":"跟財源收入表,坦白講這兩張表是假的,差太多啦。我們的支出的預算只能根據那個收入的預算來支付啦。這就是含我們的,因為我們收入的部分,包括贈餘稅、菸稅,還有房地合一稅,那是浮動的嘛。我們一般,政府在說收入的時候,財政部都比較保守啦。就是說會講比較直接啦。"},{"start":398.454,"end":404.699,"text":"實際上會比較多。我們的支出,我們要向委員報告的是,通常我們是量入為出的方式來進行我們的長照。但是你說的居住型長照等等,這長照3.0,清德總統未來要推動的,這個我們"},{"start":419.031,"end":420.011,"text":"但是坦白講這些稅"},{"start":447.332,"end":472.513,"text":"我們專家學者看待裡面,他是認為是交機會稅。所以以穩定性,尤其這個房地合一的稅,一直在打黃,這兩年可以比較高,明年後年,大後年,他或許就會急劇下降,也不一定。所以這個我是希望可能要有相關的一些應變的一些措施的,因為我們希望過去打出長照,就是找到"},{"start":473.018,"end":478.522,"text":"有關於支出的這部分的話委員剛剛提到的3.0將來要做的事情也是蠻多不過有一點會有一點差異就是我們投入到這個資源部件的成本這些的話會減少"},{"start":501.238,"end":501.738,"text":"主席主席主席"},{"start":528.636,"end":551.216,"text":"我也是第一個在本院提出這個修法的委員那時候當時是院長跟部長都有打呼我一步一步來這個我當然可以接受但是現在已經三月了今天已經三月了我知道這個衛福部今年有成立的健康政策與醫療科技的評估中心這個要肯定因為協助健保進行新醫療技術藥品醫材幾戶的審定"},{"start":554.144,"end":577.707,"text":"但是跟賴戶總總統要建制一個獨立的百億癌症心療基金這顯然落差很大因為我們的目標就是國家的防癌癌症的防治計畫目標是在2031年讓臺灣的癌症死亡人數可以減少到三分之一要達到這個目標很多的面向必須要處理的但是這個心療的百億基金我覺得是重中之重"},{"start":578.624,"end":596.184,"text":"各位報告目前的做法是在健保的總額之內總額預算之內的話那我們利用這個公務預算補助的像說去年240億今年200億那今年的200億裡面我們就有安額差不多60億"},{"start":597.085,"end":624.916,"text":"那其中24億左右是在做這個暫時性支付,那其他有三十幾億是在做這個新藥的納入。所以現在嚴格來講有60億的這個癌症新藥的錢,就今年。明年呢?明年的話我們會爭取看看是不是能夠有繼續有公務預算可以進來。"},{"start":626.737,"end":647.589,"text":"院長當時跟部長討論我是要從制度面一步一步來嘛,對不對?那我覺得這個制度面是不是可以在院長部長在短時間內可以趕快去確定,不然你明年還是要再去,就是今年年底就準備要爭取明年度的這個預算嘛,但是他可能...各位我們的計算就要處理了。各位的計算還是我們這邊會檢查。好啊,OK啊,好。但是這個基金到底什麼時候可以成立?"},{"start":657.163,"end":659.825,"text":"新藥基金並不是所有的新藥就通通一直給下去。"},{"start":675.816,"end":698.189,"text":"他是有一個過渡期的,那從暫時性支付到納入到健保裡面,變成常規性的給付,然後再過來就應該移到總額去。所以他是一個階段一個階段的,不然的話,一百億老實講都沒空當,要這個癌症的藥品就不夠人了。這是暫時性支付為主啦。不,對你說的我了解啦,但是"},{"start":701.531,"end":702.753,"text":"你現在用這個方式,當然應付這段時間,甚至是"},{"start":711.195,"end":711.715,"text":"主席主席"},{"start":734.983,"end":740.328,"text":"是不是一個月內可以給我一個比較未來的正確的一個方向跟處理的方式還有這個目標要如何去達成的一個報告好不好,謝謝。謝謝院長部長,再來就是也是去年11月在這邊討論的"},{"start":760.783,"end":788.972,"text":"護理人力方這是院長任內根部長非常重視也非常絞盡腦汁的事情但是我在這邊特別提到就是要搞在中國啦不是大夜班小夜班的問題啦也不是搞成到區議院跟醫學中心這批時間在這樣對抗還好因為八月之前的一個抗爭處理得宜嘛可接受的一個方案大家沒有走上街頭但是其實當時我們特別有提到就是針對所謂的"},{"start":792.021,"end":805.417,"text":"這個韓日班的不分這個吉曼縣的病床還有急診的這個應該也要與病去思考我們對大小月班有獎勵為什麼對這些就沒有獎勵這好像在分階級不對啦"},{"start":807.367,"end":826.691,"text":"各位委員報告,我們目前正在規劃這一塊,這已經開始在做討論了,我們內部先做討論,先把一個草案弄出來,然後再跟這一些醫界或者其他各界來做討論。這個草案什麼時候會出來?應該是在上半年會有一個草案出來,因為我們必須要爭取預算,"},{"start":830.572,"end":832.112,"text":"最後一件事情就是偏鄉醫療,這個剩下一分鐘而已,院長跟部長可以看"},{"start":856.783,"end":857.263,"text":"今朝院在110年8月18日調查報告,"},{"start":868.365,"end":891.111,"text":"只我的這個雲林的口香無牙醫診所。同時報告中雲林縣的部分鄉鎮僅有一家牙醫診所,也要求衛務部跟雲林縣政府必須檢討。不僅雲林如此,112年10月底前,全台的牙醫醫療的資源不足鄉鎮還有153個。然後再來,我們看到弱勢還有身上朋友可能需要倒載的這個牙醫的口香紮護或診治,"},{"start":893.14,"end":917.553,"text":"全國有1萬6千個牙醫師,只有160位投入這個到載。我跟這啪啦。所以我是覺得優化這個偏鄉的醫療第一期已經結束,到第二期什麼時候?院長可不可以在這邊做具體的承諾?我講我們盡快,來。這一個案子,也就是我們的優化偏鄉醫療的計畫第二期,已經在..."},{"start":930.501,"end":934.946,"text":"謝謝劉委員建國的謝謝劉委員建國的質詢。也謝謝陳院長的備詢。接下來我們請登記第6位吳委員春辰質詢。"}]}},"supported_relations":[],"relations":[]}