{"error":false,"id":["151011"],"data":{"IVOD_ID":151011,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/151011","日期":"2024-04-10","會議資料":{"會議代碼":"委員會-11-1-26-11","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11次全體委員會議","屆":11,"會期":1,"會次":11,"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11次全體委員會議"},"影片種類":"Clip","開始時間":"2024-04-10T13:05:03+08:00","結束時間":"2024-04-10T13:16:57+08:00","影片長度":"00:11:54","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/871d5246fb87948e8d3df153b91412e1533009c4a7c43105f8ba9b0039caa7a69d00c0f30f14c1985ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"楊曜","委員發言時間":"13:05:03 - 13:16:57","會議時間":"2024-04-10T09:00:00+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11次全體委員會議（事由：一、審查\n(一)委員邱議瑩等25人擬具「再生醫療法草案」案。\n(二)委員謝衣鳯等19人擬具「再生醫療發展法草案」案。\n(三)委員羅廷瑋等21人擬具「再生醫療法草案」案。\n二、審查\n(一)委員邱議瑩等25人擬具「再生醫療製劑條例草案」案。\n(二)委員謝衣鳯等18人擬具「再生醫療製劑管理條例草案」案。\n(三)委員羅廷瑋等21人擬具「再生醫療製劑管理條例草案」案。\n【一、二案採綜合詢答，本日會議僅詢答】\n【4月8日及10日二天一次會】）","gazette":{"lineno":1022,"blocks":[["楊委員曜：（13時5分）謝謝主席，請一下薛部長。"],["主席：請薛部長。"],["薛部長瑞元：委員好。"],["楊委員曜：部長好。部長，我先請教一個問題，醫學中心的家數一直在增加，可是我現在發現缺床的部分太嚴重了，有關我們的急診暫留率，醫學中心近於全國平均值的2%，這個是比較怪，理論上醫學中心握有比較龐大的資源，它的暫留率應該要比區域醫院跟地區醫院……特別是偏鄉的地區醫院，因為它確實在招募醫事人力上面是比較困難。","我們再看一個數據，22家醫學中心含準醫學中心的急性一般病床的合計許可數是2萬5,368床，近3個月的開放數是2萬3,753床，開床率只有93%，問題到底在哪裡？因為我這邊沒有拿到區域醫院的開床率，所以沒有辦法做比較，可是就我的想像上，我覺得我們既然核准了，而且有越來越多家醫學中心，醫學中心擔負了最終的醫療責任，但它的開床率真的太低了，這個問題部長怎麼解決？"],["薛部長瑞元：其實大部分的醫中、準醫中大概許可床都開了，除了幾家，這幾家包括臺大、林口長庚、淡水馬偕及彰基，之所以沒有全開的原因是它們準備要興建醫療大樓，那先把這個quota申請出來，在開始建築之後床才會開，所以目前沒有開的大概都屬於這種狀況。"],["楊委員曜：那這裡有一個問題，為什麼大樓還沒有興建之前，它就先來申請床？"],["薛部長瑞元：對，它必須要跟我們申請許可床，因為區域的關係，我們有一個計算方式，它有了許可床數才能夠開始動工去興建，如果沒有這個床的話，它到時候蓋起來沒有辦法有病床。"],["楊委員曜：不是，我的意思是說，它不是應該先興建完才申請嗎？"],["薛部長瑞元：沒有，是先申請許可。"],["楊委員曜：先申請再……"],["薛部長瑞元：對，有了這個quota的話，它才……"],["楊委員曜：就是它先匡一個概數。"],["薛部長瑞元：對。"],["楊委員曜：其實這個也是概數啦！對不對？"],["薛部長瑞元：對，因為將來蓋好了之後，是不是就按照這個quota去設置病床，有時候會做一些微調。"],["楊委員曜：因為我澎湖有很多鄉親轉診以後，直接就在急診室完成了醫療行為，沒有住院，這個是一則以喜一則以憂啦！在急診室可以完成治療行為，反正病人也康復了。"],["薛部長瑞元：對，可能是疾病嚴重度沒那麼高。"],["楊委員曜：對，不過我確實接過好幾個案子都是這樣子，沒有關係，因為我這邊沒有區域醫院跟地區醫院的資料，我相信越往下層級的醫療機構，它的開床率可能是越低的。"],["薛部長瑞元：這個不一定。"],["楊委員曜：不一定？"],["薛部長瑞元：可以說它的占床率是低，就是有開出了病床，那實際上有使用的、也有病人住進去的大概是比較低。"],["楊委員曜：沒有、沒有，占床率高低跟我們行政機關比較無關，現在是說它的開床率，就是核准數跟真正可以……"],["薛部長瑞元：對，開放數，差距比較多啦！"],["楊委員曜：可以符合護病比，其實我覺得最大的問題應該都在護病比上面。"],["薛部長瑞元：大概是這個樣子，許多小型醫院的占床率不高，但是開床率滿高的，因為是它以前所申請的，如果經營適當的話大概不會縮床啦！也就是說，它可能是100床左右，它如果經營得好，大概100床都會用，不太會關掉。","比較有問題的倒是區域醫院，中型的區域醫院─尤其像我們有一些部立醫院也是這個樣子，它已經申請這麼多床，但是病人一直沒有那麼多，所以它沒有辦法全部開，因為一開的話，護理人員就要增加嘛！所以它本身考慮到經營的部分就沒有開那麼多。這種經過許可但是還沒開放的，可能中型的區域醫院會比較多，我們的部立醫院有這種情形的也不少，所以我們現在正在清查，如果真的是沒有辦法開的話是不是要減床。"],["楊委員曜：可是偏鄉離島最高的醫療層級大概都到地區醫院。"],["薛部長瑞元：地區醫院，對，區域醫院的比較少。"],["楊委員曜：大概都到地區醫院，假如一直關床的話，其實對於居民會造成很大的不方便。"],["薛部長瑞元：偏鄉離島其實關床的不多，但是未來如果是三班護病比的話，會不會有影響這個很難說。"],["楊委員曜：部長，其實還滿多的，我不想造成醫院太大的壓力，因為人力增補真的是有它一定的困難在，這個請部裡面還是注意一下。"],["薛部長瑞元：好。"],["楊委員曜：沒有時間了，我簡單問一個關於再生醫療問題，部長，再生醫療就是將基因、細胞及它的衍生物用於人體構造或功能的重建修復，以達到治療的目的，那有一種是慈恩療法，對不對？"],["薛部長瑞元：恩慈療法。"],["楊委員曜：恩慈療法它的藥物等待時間長短不一，但現在的藥證申請必須要經過很長的時間，在我們完成立法以後，有一個問題是，會走入恩慈療法的病人大概都有一定的急迫性，對於它的藥證申請或者是核准的申請，我們應該會有特殊的設計，對不對？也就是說，我們附加許可，然後再經過再生醫療審議會審議通過就可以，是不是這樣子？"],["薛部長瑞元：這個可能不太一樣。第一個，恩慈療法這個部分，恩慈療法大部分是指在國內並沒有通過的，不管是技術或者是製劑，它沒有通過，但是病人有需要要用，在國外也有了，只是說廠商還沒有來申請，這一種就會走到恩慈。也就是說，我們國內並沒有給許可證，但是他急著要用，我們會做逐案的審查。","至於剛剛委員提到附附款的許可，這個是在再生醫療製劑條例裡面，它是說有一個再生醫療製劑要來申請，我們不知道它的效果，還沒有那麼確定，這個時候我們暫時給它許可，但是它必須要提供後續治療的資訊給我們，讓我們來做判斷。這個附附款的許可是有期限的，在期限之內，你做的這一些治療case的結果是什麼都必須要報過來，作為我們未來是否准駁的一個依據。"],["楊委員曜：這個是在製劑條例裡面有規範的部分。"],["薛部長瑞元：對。"],["楊委員曜：所以恩慈療法的藥物並沒有在這個規範裡面？"],["薛部長瑞元：應該不在。"],["楊委員曜：那我們有沒有管制？"],["薛部長瑞元：恩慈療法的部分有兩個，一個是再生醫療法，這是屬於技術方面的，我們有這一個，就是說它沒有完成人體試驗，但是可以來用的、可以來申請的，這個部分就是我之前在講的，所有的再生醫療技術都必須要有人體試驗的例外，恩慈療法就是一個例外；至於製劑條例裡面的，它已經變成一個製劑了，這個部分就是依照藥事法相關的恩慈療法的規定來進行，所以還是有恩慈療法。"],["楊委員曜：好，那其他我們逐條再討論。"],["薛部長瑞元：好。"],["楊委員曜：謝謝部長，謝謝主席。"],["薛部長瑞元：謝謝。"],["主席：謝謝楊曜委員。","接下來請劉建國委員發言。"]],"agenda":{"page_end":226,"meet_id":"委員會-11-1-26-11","speakers":["黃秀芳","邱議瑩","羅廷瑋","陳昭姿","林月琴","陳菁徽","王育敏","涂權吉","王正旭","蘇清泉","林淑芬","洪申翰","黃捷","賴士葆","陳瑩","黃國昌","洪孟楷","楊瓊瓔","蘇巧慧","陳冠廷","楊曜","劉建國","邱鎮軍","林德福","邱志偉"],"page_start":155,"meetingDate":["2024-04-10"],"gazette_id":"1132601","agenda_lcidc_ids":["1132601_00004"],"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11次全體委員會議紀錄","content":"一、審查(一)委員邱議瑩等25人擬具「再生醫療法草案」案、(二)委員謝衣鳯等19人擬具「再生\n醫療法草案」案、(三)委員羅廷瑋等21人擬具「再生醫療法草案」案；二、審查(一)委員邱議瑩\n等25人擬具「再生醫療製劑條例草案」案、(二)委員謝衣鳯等18人擬具「再生醫療製劑管理條例\n草案」案、( 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這個是比較怪理論上是醫學中心握有比較龐大的資源他的佔留率應該是要比區醫院跟地區醫院比如說特別是偏鄉的地區醫院因為他確實在招募醫事人力上面是比較困難那"},{"start":84.437,"end":96.423,"text":"我們再看一個數據22家醫學中心含準醫學中心的急性一般病床合計的許可數是25,368床近三個月的開放數是23,753大概開放率只有"},{"start":111.035,"end":131.306,"text":"九十三趴那這個問題到底在哪裡?因為我這邊沒有拿到區議院的開床率所以我沒有辦法做比較可是就我的想像上我覺得我們既然核准了而且有越來越多家的"},{"start":133.76,"end":145.387,"text":"醫學中心,醫學中心擔負了最重的醫療責任,那他的開床率真的太低了。這個部長怎麼解決?"},{"start":145.387,"end":152.431,"text":"這部分的話其實大部分的醫中、準醫中大概都許可床都開了,除了幾家。"},{"start":153.731,"end":170.182,"text":"這幾家包括臺大、林口長庚、淡水馬街、張機之所以沒有全開的原因是他們準備要興建醫療大樓"},{"start":172.203,"end":182.433,"text":"先把這個扣打先申請出來之後的話再開始建築之後床才會開所以目前沒有開的大家都屬於這種狀況"},{"start":184.57,"end":210.915,"text":"那這裡有一個問題就是為什麼大樓還沒有申請之前他就先來申請床?因為他必須要跟我們申請有這個許可床因為區域的關係我們有一個計算的方式那他有了這個許可床數的話他才能夠開始動工去興建不然沒有這個床的話他到時候"},{"start":212.596,"end":238.351,"text":"蓋起來的話沒有辦法有病床。不是,我的意思是說不是應該要他先興建完才申請。沒有沒有,是先申請。先申請。對。先申請再。對,有了這個擴大的話。所以他先框一個蓋數。對對對。其實這個也是蓋數啦。對不對。對,將來蓋好了之後的話,是不是就是按照這個擴大去設置病床,這有時候會有做一些微調。"},{"start":238.851,"end":255.222,"text":"因為其實我朋友有很多鄉親就是轉診了以後就在急診室完成了醫療行為就直接沒有住院就對這個對於"},{"start":260.425,"end":270.509,"text":"一則於喜一則於憂,在急診室可以完成治療行為,好像反正就是病人也康復了。不過我確實接過好幾個案子都是這樣子。"},{"start":283.955,"end":301.711,"text":"因為我這邊沒有區域醫院跟地區醫院,我相信越往下層級的醫療機構可能它的開床率可能是越低的。"},{"start":303.327,"end":318.993,"text":"這個不一定,可以講的是說他的戰床率是低,就有開出了變床那實際上有使用的也有變床沒有戰床率高低跟我們行政機關比較無關"},{"start":321.014,"end":334.427,"text":"現在是說它的開創率合準數跟真正可以符合互併比其實我覺得最大的問題應該都在互併比上面"},{"start":337.409,"end":365.805,"text":"這個跟委員報告大概是這樣子許多小型的醫院他的占床率不高但是他的開床率蠻高的因為他以前申請的大概如果他經驗是一個適當的話大概不會縮床啦也就是說他可能是100床左右大概他如果經驗好大概一百床大家都會用啦不太會關掉那比較有問題的倒是區醫院"},{"start":367.041,"end":372.559,"text":"基院中型,尤其像我們有一些部立院也是這個樣子,"},{"start":375.265,"end":401.906,"text":"醫療醫療行政加多層啊但是他的病人一直就是沒有那麼多所以他沒有辦法全部去開一開的話這一個護理人員就要增加嘛所以他的本身的話就會考慮到這個經營的部分的話就會沒有沒有開那麼多所以有這種經過許可但是還沒開放的比較多的都是可能這種中型的去醫院會比較多"},{"start":402.606,"end":417.026,"text":"那我們的不利院這種情形的也不少所以我們現在正在清查如果真的是沒有辦法開的話是不是要檢查可是像有"},{"start":419.049,"end":434.793,"text":"偏鄉離島大概最高的醫療成績都到地區醫院,那假如一直關床的話其實對於居民會造成很大的不同。"},{"start":438.089,"end":464.819,"text":"但是未來如果說有三萬戶變比的話,這會不會影響?不然其實還蠻多的。我不想造成醫院太大的那個,因為人力的增補是有它一定的困難在。這個請部裡面還是注意一下。我們今天還是,哇沒時間了。"},{"start":470.796,"end":491.202,"text":"就醫療我簡單問一個問題再生醫療部長再生醫療就是將基因細胞和他的衍生生物用於人體構造或功能的重建修復"},{"start":495.891,"end":519.249,"text":"來達到治療的目的。」有一種是慈恩療法。恩慈療法。恩慈療法它的藥物的等待時間長短不一。我們現在的藥證申請其實是必須要經過很長的時間。"},{"start":521.533,"end":548.892,"text":"那我們完成立法了以後有一個問題就是因為會走入恩慈療法的病人大概都有他一定的急迫性那他的藥證的申請或是他核准的申請我們應該是會有特殊的設計對不對也就是說我們"},{"start":552.523,"end":557.216,"text":"福家許可然後再經過一個再生醫療審議會議的審議通過就可以是不是這樣子"},{"start":562.258,"end":582.864,"text":"這可能不太一樣,恩慈療法大部分指的是說在國內並沒有通過的不管是技術或者是說字跡,沒有通過但是變成有需要要用,國外也有了"},{"start":583.8,"end":597.294,"text":"只是說廠商還沒有來申請。這一種的話就是會走到恩賜。也就是說我們國內並沒有給許可證,但是他急著要用。我們會做逐案的審查。"},{"start":600.43,"end":620.655,"text":"剛剛委員提到的付付款的許可這個是在再生醫療制計條例裡面他是說有一個再生醫療制計他要來申請我們不知道說他的效果怎麼樣還沒有那麼確定"},{"start":622.035,"end":646.016,"text":"這時候我們暫時給他許可但是他必須要提供後續治療的一些資訊給我們讓我們來做判斷這個付付款的許可的話他是有期限的在期限之內你做的這一些治療的case他的結果是什麼都必須要報過來那我們再來做未來的是否準博的一個依據"},{"start":647.918,"end":656.749,"text":"這是有在自治條例裡面規範的部分所以恩慈療法的藥物並沒有在這個規範裡面。應該不在"},{"start":659.821,"end":675.868,"text":"草案：立法院第11屆第1會期社會福利及衛生環境委員會第11屆第2會期社會福利及衛生環境委員會第1會期社會福利及衛生環境委員會第2會期社會福利及衛生環境委員會第1會期社會福利及衛生環境委員會第2會期社會福利及衛生環境委員會第3會期社會福利及衛生環境委員會第4會期社會福利及衛生環境委員會第5會期社會福利及衛生環境委員會第6會期社會福利及衛生環境委員會第7會期社會福利及衛生環境委員會第8會期社會福利及"},{"start":688.837,"end":714.209,"text":"那至於治劑條例裡面的它已經變成一個治劑了那這一個的部分的話那就是依照我們的藥術法相關的這種恩恥療法的規定來進行所以還是有恩恥療法好那其他我們主條再討論好謝謝部長謝謝主席好謝謝楊耀委員接下來請劉建國委員發言"}]}},"supported_relations":[],"relations":[]}