{"error":false,"id":["152054"],"data":{"IVOD_ID":152054,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/152054","日期":"2024-05-02","會議資料":{"會議代碼":"委員會-11-1-26-14","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14次全體委員會議","屆":11,"會期":1,"會次":14,"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14次全體委員會議"},"影片種類":"Clip","開始時間":"2024-05-02T10:43:10+08:00","結束時間":"2024-05-02T10:58:10+08:00","影片長度":"00:15:00","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/6f015fe8e6787db1ca4c870093958bfbd575e50b9cd8685a55be169921a0a7177a74fa3952d5ae645ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"劉建國","委員發言時間":"10:43:10 - 10:58:10","會議時間":"2024-05-02T09:00:00+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14次全體委員會議（事由：審查\n一、委員王育敏等19人擬具「全民健康保險法第六十二條條文修正草案」案。\n二、委員蘇清泉等28人擬具「全民健康保險法第六十二條條文修正草案」案。\n三、國民黨黨團擬具「全民健康保險法第六十二條條文修正草案」案。\n【以上議案，如經復議則不予審查】）","gazette":{"lineno":568,"blocks":[["劉委員建國：（10時43分）謝謝召委，有請部長。"],["主席：請薛部長。"],["劉委員建國：署長也順便一起，謝謝。"],["薛部長瑞元：委員好。"],["主席：他是健保署署長，很重要。"],["劉委員建國：是。委員會現在剩下我跟你而已，兩個。我先肯定召委，好不好？召委跟蘇委員今天把健保點數要等值，一點要等值一元的提案、法律修正案提到委員會來討論，這是我們必須要面對的事情。我想不只是國會議員，還有行政機關、衛福部，甚至在這次總統大選，三黨的總統候選人都有提出來，所以這是具高度共識的一件事情。但是在高度共識的過程裡面，我剛剛看到衛福部的相關報告，也看到很多委員的垂詢、看到部長的答復，我是真的從一個角度來做思考，我們站在醫界、政府、雇主還有被保險人，也就是要繳保費的全體國民，從這個角度來做思考的情況之下，部長跟署長還有剛到的王委員都來自醫界，下一屆的部長也來自醫界，針對這些事情的處理，我想不能只站在醫界的角度，當然也是要從醫界的角度來思考、探討，這也不為過，畢竟提案的委員除了王召委之外，蘇清泉委員也來自醫界，所以要從很多面向都要思考的情況之下，才可以讓這樣的制度可長可久，不會為了達到這個目標，反而造成沒必要的一些後續擔憂或是困擾，我想這才是我們真正要解決的一個方式。","我先給部長跟署長還有委員會看一個資料，我說人離開之後，講的話都會比較中肯一些，這是前署長，他直接就講什麼是健保點值一點一元，我可能速度要快一點。因為三黨候選人都不約而同提出健保點值一點一元的方向，選舉的政治行銷都是編織一個美麗的理念，而政治家跟政客的差異在於誰能務實面對問題，以爭取更多選票。臺灣全民健保是自給自足的社會保險，主要收入來源還是民眾的保費、雇主及政府，所以我剛剛才講這三方面我們都必須要做思考，如果單純修一個法條就可以解決，我們大家就不用在這邊爭論這麼久，雙腳雙手通通要贊成。但是要從這三方面去做思考的情況之下，單純只修這一條，我覺得還有討論的空間，是不是要有更完整的思維，還有更完善的作法？包含可能會連動到健保法第二十六條還是第十八條，還有安全準備金的部分，這是三個面向都必須要去思考的問題。至於公務預算的挹注，公務預算是不是要常態性的配套？我想都有討論的空間。","前署長就提到，每年訂定要花費的醫療費用就是總額，其給付是用點數，當大家不斷衝業務量時，醫療點數就超過總額，也就是最近很夯的點值下降，當大家減少不必要的醫療行為，總額高於醫療點數，點值就會上升。醫療費用主要是藥品費用和醫療服務的手術診療費、看病診察費及檢驗檢查費，健保也請醫院自主管理制度，超出額度就自動斷頭，現在除了被斷頭外，點值依然直直落才是醫界的痛。我們現在要來解決這個醫界的痛，所以臺灣健保改革一定要落實分級醫療、醫藥分類，要有「使用者付費的部分負擔」做配套，如此才有機會減少不必要的醫療行為，也才能有效減少醫療人力體系的負擔。現在的負擔真的非常非常重，大家都知道，所以當時民進黨的總統候選人承諾健保點值不低於0.9，並朝一點一元的目標邁進，這是負責任的政治風範。我想剛剛很多委員都有提出來，我再把當時有講的話、歷史背景拿出來，這是在選前的前一天投到自由廣場，也就是在今年1月12號。政府只是一個團體，沒有錢，錢都是來自國民稅收，所以去調這個、調那個對於被保險人、雇主、政府來說，簡單一句話，還是要從百姓的口袋裡面掏錢出來。","我們先來看，今（113）年度的中央政府總預算，歲入編列2兆7,092億，歲出是兩兆八千多億，明年度的國防預算，應該是講今年編列六千多億，但是健保總額現在已經高達八千三百多億，應該還更高吧？署長會比我更清楚。醫界的主流是想得到更多總額的錢來補足點值一點一元，但是在收支平衡之下就必須提高健保費率，工商界的老闆是否願意承受負擔健保保費增加的成本問題，這是李前署長講的，這也不是我們醫界在同溫層中討論就可以解決的問題，民眾端是否溝通到位還需要更多的論述。所以他已經把這三個面向通通點出來，目前許多醫療手術處置給付都不合理，放手調整醫療點數，提高急診、困難手術與治療等支付標準，讓辛苦的醫療人員都能夠獲得合理的報酬，讓醫療院所以專業獲取合理利潤，不靠衝病人數多、藥物使用量大來賺取藥價差。下面應該還有，大致上是這樣。他最後一段話說，臺灣的健保改革不難，相信以賴副的能力、實力和擔當來務實面對這個問題，醫界、民眾一定會更懂得政府的用心，多溝通、把握時間改革，健保才得以永續經營。大致上是這樣。","我為什麼要講這些，然後用這個來處理？今天這個案，坦白講，我們一定是站在支持的角度，其實李前署長也把相關的現狀都點出來，但是我們要處理這個事情，如果單純修正這一條就可以解決，那沒有理由反對；如果單純修這一條，還有很多事情要思考，是不是大家應該要有更多的討論空間？請署長簡單回應一下。剛剛誇獎你，你都沒來。"],["石署長崇良：確實像委員所提到的，我們過去這幾年也不斷地在修這些支付標準，希望讓各科之間可以平衡，但是它也是會影響到點值的下降，從我們的分析裡面，它也是一個因素，所以還是要全面性的思考，包含總額如何適當的成長，還有各項財源多元化、擴大費基等等，都是應該要一併思考公平性、合理性，兼顧到醫療體系的發展，也兼顧到民眾的權益。"],["劉委員建國：就這樣？我講這麼多，你只有講這樣？"],["石署長崇良：因為時間到了。"],["劉委員建國：時間到了，主席都還沒有講，奇怪了！部長，請補充吧！"],["薛部長瑞元：好。"],["劉委員建國：你們都是來自醫界，對不對？蘇委員是醫界，王委員也是醫界，下一任的部長也是來自醫界，還當過中華民國醫師公會全聯會的理事長。"],["薛部長瑞元：的確，委員也瞭解，我來自醫界，而且我是從基層做過，在醫院也當過，也當過準醫學中心裡面的醫師，這整個生態我非常清楚，我也知道醫界經營上的痛苦，因為我自己也做過行政管理的經營者。這些都是問題，但這個問題是否就從1點1元這樣單純的修法就能夠解決？我不認為，因為裡面要處理的事情非常多，如果今天通過1點1元，假設通過了，健保幾乎沒有能力再去處理其他事情，因為所有的資源都弄到增加點值，其他那些不平衡的要增加就沒有了，沒有多餘的資源來處理。至於醫護人員的薪資要調整，尤其是護理人員，也沒有資源可以再來做這方面的調整，所以必須要整體來看，怎麼樣設計制度才是最好的。說一句比較難聽的，如果只有處理這一條就有辦法解決所有的問題，我早就做了。"],["劉委員建國：我們要解決這個問題，大家的目標都一致，我想是這樣，所以包含召委、蘇委員，對不對？因為大家要達到這個目標，今天把這個案提出來也對啦！"],["薛部長瑞元：對，有討論的空間。"],["劉委員建國：大家有討論的空間，所以這個事情該怎麼處理，我才希望有一點時間讓部長講清楚一點。對不起，因為部長已經要走了，臨別秋去，其言也善，大家多聽一些。部長是不是再講清楚一點，該怎麼處理？或許會在你卸任之前把這個事情解決掉，也不一定。"],["薛部長瑞元：本來健保制度就是有收入面跟支出面的問題，現在這個條文要處理的是收入面，我希望引入公務預算來挹注，但是它的金額必須要在國家整體財政收入能夠負擔的條件之下，要不然的話，就會變成需要漲健保。這個大家要有共識，如果哪一天公務預算沒有辦法補到1,000億的時候，就要調整健保費，這是必然的，要不然的話，健保就會倒。如果這個條文要這樣，等於是把總額支付制度的精神已經拿掉了，拿掉了之後，公務預算每年要去補貼，事先就要預估。如果今年預估明年要有1,000億，公務預算也編了，明年超出1,000億的部分就要用健保的安全準備。安全準備現在當然有一千多億，但是可能兩年之內，如果按照這樣，公務預算沒有辦法全部滿足的話，安全準備馬上就用完了，而用完之後就要調保費，所以這個必須要大家有共識。如果真的要按照1點1元去做，很可能一、兩年之內就要調保費，這是必須的。這是整個連動的，公務預算不是無限的，取之不盡、用之不竭，不是這個樣子。"],["劉委員建國：我知道，因為主席也站起來很久了，部長，只有一句話就好了。就剩下十多天，我們要來處理這個事情，依你的智慧跟經驗……"],["薛部長瑞元：我大概沒有什麼智慧了。"],["劉委員建國：你這麼講，我怎麼接下去？"],["薛部長瑞元：沒有，這其實是全國各界大家都必須要好好來討論的。"],["劉委員建國：是，沒有錯，對。"],["薛部長瑞元：因為方方面面大家要全部都想清楚。"],["劉委員建國：部長，最後一句話，我想有時候稱職比職稱更重要，你比我更清楚，所以我才會說，這其實也是大家的一個痛，坦白講，對不對？如果在最後的十多天，因為你的稱職，也因為你累積了這麼多你自己剛才講的經歷，我們就不再贅述了，這個事情是不是可以在短時間來處理？當然也要上面的人積極來支持，是不是可以依照你的累積跟你的智慧？你不要否認你沒有智慧，好不好？用最短時間來回應大家的期待。"],["薛部長瑞元：我仍然覺得應該要有各界的共識才比較重要，因為這是影響深遠的。"],["主席：好，謝謝。"],["劉委員建國：還是請部長最後十多天努力、展現一下。"],["主席：好，謝謝。","接下來請王正旭委員質詢。"]],"agenda":{"page_end":242,"meet_id":"委員會-11-1-26-14","speakers":["王育敏","蘇清泉","陳昭姿","陳菁徽","林月琴","黃秀芳","邱鎮軍","涂權吉","廖偉翔","劉建國","王正旭","林淑芬","林德福","賴士葆","李彥秀","盧縣一","楊瓊瓔","黃國昌","賴惠員","陳瑩","楊曜"],"page_start":167,"meetingDate":["2024-05-02"],"gazette_id":"1133901","agenda_lcidc_ids":["1133901_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14次全體委員會議紀錄","content":"審查一、委員王育敏等18人擬具「全民健康保險法第六十二條條文修正草案」案；二、委員蘇清\n泉等27人擬具「全民健康保險法第六十二條條文修正草案」案；三、國民黨黨團擬具「全民健康\n保險法第六十二條條文修正草案」案","agenda_id":"1133901_00003"}},"transcript":{"pyannote":[{"speaker":"SPEAKER_00","start":0.03096875,"end":1.9715937500000003},{"speaker":"SPEAKER_01","start":8.012843750000002,"end":9.83534375},{"speaker":"SPEAKER_01","start":10.324718750000002,"end":11.37096875},{"speaker":"SPEAKER_01","start":11.489093750000002,"end":11.72534375},{"speaker":"SPEAKER_01","start":13.93596875,"end":15.74159375},{"speaker":"SPEAKER_01","start":16.28159375,"end":16.48409375},{"speaker":"SPEAKER_01","start":16.720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bicyn Kwan-kwan"},{"start":97.688,"end":121.596,"text":"​​​​​​​​​​​​​​"},{"start":122.113,"end":145.252,"text":" bicyn 要很多的這樣的一個面向都要去思考的情況之下才可以把這樣的一個制度可長可久不會去因為要達到這個目標反而去造成沒有必要的後續的一些擔憂或是困擾我想這才是我們真正要解決的一個方式我先給部長跟署長還有委員會看一個資料"},{"start":150.836,"end":163.444,"text":"我說這個人離開之後講的話都會比較中肯一些這是前署長他直接就講了健保點子什麼叫做一點議員我也可能要速度快一點"},{"start":164.758,"end":175.77,"text":" disadvant二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第11屆第11會期社會福利及衛生環境委員會第12條條文修正草案：立法院第11會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第12會期社會福利及衛生環境委員會第13會期社會福利及衛生環境委員會第13會期社會福利及衛生環境委員會第14會期社會福利及衛生環境"},{"start":183.038,"end":186.86,"text":" bicyn Kwan-yong等19人擬具〈全民健康保險法第六十二條條文修正草案案〉案。 bicyn Kwan-yong等19人擬具〉"},{"start":211.335,"end":224.62,"text":"二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條條文修正草案．事由、委員王育敏等19人擬具:「全民"},{"start":240.507,"end":258.014,"text":"adequ不斷在衝業務量時,醫療點數就超過總額,也就是最近很夯的點值下降。當大家減少不必要浪費的醫療行為,那總額高於醫療點數,點值就會上升。醫療費用主要是藥品費用和醫療服務的手術診療費。"},{"start":260.196,"end":280.572,"text":""},{"start":280.896,"end":303.473,"text":""},{"start":304.284,"end":331.882,"text":"則承諾健保點子不低於0.9並朝1.1元的目標邁進這是負責任的正式風範我想這剛剛很多委員都有提出來我再把這個當時有講的話歷史背景再拿出來這是在選前的前一天這個頭到最後廣場是在今年的1月12號那政府只是一個團體沒有錢錢都是來自國民的稅收所以去調這個調那個調那個也是都對"},{"start":334.64,"end":350.54,"text":" lapt��保養民內、國住、政府、肝膽及顧慮、負責負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的負責的�"},{"start":352.202,"end":381.151,"text":"而七、七零九二億啦齁。稅數是兩兆八千多億。民運隊的國防預算是在六千應該他是講今年啦齁。六千出啦。但是健保的總額現在已經高達八千三百多億啦。應該還更高吧。蘇長你會比我更清楚。一屆的主流是想得到更多的總額的錢來補足這個點值一點億元。但是在收支這個平衡之下就必須要提高健保匯率。"},{"start":382.808,"end":385.789,"text":" bicyn Kwan-hung,副副副副副副"},{"start":412.83,"end":430.962,"text":" disadvant四、國民黨黨團擬具:「全民健康保險法第六十二條條文修正草案：立法院第14次全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次"},{"start":438.933,"end":455.576,"text":" disadvant二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案．事由、委員王育敏等19人擬具:「全民健康保險法第六十二條條條文修正草案．事由、委員王育敏等19人擬具:「全"},{"start":468.999,"end":489.867,"text":"但是我們要去處理這事情,如果單純去修正這一條就可以解決,那沒有理由去反對。那如果單純修這一條,還有很多事情要去做思考,那是不是大家應該有更多的討論的空間。我是不是請署長回應一下。"},{"start":494.703,"end":520.351,"text":"跟委員報告確實像委員所提到的那麼過去我們這幾年也不斷的在修這些支付標準希望讓各科之間可以平衡但是它也是會影響到點值的下降啦從我們的分析裡面它也是一個因素所以還是要全面性的思考包含這個總額如何適當的成長還有各項的財源多元化的這個"},{"start":521.471,"end":522.152,"text":"二、國民黨黨團擬具"},{"start":535.161,"end":551.826,"text":"就這樣。我講這麼多,你主要講那樣?因為時間到了。時間到了,人家主席都還沒有講,奇怪。部長,請補充吧。你們都是來自一屆嘛,對不對?蘇委員是一屆,王委員是一屆。"},{"start":554.667,"end":570.333,"text":"​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​"},{"start":570.333,"end":592.756,"text":"​​​​​​​​​​​​"},{"start":593.154,"end":619.823,"text":"但是這個問題是否就從一點一元這樣子一個單純的修法就能夠解決?我不認為。因為裡面的要去處理的事情是非常多。但是你如果今天通過一點一元,假設這個通過了,健保幾乎沒有能力再去處理其他的事情。因為所有的資源都弄到去增加這一個點子。"},{"start":621.574,"end":631.282,"text":"二、委員王育敏等19人擬具〈全民健康保險法第六十二條條文修正草案案〉案〈全民健康保險法第六十二條條文修正草案〉"},{"start":651.806,"end":654.273,"text":"只要處理這條,就有辦法解決所有問題,我才會做。"},{"start":661.755,"end":678.51,"text":"二、委員王育敏等19人擬具:「全民健康保險法第六十二條條文修正草案：立法院第11屆第1會期社會福利及衛生環境委員會第16次全民健康保險法第六十二條條文修正草案：立法院第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次全民健康保險法第16次"},{"start":689.363,"end":690.904,"text":"這個本來就是健保的制度就是有收入面跟支出面的問題。"},{"start":710.1,"end":729.62,"text":"那現在是這個條文是要處理的是收入面我希望是把這個引入公務預算來預注但是它的金額是必須要在我們整體的國家的財政的收入能夠負擔的一個條件之下"},{"start":730.06,"end":745.333,"text":"​​​​​​"},{"start":746.34,"end":774.742,"text":"所以,如果說這條文要這樣子,等於說把總額支付制度的精神已經拿掉了。拿掉之後的話,公務預算每年要去做補貼,事先就要先預估。如果說我今年預估明年要有一千億,我公務預算也編了明年如果超出一千億的部分,就是要健保那邊的安全準備要去用。"},{"start":776.118,"end":805.401,"text":"​​​​​​​​​​​​​​"},{"start":806.347,"end":827.707,"text":"公務預算不是燙害,要啟示不禁用字不解,不是這個樣子。我知道啦,因為主席也站起來很久了,不想就一句話就好啦,就剩下十多天,我們要來處理這事情,依你的智慧跟經驗。我大概沒有什麼智慧啦。你這麼講我怎麼接下去?"},{"start":831.035,"end":858.263,"text":"沒有,這其實是全國各界大家都必須要好好來做討論啦。是,沒有錯啊,沒有錯,對。因為方方面面大家都要全部都想清楚了。不是,不是,不想,最後一句話啦齁。我想,我想有時候秤值比支撐更重要,這個你都比我更清楚了。所以我才會想說,這其實也是,也是大家的一個痛啦。坦白講嘛,對不對。那如果在最後十多天,也因為你的秤值,"},{"start":858.968,"end":881.63,"text":"​​​​​​​​​​"},{"start":882.523,"end":890.136,"text":"我是仍然是覺得應該有各界的這個共識才比較重要,因為這個影響是深遠的。"}]}},"supported_relations":[],"relations":[]}