{"error":false,"id":["154577"],"data":{"IVOD_ID":154577,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/154577","日期":"2024-07-09","會議資料":{"會議代碼":"院會-11-1-21","會議代碼:str":"第11屆第1會期第21次會議","屆":11,"會期":1,"會次":21,"臨時會會次":null,"種類":"院會","標題":"第11屆第1會期第21次會議"},"影片種類":"Clip","開始時間":"2024-07-09T11:26:39+08:00","結束時間":"2024-07-09T11:42:07+08:00","影片長度":"00:15:28","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/21d04b5a781cb618e3095c6c53b28745a09fb1100d58f4be0e42658b4167efd5e0e135e5ff889c205ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"盧縣一","委員發言時間":"11:26:39 - 11:42:07","會議時間":"2024-07-09T09:00:00+08:00","會議名稱":"第11屆第1會期第21次會議（事由：一、對行政院院長報告施政方針繼續質詢。\n二、7月5日上午9時至10時為國是論壇時間。\n三、7月9日下午1時50分至2時30分為處理臨時提案時間。）","gazette":{"lineno":605,"blocks":[["盧委員縣一：（11時26分）主席，有請院長。"],["主席：請卓院長。"],["卓院長榮泰：盧委員好。"],["盧委員縣一：院長好，今天是第二次見面囉！"],["卓院長榮泰：是。"],["盧委員縣一：我先考你幾個問題，我們的文化安全是什麼？文化安全，根據加拿大的一個研究，就是說你要降低彼此之間的一個誤解、歧視，要建構一個文化安全的模式，通常是在講醫療機構，我想醫療機構的文化安全要建立，不過，不只醫療機構，學校、各級機關應該都要有文化安全的一個教育，我們現在都在推文化安全的課程，這是在原住民族健康法裡面所保障，應該要擴及全國的一個教育，請問國家做了哪些努力？"],["邱部長泰源：我想文化這件事情牽涉得很廣，如果以醫療的場域來看，我們必須對於不同文化的族群，他在就醫時一定要有平權，包括他的可近性，包括他……"],["盧委員縣一：我們先看一下第三個，就是CULTURAL SAFETY的下面，Trauma- and violence-informed care，也就是說，你在面對這樣一個病人，你知不知道他跨世代的一個仇恨，對他心理所造成的影響？醫療人員有沒有基本上這樣的概念？而Cultural Humility就是說，你有沒有先入為主的概念？Anti-racism 就是我們一直在講的歧視，這些文化安全的課程能不能降低這些歧視？就在這個安全課程裡面所涵蓋的這整個範圍，我們目前臺灣在做的步驟裡面有沒有在進行？因為這是在原住民族健康法裡面所規定應該要進行的課程，我相信有在做，可是沒有做得很澈底，有沒有一個步驟，比如說10年計畫、20年計畫、長遠的規劃，我們什麼時候可以達成完全消弭對文化所謂的先入為主的一個概念？有沒有這樣的一個想法？"],["邱部長泰源：謝謝委員的關心，我們共同來關心原住民的醫療權利。因為在過去七、八年當中，在立法院討論到這個題目是非常的熱烈，而且大家真的都是同心一致看怎麼樣用各種方式來提升原住民的健康水準。過去幾年的努力，我們在原住民方面的平均壽命，其實已經跟一般臺灣從10歲……"],["盧委員縣一：等一下後面會講到。"],["邱部長泰源：對，這表示我們在軟硬體方面其實都一直在進行，不管是在偏鄉的硬體、衛生所各方面或衛生室，甚至活動中心的重建，我想至少有40個計畫在進行。在軟體方面，我們希望，也曾經談過語言方面的協助……"],["盧委員縣一：我是希望能夠聽到衛福部有一個短程的、遠程的計畫，在整個文化教育裡面能不能扮演一個角色？就是說你先主導，以後可以推廣到比如說教育部，或者是相關的公部門等等，我們這些主流社會在面對弱勢族群的時候，應該要有文化的素養，我的想法是這樣。"],["邱部長泰源：是。"],["盧委員縣一：因為我們最常面對的就是醫療機構，最常使用的也是醫療機構，所以先從這邊來做一個計畫性的培植，我是指文化教育這個部分，可以嗎？"],["邱部長泰源：好，其實我們已經成立了原住民健康政策會，也補助國家衛生研究院成立原住民健康研究中心，我們都往這方面在努力，我們會繼續努力。"],["盧委員縣一：好。"],["卓院長榮泰：我也跟委員報告，因為原民會今天不在現場，原民會跟教育部已經針對文化安全課程有訂定一個相關的辦法，未來跟衛福部還會再進行後續的動作。"],["盧委員縣一：好，沒關係，我今天為什麼會講這個？就是因為沒有專責機構，關於專責機構，我上次有請衛福部到辦公室來討論，他們就說目前的想法還是放在一個「科」的概念，我希望能夠升級到「處」的概念，或者是說更高「司」的概念，是不是在照顧原住民族或者是山地離島，因為以往都是放在一起，照顧山地離島的族群來說，放在一個「科」的層級太低。到目前為止，去年就已經通過這個法律，可是專責機構卻還是沒有，如果有專責機構的話，有關文化安全的這些議題都可以在那裡面進行，不是嗎？因為去年就已經立法，而且三讀通過了，可是到現在還沒有看到一個專責機構的初步草案，或者是要設置在哪裡，有沒有那樣的想法？部長。"],["邱部長泰源：謝謝委員的質詢，我想盧醫師很清楚我們這幾十年來，從我年輕的時候在參與衛生署的工作，就是有一個專門的單位，當然是「科」在負責，我想您很清楚，也幫忙非常的多，一直在推展，其實當時這些科長後來也都晉升到相關重要的位置，他們心目中還是一直關心著原住民的推展。至於是不是要成立一個專責機構，我想我們再來……"],["盧委員縣一：不是「是不是」，是一定要！它是原住民族基本法……"],["邱部長泰源：就是說到底要到哪一個層級。"],["盧委員縣一：OK！"],["邱部長泰源：專責是一定有，但是它的層級在哪裡，我們可以再來研議。"],["盧委員縣一：好。現在看到一個比較屬於研究單位的是放在國衛院的原住民族健康研究中心，它是有成立了，謝謝有這樣一個單位，可是我們還是希望有專責機構。"],["邱部長泰源：是。"],["盧委員縣一：我們也都知道在原住民地區照顧我們的都是衛生所，我問一下院長，你最近一次去衛生所被服務的時候是什麼時候？"],["邱部長泰源：我？"],["盧委員縣一：沒有，我是說院長。"],["卓院長榮泰：我要去打疫苗。"],["盧委員縣一：那是什麼時候？"],["卓院長榮泰：去年。"],["盧委員縣一：部長呢？最近有去衛生所嗎？"],["邱部長泰源：我當過衛生所主任。"],["盧委員縣一：我知道。"],["邱部長泰源：民國77年我就當衛生所主任了，至於最近有沒有到……"],["盧委員縣一：好，我希望……"],["邱部長泰源：我是到基層醫療打針啦！"],["盧委員縣一：我希望你們有空的時候去山地離島的衛生所看一下，可以嗎？"],["邱部長泰源：沒問題。"],["卓院長榮泰：好的。"],["盧委員縣一：我要討論山地離島的問題。"],["邱部長泰源：我在當立委的時候也考察過原鄉衛生所幾次。"],["盧委員縣一：你有沒有去山地的衛生所就醫過？兩位有沒有？"],["卓院長榮泰：沒有。"],["盧委員縣一：如果有一天你去霧台的時候看一下，因為離霧台最近的醫院大概要1個小時以上的距離，所有的遊客如果受傷，或當地居民需要藥物，都是到那裡，我們就要講它的沿革，其實偏遠地區，大概只有衛生所可以服務大家，而它的沿革是從公共衛生、從行政相驗、四癌篩檢等等，全部都落在衛生所身上，我們一直說要升級，110年有公共衛生服務體系升級策略，有這樣一個策略，然後我們就看它到底做了哪些，它是4個方向，第一個就是遠距的建構，它設置的5G場域是52所，可是你知道現在山地離島的鄉大概是55個鄉，那一個鄉才一個根本就不夠，每一個鄉有好幾個部落，就光復興區就有58個部落，你說52所就全國來講，根本就是緩不濟急；因為常常在做遠距醫療的時候，網速跟建構的基礎建設是最重要的，每次我們召集了很多病人到衛生所來，譬如跟長庚醫院要做媒合、做遠距醫療，結果所有的速度都down在那邊，也接不起來，然後又說是網路的問題；所以常常就是因為網路建置得不夠，這個遠距醫療你們說有達成目標，我感覺是有點在騙人，因為我看112年服務量是4,958案，要除以全國呢！全國有五十幾個鄉鎮，那是全年的人數，這樣子實在是一天可能照顧不到一個病人。所以我覺得這個部分應該是要加強各地區的基礎建設，才能夠真正把遠距醫療做好。","第二個就是我們所謂的衛生所整建、耐震補強，這個我查得到我們自己本身山地的部分，霧台鄉還在招標當中，我覺得它的問題就是金額太低，如果說只有兩百多萬，你要怎麼在偏遠地區去蓋一個衛生室？是從無到有的，它不是整建喔！它是完全重新蓋一間新的衛生室，霧台鄉大武村那個地方是非常偏遠，只有這樣的金額，誰會去標這個工程來做呢？我看目前在招標的大概就有3間都是在山地鄉，一個是在卑南鄉，還有一個是在秀林鄉。也就是說，這些都是偏遠地區，金額那麼低，根本就沒有辦法做。","第三個問題就是，你們說要強化醫事人員，就是要有彈性，不過我看報告上面寫，目前符合的就是臺北跟屏東，也就是說，臺北跟屏東是完全沒有問題喔！我想舉例問一下，因為現在我們進用的醫護人員幾乎沒有所謂的族別限制、語言限制，所以他只要是現場OK的人，他都可以進來，也就是說，背景比較重要，然後真正應該到當地服務、聽得懂母語的人，卻永遠都沒有辦法進去。所以應該要從哪裡去改變？應該是要把我們偏遠地區服務的人限制所謂的百分比，就是80%應該是在地的人，或者是會講族語的人，他有護理師的資格、有母語的資格，應該就要優先錄用，而不是用我們現在政治酬庸的方式，全部給縣長當作給支持他的人來當護理師，不是這樣嗎？"],["邱部長泰源：好，謝謝！容我回答一下，第一個就是，有關於基層視訊遠距醫療的設備，我想這個就是我們多年來一直在強調的，一定要給錢、給技術，不然的話常常停頓在那裡，它的效果也不好，其實這個30年前我們就一直在發展了啦！但是真的還是希望大家……我想我們會努力再把它……"],["盧委員縣一：我們的時間有限，繼續看一下我們平均餘命的問題，我們現在做的，按照平均餘命來看的話，比澳洲還好，因為我們確實是在紐西蘭下面，然後是澳洲的前面，我有自己分析一下，大概是什麼原因？看下一頁，澳洲光是政府的投資大概972萬美金，這幾年增加了大概38%。好，我們再看下一頁，又說今年增加了100萬美金，如果我們這樣看換算臺幣其實也沒有很多，大概三千多萬元。","好，我們看下一個，如果就紐西蘭來看，就差很遠了，紐西蘭的話大概就是billion，billion的話就是30億紐幣，也是將近是四十幾億。如果是對primary care的話就是20億，20億如果乘以70%是14億，這是14億美金，不是臺幣。對毛利人、非毛利人的醫療差距，按照cost，即生活上面造成的一些代價，他們也算出來了。我最主要凸顯的是，澳洲的投資只有大概幾千萬美金，紐西蘭會那麼進步，在我們之上，是因為他們投入幾十億美金，我要講的重點是這個。紐西蘭的毛利人一直把臺灣當作母國，感覺很像他們是從臺灣過去的，是相對友好的一個國家。如果臺灣作為他們相對友好的國家，可是我們對原住民的付出遠遠不如他們的話，國家是不是要檢討？我的用意是在這裡。","接下來，最近要開始建置身體密碼庫，它是國衛院的計畫，它在雲林。我希望55歲以上長者的資料庫不要獨漏原住民，原住民等一下要找資料的時候又沒有辦法實際survey。這個東西應該跟我們剛剛看的國衛院裡面的原住民健康中心連結，而不是做了這一塊，原住民又漏了。"],["邱部長泰源：不會，一定會連結。"],["盧委員縣一：我是在提醒這方面的研究要留意，好不好？"],["邱部長泰源：好，一定會連結。這兩個中心都是國衛院很重要的重點。"],["盧委員縣一：好，謝謝院長，謝謝部長，我們一起努力。"],["邱部長泰源：好，謝謝委員。"],["卓院長榮泰：謝謝委員指教。"],["主席：謝謝盧委員。","下一位請蘇清泉委員質詢。"]],"agenda":{"page_end":182,"meet_id":"院會-11-1-21","speakers":["江啟臣","王定宇","黃國昌","羅明才","吳琪銘","葉元之","邱若華","楊曜","羅智強","黃健豪","盧縣一","蘇清泉","林國成","李昆澤","羅廷瑋","陳培瑜","林月琴","游顥","王正旭","林淑芬","涂權吉"],"page_start":93,"meetingDate":["2024-07-09"],"gazette_id":"1136601","agenda_lcidc_ids":["1136601_00005","1136601_00006"],"meet_name":"立法院第11屆第1會期第21次會議紀錄","content":"施政質詢\n對行政院院長報告施政方針繼續質詢─ 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Safety的下面那個TRAUMATIC AND VIOLENT INFORMED CARE也就是說你在面對這樣一個病人你知不知道他這個跨世代的一個仇恨對他心裡面所造成的影響醫療人員有沒有基本上這樣的一個概念"},{"start":129.944,"end":156.748,"text":"那Cultural Humility就是說你沒有先入為主的概念那Anti-Racism就是我們一直在講的歧視如果這些文化安全的課程能不能降低這些歧視就在這個安全課程裡面所涵蓋的這個整個範圍那我們目前台灣在做的步驟裡面有沒有在進行因為這個是在原住民主健康法裡面所規定應該要進行的課程我相信"},{"start":157.915,"end":182.962,"text":"有在做可是沒有做得很徹底有沒有一個步驟比如說10年計畫20年計畫長遠的規劃我們什麼時候可以達成一個完全消明對文化一個所謂的一個先入為主的一個概念有沒有這樣的一個想法好謝謝委員的關心我們共同來關心原住民的醫療的權利那因為在過去"},{"start":184.394,"end":184.414,"text":"﹚一、"},{"start":204.372,"end":226.697,"text":"一般這臺灣的從10歲﹖這個等一下下面會講到﹖對會這樣那這中間表示說我們在軟硬體方面其實都一直在進行不管是在偏鄉的一個硬體衛生所各方面或衛生室甚至活動中心的一個重建我想都有至少有40個計畫在進行那在軟體方面我們也希望"},{"start":227.369,"end":244.854,"text":"也曾經談過語言方面的一個協助。我是希望能夠聽到衛福部有一個短程的遠程的一個計畫對整個文化一個教育裡面能不能扮演一個角色就是說你先主導以後可以推廣到比如說教育部啊"},{"start":245.314,"end":245.334,"text":"盧縣一"},{"start":266.516,"end":281.928,"text":"好,我想...可以嗎?其實以前我們已經成立了原住民健康政策會,也補助國家衛生研究成立原住民健康研究中心。其實都往這方面在努力,我們會繼續努力。好,第二位...我也跟委員報告,因為原民會今天不在,不在現場。"},{"start":282.968,"end":297.154,"text":"委員會跟教育部已經針對這個文化安全的課程有在訂定一個相關的一個辦法。那未來跟衛福部還會再進行後續的動作。我今天為什麼會講這個就是因為沒有專責機構"},{"start":298.993,"end":324.304,"text":"那專責機構我上次有請衛福部到辦公室來討論他們就說目前的想法還是放在一個科科的一個概念我希望能夠升級到處的概念或者是說更高師的概念是不是那在照顧民族民族或者是三地離島因為以往都是放在一起照顧三地離島的一個族群來說你放在一個科的成績太低"},{"start":324.984,"end":325.184,"text":"謝謝委員的執行"},{"start":353.993,"end":382.064,"text":"我想盧醫師很清楚我們這幾十年來從我年輕的時候在參與健保署的衛生署的工作就是有一個專門的單位當然是科啦在負責我想您也很清楚幫忙非常的多那一直在推展那這些其實這些當時的科長後來也都比較晉升到相關重要的位置他們心目中還是一直關心著原住民的一個"},{"start":382.762,"end":395.263,"text":"一個一個一個推展那至於說是不是要用成立一個專走機構我想我們再來不是是一定要他是原尊民主基本法他有就是說他到底要到哪一個層次"},{"start":397.173,"end":397.333,"text":"對下一張。"},{"start":420.905,"end":442.12,"text":"那我們也都知道說我們在原住民地區照顧我們的都是衛生所我問一下院長你最近一次去衛生所被服務的時候是什麼時候我沒有我說我院長我要去打疫苗那什麼時候去年去年去年嗎那部長呢最近有去衛生所嗎"},{"start":443.676,"end":469.049,"text":"我當過衛生所主任。明年我77年我就當過衛生所主任了。最近有沒有到基層醫療打針。我希望你們有空的時候去山地離島的衛生所看一下。沒有問題。大概就是要討論山地離島的問題。我在當立委的時候也考察過原鄉的一個衛生所幾次。你有沒有去過山地的衛生所去就醫過?兩位有沒有?"},{"start":472.889,"end":483.64,"text":"如果有一天你去霧台的時候看一下齁,因為霧台距離最近的醫院大概一個小時以上的距離。那所有的遊客如果受傷或當地的居民需要藥物都是到那裡。"},{"start":484.568,"end":484.588,"text":"盧縣一"},{"start":506.392,"end":524.186,"text":"公共衛生服務體系升級策略有這樣的一個策略然後我們就看他到底做了哪些他說四個方向嘛就是第一個就是我們遠距的一個建構遠距的建構他說現在他設計的設置的5G場場域是52所可是知道現在3D離島的"},{"start":525.387,"end":525.407,"text":"韓國藝術院長"},{"start":543.118,"end":567.219,"text":"他建構的一個基礎建設是最重要的每次我們召集了很多病人到衛生所來然後要跟比如說長根的醫院要做一個媒合要做遠距醫療結果所有的速度都當在那邊然後也接不起來然後又又說是網路的問題所以常常就是因為網路建制的不夠所以這個遠距醫療我覺得真的是"},{"start":568.649,"end":580.076,"text":"我是你們說有有打成目標我是覺得感覺是非常的是有點在騙人因為我看那個服務量哈112年4952年4958年要處於全國全國五十幾個鄉下來是全年的"},{"start":586.019,"end":614.362,"text":"人數將實在是一天可能照顧不到一個病人所以我覺得這個部分應該是要加強它的基礎建設各地區的才能夠把真正的遠距醫療把它做好第二個就是我們所謂的衛生所整建、耐震補強這個我查到我們自己本身的3D的部分還有霧台箱它還在招標當中我覺得它的問題就是金額太低"},{"start":615.407,"end":633.696,"text":"你如果說只是兩百多萬你要怎麼去在偏遠地區蓋一個衛生室是從無到有的衛生室他不是整建喔他是完全重新蓋一個新的衛生室霧台鄉大武村那那個地方是非常偏遠啊你只有這樣的一個金額他誰會去標這個工程來做呢"},{"start":634.036,"end":634.256,"text":"第三個問題就是"},{"start":651.923,"end":679.591,"text":"你們說要強化醫師人員就是說要有彈性不過我看這邊報告上面寫目前符合的就是臺北跟屏東也就是說臺北跟屏東是完全沒有問題那我想舉例問一下因為現在禁用的我們的醫護人員幾乎他沒有所謂的族別限制語言限制所以他只要是現場OK的人他都可以進來也就是說背景比較重要"},{"start":680.424,"end":680.444,"text":"﹚盧縣一"},{"start":708.129,"end":716.641,"text":"呃他給他支持他的人來來當護理師不是這樣嗎好謝謝我容我回答一下嗯那第一個就是說"},{"start":717.543,"end":740.523,"text":"有關於基層的一個視訊演技醫療的設備我想這個就是我們多年來一直在強調的那一定要給錢給技術不然的話常常停頓在那裡其實它的效果也不好其實這個在30年前我們就一直在發展了但是真的還是希望"},{"start":741.824,"end":741.984,"text":"光在"},{"start":767.605,"end":786.001,"text":"澳洲在政府的一個投資大概972萬美金,這是他說他這幾年增加了大概38%,我們再看下一頁。又說今年增加了100萬美金,如果我們這樣看其實換算台幣的也沒有很多,大概3000多萬,我們看一下下一個。"},{"start":787.301,"end":811.66,"text":"那如果就紐西蘭來看就差很遠了紐西蘭的話大概就是BillionBillion的話就是30億紐幣的話也是將近是十幾億那如果是20億的對Primary Care的話就是20億20億的話如果乘以大概是70%的話是14億這是14億美金喔不是台幣喔那我們看下面"},{"start":812.858,"end":814.439,"text":"我最主要的凸顯就是說澳洲的投資只有大概是幾千萬美金"},{"start":840.034,"end":855.607,"text":"那紐西蘭會那麼進步在我們之上是因為他投入了幾十億美金我是要講的重點是這個那也就是說紐西蘭他一直認為說我們很像是他們毛利人很像把台灣當作母國嗎"},{"start":857.043,"end":857.063,"text":"﹚盧縣一"},{"start":883.59,"end":898.017,"text":"這個55歲以上長者的資料庫不要不要讀到了原住民然後原住民等一下找資料的時候這個又沒有辦法做實際的一個 survey所以應該這個東西應該是要跟剛才我們剛看的國會裡面的研究原住民的健康中心要"},{"start":899.143,"end":900.724,"text":"謝謝盧委員下一位我們請蘇清泉委員質詢"}]}},"supported_relations":[],"relations":[]}