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主席請一下邱部長請邱部長委員好部長好部長我先確認幾個問題因為我們病人自主潛力法上路那麼久了台灣簽署的人數未達1%"},{"start":34.765,"end":58.798,"text":"到底最主要的原因是什麼當然我們這個原因應該是有多重因素那當然過去的調查會顯現說因為他的費用比較費用的因素是一個因素但是是不是一個絕對的因素在有待觀察這樣子"},{"start":59.821,"end":85.471,"text":"好那我就先講費用,因為部長講到費用是健保不給付對不對?從去年開始7月...住院的,那5月又擴展到65歲上的一個多重疾病我是這樣子建議啦齁,我向來主張"},{"start":91.848,"end":115.208,"text":"把錢花在前端上像我覺得預防醫學多花一點錢後續的醫療支出就減少那也一樣就是疫力醫療可以減少以後很多無益無效的醫療所以我是主張盡量放寬"},{"start":118.973,"end":134.957,"text":"免費的健保給付的對象這個是我的主張第二個問題就是好像是劉金國委員的資料通常是對的所以假如說預約要立醫療"},{"start":140.937,"end":157.507,"text":"醫療簽署必須要那麼久的時間會不會也是影響簽署人數的一個很重要的因素部長覺得會不會因為他是預約還是預約得上所以到底"},{"start":160.635,"end":185.337,"text":"過去研究裡面等候時間比較沒有在前面幾名前面幾名大概有兩大因素一個是費用一個是民眾認知就是醫院的問題這是兩大因素其他的以等候時間這邊的話有出現過可是它並沒有在前面所以它可能是一個影響因素可能不是主要影響因素以上就是說對於"},{"start":186.698,"end":210.296,"text":"疫力醫療決定的認知可能是一個因素對不對然後費用是一個因素那費用剛才我們講過了那有關疫力醫療的認知的問題還是要加強宣導因為我覺得像我個人就還蠻支持大家都去做疫力醫療的因為這個可以避免很多困擾"},{"start":213.749,"end":241.887,"text":"那假如說是真的也有部分的地區是必須要等候很久才能夠看到門診我想要請教一個問題就是我們簽署屹立醫療的時候呢是必須要我先問好了屹立醫療的簽署到底是不是醫療行為"},{"start":245.575,"end":260.99,"text":"你到底是不是醫療行為?簽AD這個動作簽署這個鉤嘛 簽名這個應該不算醫療行為啦石川署長說不算那不算醫療行為"},{"start":264.145,"end":285.019,"text":"那我問一下,因為簽署的時候我們必須要有醫師、護理師、心理諮商師、社工等等我想問一下醫師到底在醫療的時候他的角色是什麼?他扮演什麼角色?"},{"start":286.906,"end":295.479,"text":"部長你懂我的問題嗎?我想這個辦法是過去定出來的啦,也不是我每天找的那我現在,以我的個人經驗來講"},{"start":303.971,"end":319.107,"text":"說實在在開辦,譬如說某個醫院,像台大醫院在開辦這個諮商門診也是我們幫忙去設立的,當然我也會去看幾次裡面的角色醫師,因為他有兩大類,一個是說維持生命的治療"},{"start":321.472,"end":338.152,"text":"第二就是人工的營養輸益所以我現在一個民眾我同意到時候不用維持生命治療他一定會問你這是什麼東西"},{"start":340.102,"end":364.732,"text":"那你當然就會跟他講說這包括鴨胸啊那這個可能是護理師就可以像我啦 保定沒關係我也不想佔用太多時間因為我們現在是修法的大體詢問所以我是說大家想一想看要怎麼讓醫療更"},{"start":369.494,"end":389.043,"text":"更可見性提高一點啦我覺得應該是很多人都會因為現在的人就是人生終須一別嘛那假如可以自己做決定的時候到我有法定的"},{"start":392.501,"end":420.616,"text":"規定的事項成就的時候我可以自己做決定這個我想很多人接受啦我們看透過這一次的修法能不能讓更多的人願意願意參與的人很方便就參與那不知道資訊的人讓他知道資訊好不好其他我們大概就是修法的時候再來做討論啦我還是要講一個健保的問題"},{"start":425.048,"end":431.195,"text":"部長,總統拋出了健保不同工不同酬的想法,不准你入場是怎樣?"},{"start":432.929,"end":446.815,"text":"我想我支持啊應該那個有許比較手術比較複雜的我大力支持而且我覺得風險醫療糾紛的風險越高的科別報酬也要不投我覺得我們不應該再放任讓五大皆空"},{"start":460.02,"end":486.534,"text":"就是說不能夠所有的給付都一樣然後醫師的人員每年控款一千三然後讓這些人自由選擇科別那比較高風險工作繁重然後必須要緊急的像急診"},{"start":488.448,"end":504.344,"text":"讓這些科別一直沒有人投入這個對於台灣高齡化發展趨勢這麼迅速的社會是很危險的一個現象這個你們能不能趕快把它定出來"},{"start":505.598,"end":524.011,"text":"有啊,一直在努力,要不要市長報告我們謝謝委員關心,確實這個我們今年先從急重症開始所以急診的診察費啦,還有護理費啊急性一般病床ICU,這些我們都先調高,今年一共預注42億"},{"start":525.652,"end":554.896,"text":"那另外接下來這個產科也是從今天5月1號開始夜間假日出來執行業務也加成30%所以這個都是相對風險高投入心力辛勞的接下來還有兒童重症那我們逐科逐科的會去討論調整現在你們調整的方向就是只有就內外婦兒急診的部分來做提高嗎"},{"start":555.556,"end":574.094,"text":"目前是這樣但是之後還會一直每一個外科啊什麼都是會拉近我的意思是有的要提高有的要減少這個沒有什麼好迴避的我大概也不怕被罵因為我覺得台灣的社會不應該發展成這個樣子"},{"start":579.092,"end":596.929,"text":"我今天因為我也不想再用太多時間下一次有機會的時候我們再來看看到底為什麼醫學系出來的時候是不是我們在分科的時候就必須要做控管"},{"start":598.53,"end":611.643,"text":"補充你聽我的意思嗎這個都有空管啊都有空管只是依照這個國家的需求只是後來受過內外負額的專科醫師跑去做其他的業務"},{"start":614.069,"end":635.523,"text":"是不是這樣子不是 部長假如講說我們現在就是在分科的時候就已經有比例的分配這個我是不知道 假如有那就表示有一些人他是受外科的訓練可是他可能去開假醫有時候有那個容額給他問題是遭不到足額遭不到足額"},{"start":639.591,"end":657.014,"text":"就是學生不願意台大外科只有20個跟R2的學生在理工就17個不是 我的意思是說我們也必須要從這裡就做控管因為我覺得這十幾年來我們對這個問題就是"},{"start":666.769,"end":687.435,"text":"口號喊得太多可是實際做出來因應的措施太少這個對於台灣整體的社會跟國民的就義權益是一個很大的損害其他的因為我不大想再用太多時間其他的我們下次再做討論好 謝謝部長 謝謝署長 謝謝市長 謝謝主席"}]},"gazette":{"lineno":771,"blocks":[["楊委員曜：（12時58分）謝謝主席，請邱部長。"],["主席：好，請邱部長。"],["邱部長泰源：委員好。"],["楊委員曜：部長好。部長，我先確認幾個問題，我們病人自主權利法已經上路那麼久了，臺灣簽署的人數未達1%，到底最主要的原因是什麼？"],["邱部長泰源：當然這個有多重的因素，從過去的調查顯現出費用是因素之一，但是不是一個絕對的因素還有待觀察。"],["楊委員曜：好，那我就先講費用，因為部長講到費用。健保不給付，對不對？"],["邱部長泰源：從去年開始，7月……是住院的，5月又擴展到65歲以上重大疾病的。"],["楊委員曜：我是這樣子建議，我向來主張把錢花在前端上，像我覺得預防醫學多花一點錢，後續的醫療支出就減少，也一樣，預立醫療可以減少以後很多無益、無效的醫療，所以我是主張儘量放寬免費健保給付的對象，這個是我的主張。"],["邱部長泰源：是。"],["楊委員曜：第二個問題就是，劉建國委員的資料通常是對的，假如預約要預立醫療簽署必須要那麼久的時間，會不會也是影響簽署人數的一個很重要的因素？部長覺得會不會？"],["邱部長泰源：因為他要預約還是預約得上，所以到底……"],["劉司長越萍：過去的研究裡面，等候時間比較沒有在前面幾名，前面幾名大概有兩大因素，一個是費用，一個是民眾的認知，就是意願的問題……"],["楊委員曜：認知，對。"],["劉司長越萍：這是兩大因素，其他的，以等候時間這個來說是有出現過，可是它並沒有在前面，所以它可能是一個影響因素，但不是主要的影響因素。以上。"],["楊委員曜：對於預立醫療決定的認知可能是一個因素，對不對？然後費用是一個因素，費用剛才我們講過了，有關預立醫療的認知問題還是要加強宣導，像我個人就還滿支持大家都去做預立醫療的，因為這個可以避免很多困擾。假如是真的，也有部分的地區必須要等候很久才能夠看到門診。我想要請教一個問題，就是我們簽署預立醫療的時候必須要……我先問好了，預立醫療的簽署到底是不是醫療行為？"],["邱部長泰源：簽AD這個動作，簽署這個，勾嘛！然後簽名，這個應該不算醫療行為。"],["楊委員曜：署長說不算，那不算醫療行為。因為簽署的時候，我們必須要有醫師、護理師，然後心理諮商師、社工等等，我想問一下醫師在預立醫療的時候，他的角色到底是什麼，他扮演什麼角色？部長，你懂我的問題嗎？"],["邱部長泰源：我想這個辦法是過去定出來的啦，也不是我……"],["楊委員曜：對……"],["邱部長泰源：以我個人的經驗來講，因為說實在在開辦……譬如說像臺大醫院在開辦諮商門診，也是我們幫忙去設立的，當然我也會去看幾次裡面的角色，因為它有兩大類，一個是維持生命的治療，第二就是人工的營養輸液，這兩個嘛！所以現在一個民眾說我同意到時候不用維持生命治療，他一定會問你這是什麼東西，那你當然就會跟他說這包括壓胸、插管……"],["楊委員曜：這個可能護理師就可以？"],["邱部長泰源：護理師……"],["楊委員曜：部長，沒關係，我也不想占用太多時間，因為我們現在是修法的大體詢答嘛！所以我是說大家想一想，看要怎麼讓預立醫療的可近性提高一點。我覺得應該很多人都會……因為現在的人就是人生終須一別，假如可以自己決定的時候，到我有法定的規定事項成就的時候，我可以自己決定，這個我想很多人接受啦。我們看透過這一次的修法能不能讓更多的人、願意參與的人很方便參與，不知道資訊的人讓他知道資訊好不好？"],["邱部長泰源：好。"],["楊委員曜：其他我們大概就是修法的時候再來討論。我還是要講一個健保的問題，部長，總統拋出了健保不同工不同酬的想法，部長的立場是怎樣？"],["邱部長泰源：我想我支持啊，尤其比較……"],["楊委員曜：你支持？"],["邱部長泰源：手術比較複雜的……"],["楊委員曜：我大力支持，而且我覺得……"],["邱部長泰源：我們現在也在做，一直在做。"],["楊委員曜：醫療糾紛的風險越高的科別，報酬也要不同。"],["邱部長泰源：是的。"],["楊委員曜：我覺得我們不應該再放任讓五大皆空，不能夠所有的給付都一樣，醫師的人員每年控管1,300，讓這些人自由選擇科別，比較高風險、比較工作繁重然後必須要緊急的，像急診，讓這一些科別一直沒有人投入，這個對於臺灣高齡化發展趨勢這麼迅速的社會是很危險的一個現象，這個你們能不能趕快把它定出來？"],["邱部長泰源：有啊！一直在努力，要不要署長報告我們現在……"],["石署長崇良：謝謝委員關心，確實我們今年先從急重症開始，所以急診的診察費還有護理費、急性一般病床、ICU這些我們都先調高，今年一共挹注42億。另外接下來產科也是從5月1號開始，夜間、假日出來執行業務也加成30%，這個都是相對風險高、投入心力、辛勞的，接下來還有兒童重症，我們會逐科、逐科地討論調整。"],["楊委員曜：現在你們調整的方向，只有就內外婦兒急診的部分提高嘛！"],["石署長崇良：目前是這樣，但是之後還會一直每一個外科、什麼都會納進來。"],["楊委員曜：對，我的意思是有的要提高、有的要減少，這個沒有什麼好迴避的，我大概也不怕被罵，因為我覺得臺灣的社會不應該發展成這個樣子。我也不想占用太多時間，下一次有機會的時候，我們再來看看到底為什麼分……就是醫學系出來的時候，是不是我們在分科的時候就必須要控管，部長，你聽懂我的意思嗎？"],["邱部長泰源：有啊，這個都有控管啊！"],["楊委員曜：都有控管？"],["邱部長泰源：會依照國家的需求……"],["楊委員曜：只是後來受過內外婦兒的專科醫師跑去做其他的業務？是不是這樣子？"],["邱部長泰源：當然也是有。"],["楊委員曜：不是，部長假如說我們現在就是在分科的時候就已經有比例的分配……"],["邱部長泰源：有。"],["楊委員曜：這個我是不知道，假如有，那就表示有一些人，他是受外科的訓練，可是他可能去開家醫。"],["邱部長泰源：有時候有容額給他，問題是招不到足額啦！"],["楊委員曜：招不到足額？就是學生不願意……"],["邱部長泰源：對，像臺大外科招20個，到R2的時候，第2年就跑掉7個。"],["楊委員曜：不是，我的意思就是說我們也必須要從這裡就控管，因為我覺得這十幾年來，我們對這個問題就是口號喊得太多，可是實際做出來因應的措施太少，這個對於臺灣整體社會跟國民的就醫權益是一個很大的傷害。因為我不大想占用太多時間，其他的我們下次再討論……"],["邱部長泰源：我們努力……"],["楊委員曜：謝謝部長、謝謝署長、謝謝司長、謝謝主席。"],["主席（劉委員建國）：你還在占用，你也占用很久。","鄭正鈐委員，鄭正鈐委員，鄭正鈐委員不在。","蔡易餘委員，蔡易餘委員，蔡易餘委員不在。","涂權吉委員，涂權吉委員，涂權吉委員不在。","何欣純委員，何欣純委員，何欣純委員不在。","請陳瑩委員詢答。"]],"agenda":{"page_end":422,"meet_id":"委員會-11-3-26-9","speakers":["劉建國","陳昭姿","林月琴","蘇清泉","邱鎮軍","王育敏","楊瓊瓔","莊瑞雄","廖偉翔","林淑芬","黃秀芳","王正旭","陳培瑜","楊曜","陳瑩","涂權吉","陳菁徽"],"page_start":359,"meetingDate":["2025-05-01"],"gazette_id":"1144501","agenda_lcidc_ids":["1144501_00008"],"meet_name":"立法院第11屆第3會期社會福利及衛生環境委員會第9次全體委員會議紀錄","content":"審查：一、委員王育敏等18人擬具「病人自主權利法部分條文修正草案」案；二、委員劉建國等\n16人擬具「病人自主權利法部分條文修正草案」案；三、委員邱志偉等19人擬具「病人自主權利\n法第八條、第九條及第十五條條文修正草案」案【僅詢答】","agenda_id":"1144501_00007"}}},"supported_relations":[],"relations":[]}