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謝謝主席主席請一下長照師 處市長委員好市長好 市長我只有問你讓部長跟市長休息一下你能不能"},{"start":27.762,"end":38.116,"text":"用最簡單的方式最少的時間大概跟我講一下長照2.0跟長照3.0最大的區別到底在哪裡"},{"start":39.056,"end":48.664,"text":"好那簡單講其實他的基本的理念跟架構其實都是延續的都是以人為本社區為基礎提供連續性的照顧那在3.0要去強化的就是2.0過往跟醫療的那個銜接上面還是沒有很及時所以我們3.0要強化他能夠及時能夠接住銜接上盡量無縫能夠銜接"},{"start":64.997,"end":85.835,"text":"醫療面向就有很多元所以這一塊是我們一個強化重點第二個強化重點就是我們要導入一些積極的賦能就是配合在醫療這一端接過來之後不管他今天是在家還是今天在社區在這些相關不同場域裡面怎麼樣透過一些怎麼樣的鼓勵機制讓我們的長輩能夠被訓練讓他可以自主生活盡量減少依賴照顧這是第二個部分"},{"start":93.621,"end":117.86,"text":"那第三個部分當然會有伴隨因為2.0這邊有一些的檢討的一些服務的不足那這個部分會來積極強化把這樣的一個資源補起來老師我為什麼這樣子問呢因為就是我們從長照1.0 2.0到3.0其實我個人是不大喜歡這樣子的分類長照制度就是一個制度"},{"start":118.641,"end":136.676,"text":"那你剛剛講的也是在長照制度裡面加入醫療體系事實上醫療支撐事實上這個本來也是廣義長照的一環我實在是不知道為什麼你們會一直很喜歡用1.0、2.0、3.0我怕過幾年到10.0所以我才刻意提出這個問題"},{"start":144.522,"end":171.513,"text":"就是增加醫療的照護其實本身本來就是長照的一環長照是不可能脫離脫離醫療照護的好那我我先問就是說我們長照需求服務的涵蓋率是用需求人數推估的需求人數好那我問你"},{"start":174.614,"end":193.554,"text":"上一次的推估在113年就去年必須要需求的人需求的人數是94萬那衛福部最新的統計數字出來只有將近90萬差距超過5% 為什麼"},{"start":198.986,"end":217.276,"text":"委員您提的94萬是在長照2.0的核定本裡面的退估數那我們目前的退估數是因應人工普查的資料出來之後那有一些改變因為2.0的時期當時用的一些相關的參數包括失能率那時候是12.6"},{"start":218.797,"end":247.457,"text":"那到了這個等於在2.0執行的過程裡面因為人口普查又重新公告了已經從12.6調高到13.3所以我們就是重新把這些參數重算那對於過往2.0裡面有一些這個相關的一些身障的一些推估他採取的是高推估跟衰弱的部分也採取高推估那我們就是在這一批整體重新做一些處理低推估"},{"start":248.838,"end":263.621,"text":"我們把它調整因為因為身心障礙者65歲以上的增加幅度高可是他未滿65歲的這一塊他的年輕型的障礙者他其實人數是沒有那樣子的大幅增加所以我們就是改採低推估"},{"start":264.022,"end":291.931,"text":"所以才有這個數字的一個變動我這樣子問呢是因為其實事實上就是要推估本身就是一件很困難的事情啦要精準的推估本來就不過呢因為你推估出來的人數會影響到需求服務涵蓋率對不對所以我希望你們就是我不覺得"},{"start":294.249,"end":321.679,"text":"政府必須要把很多數字美化我覺得我現在不是在說你這件事我個人覺得就是應該是多少人數就多少人數我們服務的多少就服務多少總是盡可能的把事情做到最完美這個才是對的總比把數字文字"},{"start":322.779,"end":348.486,"text":"做的美化這個高明的多好不好我大概就是希望你們以後再推估的時候可以再精準一點因為這個會影響影響影響到後續很多很多東西包括預算的的編列好不好跟委員報告3.0這邊的退估就是用分零了因為我們後來新的調查有分零的失能率好"},{"start":350.818,"end":372.491,"text":"台灣今年開始邁入超高齡社會高齡人口的總數已經超過20%我們目前面臨的有關長照比較有問題的是台灣接受長照服務的平均年齡是76歲"},{"start":374.738,"end":398.883,"text":"也就是說在十年後戰後嬰兒潮的人口在這十年之內會逐步達到長照需求那現在有幾個問題我來人力上你們可能要盡可能的儲備長照所需要的人力另外一個就是我們的財源"},{"start":402.77,"end":425.522,"text":"因為戰鬥嬰兒潮的人數太多了占台灣總人口數的占比太高了根據OECD的國家統計長照的支出大概要占GDP的1.8%而且八成為公共長照支出"},{"start":428.382,"end":457.447,"text":"事實上我再講一次長照的總體支出要佔到GDP的1.8%而且其中這1.8%要八成是公共長照支出可是台灣這幾年長照的總支出未達GDP的百分之一公共支出更只佔四成"},{"start":461.735,"end":481.707,"text":"假如說比照韓國長照支出佔GDP的1.11.1就好了台灣的長照支出必須要有2600億以上可是今年只編列了900多億也就是說900多億是我們用韓國的1.1%來做比例"},{"start":490.256,"end":513.178,"text":"其實我們現在編列的只有必須編列的四成市長我這段話你有聽懂嗎有好那我想要問一下就是說面對人口結構的變化未來的支出一定會一直上升"},{"start":516.628,"end":543.076,"text":"在財源上我們現在單靠遺產稅、菸稅、菸捐和房地合一稅可以支應嗎目前是無餘因為我們現在累積的盈餘現在有2039億那我剛才就講了嘛因為我們的公共支出佔比太低嘛人民自行吸收的太高嘛"},{"start":545.175,"end":560.149,"text":"所以你才會覺得夠用嘛你假如說是按照OECD的標準八成必須要是公共長照裁員那你是不夠的嘛"},{"start":561.549,"end":584.89,"text":"這部分也要跟委員說明因為畢竟就是我們不管今天是長照還是小朋友幼兒的照顧其實在國家的立場其實是幫忙家庭一起來照顧大概沒有辦法替代家人照顧所以這個跟OECD國家有一些是走福利體系的國家的概念其實是不一樣"},{"start":586.191,"end":593.434,"text":"就是因為賦稅的問題師長這麼說呢我是覺得台灣這幾年的經濟成長跟台灣邁向高齡化台灣強調福利國政策然後我們把長照做這樣子的"},{"start":610.953,"end":635.612,"text":"的定位我覺得我覺得我好像不能介紹因為福利國家的話基本上的稅負每一個民眾的繳稅的稅負要高那現階段我們台灣的整個的一個稅負大概只有佔14%跟福利國家高達三四成以上是截然不同對對不是我現在我現在我現在講的是說是說"},{"start":637.625,"end":643.824,"text":"譬如我這樣子講啦市長你把長照定義為個人的"},{"start":646.91,"end":672.02,"text":"應該是說政府沒有辦法替代家人照顧沒有辦法替代對 是協助家人一起來做照顧就跟小朋友的照顧是一樣的概念所以我們已經沒有 我們不排富了相關的都普及式的都可以提供只是提供的方式是跟著家人一起來我因為時間的關係啦所以我大概也不想佔用其他的同事太多時間"},{"start":675.604,"end":682.454,"text":"就剛剛包括我的題目裡面就大家都覺得你們現在編了900多億從屏東到台中"},{"start":689.551,"end":713.712,"text":"到澎湖我相信是全台灣都覺得關懷據點給的經費太少那我也一直強調我向來主張預防勝於治療關懷據點做得好後續的長照支出就會少所以關懷據點這個從伙食到人力這個你們真的必須要很快的把"},{"start":715.433,"end":744.093,"text":"把補助金額提高我最後一個問題讓你回去想就是說假如說我們真的真的國家的財政沒有辦法支出很多的長照讓高齡化的台灣可以有一個安定的長照制度來支應老人生活為什麼"},{"start":745.638,"end":752.18,"text":"為什麼你們從來不考慮從來不考慮走保險制保險制 長照保險或者是保險跟公務預算雙軌這個我讓你待會去想不過我想我會找一天好好的跟你們討論這個問題謝謝市長 謝謝主席好 謝謝委員"},{"start":774.582,"end":774.683,"text":"謝謝袁偉仁 謝謝市長"}]},"gazette":{"lineno":1114,"blocks":[["楊委員曜：（13時16分）謝謝主席，主席請一下長照司祝司長。"],["主席：請祝司長。"],["祝司長健芳：委員好。"],["楊委員曜：司長好。司長，我直接問你，讓部長跟次長休息一下。"],["祝司長健芳：好。"],["楊委員曜：你能不能用最簡單的方式、最少的時間，大概跟我講一下長照2.0跟長照3.0最大的區別到底在哪裡？"],["祝司長健芳：簡單講他的基本理念跟架構其實都是延續的，都是以人為本，社區為基礎，提供連續性的照顧。在3.0要去強化的就是2.0過往跟醫療的銜接上還是沒有很及時，所以我們3.0要強化並能夠及時接住，銜接上儘量能夠無縫銜接，因為醫療面向很多元，所以這塊是我們的一個強化重點。","第二個強化重點是我們要導入一些積極的賦能，就是配合醫療端接過來之後，不管今天是在家還是社區，在這些相關不同的場域裡面，如何透過一些鼓勵機制，讓我們的長輩能夠被訓練到可以自主生活，儘量減少依賴照顧，這是第二個部分。第三個部分是伴隨因為2.0一些檢討和服務的不足，這個部分會來積極強化，把這樣的資源補起來。"],["楊委員曜：司長，我為什麼這樣子問，因為我們從長照1.0、2.0到3.0，其實我個人是不太喜歡這樣子的分類。長照制度就是一個制度，你剛剛講的也是在長照制度裡面加入醫療體系，事實上醫療的支撐本來也是廣義長照的一環。我實在是不知道為什麼，你們一直很喜歡用1.0、2.0、3.0，我怕過幾年到10.0，所以我才刻意提出這個問題，增加醫療的照護本來就是長照的一環，長照是不可能脫離醫療照護的。我先問，我們長照需求服務的涵蓋率，是用需求人數跟……"],["祝司長健芳：推估的需求人數。"],["楊委員曜：那我問你，上一次的推估是113年，也就是去年，需求的人數是94萬，但衛福部最新的統計數字出來只有將近90萬，差距超過5%，為什麼？"],["祝司長健芳：委員，您提的94萬是在長照2.0核定本裡的推估數。"],["楊委員曜：對。"],["祝司長健芳：我們目前的推估數，是因應人口普查的資料出來之後有一些改變，因為2.0時期用的一些相關參數，包括失能率當時是12.6，後來在2.0執行的過程中，因為人口普查又重新公告了，已經從12.6調高到13.3。所以我們就重新把這些參數重算，對於過往2.0裡面有一些身障相關的推估，它採取的是高推估，在衰弱的部分也採取高推估，那我們就是在這一批整體重新做一些處理，包括……"],["楊委員曜：低推估。"],["祝司長健芳：我們把它調整，因為身心障礙者65歲以上的增加幅度高，可是未滿65歲的這一塊，年輕型的障礙者其實人數是沒有那樣子的大幅增加，所以我們就是改採低推估，才會有數字的變動。"],["楊委員曜：我這樣子問是因為要精準地推估本身就是一件很困難的事情，不過你推估出來的人數會影響到需求服務涵蓋率，對不對？"],["祝司長健芳：是。"],["楊委員曜：我不覺得政府必須要把很多數字美化，我現在不是在說你這件，我個人覺得應該是多少人數就多少人數，我們服務了多少就服務多少，總是盡可能地把事情做到最完美，這個才是對的，總比把數字、文字美化高明得多，好不好？我希望你們以後在推估的時候可以再精準一點，因為這個會影響到後續很多東西，包括預算的編列，好不好？"],["祝司長健芳：跟委員報告，我們3.0這邊的推估就是用分齡了，因為我們後來新的調查有分齡的失能率。"],["楊委員曜：好，臺灣今年開始邁入超高齡社會，高齡人口的總數已經超過20%，我們目前面臨長照比較有問題的是，臺灣接受長照服務的平均年齡是76歲，也就是說，戰後嬰兒潮的人口在10年之內會逐步達到長照需求，那現在有幾個問題，在人力上，你們要盡可能地儲備長照所需要的人力，另外一個就是我們的財源，因為戰後嬰兒潮的人數太多了，占臺灣總人口數的占比太高了。","根據OECD國家統計，長照支出大概要占GDP的1.8%，而且八成為公共長照支出。司長，我再講一次，長照的總體支出占GDP的1.8%，而且這1.8%要有八成是公共長照支出，可是臺灣這幾年的長照總支出未達GDP的1%，公共支出更只占四成。假如說比照韓國長照支出占GDP的1.1%就好了，臺灣的長照支出必須要有2,600億以上，可是今年只編列了九百多億，也就是說，我們假如用韓國的1.1%來做比例，其實我們現在編列的只有必須編列的四成，司長，我這一段話你有聽懂嗎？"],["祝司長健芳：有。"],["楊委員曜：好，那我想要問一下，面對人口結構的變化，未來的支出一定會一直上升，在財源上我們現在單靠遺產稅、菸稅菸捐和房地合一稅，可以支應嗎？"],["祝司長健芳：目前是無虞，因為我們現在累積的盈餘……"],["楊委員曜：目前是什麼？"],["祝司長健芳：現在有2,039億在我們的長照基金裡面。"],["楊委員曜：好，那我剛才就講了嘛！因為我們的公共支出占比太低，人民自行吸收得太高，所以你才會覺得夠用嘛！假如說你按照OECD的標準，八成必須要是公共長照財源，那這樣是不夠的嘛！"],["祝司長健芳：是，這個部分也要跟委員說明，不管今天是長照還是小朋友幼兒的照顧，在國家的立場其實是幫忙家庭一起來照顧，大概沒有辦法替代家人照顧，所以這個跟OECD國家有一些是走福利體系的概念其實是不一樣，就是因為賦稅的問題。"],["楊委員曜：司長這麼說的話，我是覺得臺灣這幾年的經濟成長跟臺灣邁向高齡化，臺灣強調福利國政策，然後我們把長照做這樣子的定位，我覺得我好像不能接受耶！"],["祝司長健芳：因為福利國家基本上它的稅賦，每一個民眾繳稅的稅賦要高，現階段我們臺灣整個稅賦大概只有占14%，與福利國家高達三、四成以上是截然不同。"],["楊委員曜：不是，我現在講的是說，我這樣子講啦！司長，你把長照定義為個人的……"],["祝司長健芳：應該是說政府沒有辦法替代家人照顧。"],["楊委員曜：沒有辦法替代。"],["祝司長健芳：對，是協助家人一起來照顧，就跟小朋友的照顧是一樣的概念，所以我們已經不排富了，相關的都普及式的可以提供，只是提供的方式是跟著家人一起來。"],["楊委員曜：因為時間的關係，我也不想占用其他同事太多時間，你看啦！包括我剛剛的題目裡面，大家都覺得你們現在編了九百多億，從屏東到臺中到澎湖，我相信是全臺灣都覺得關懷據點給的經費太少，而且我也一直強調，我向來主張預防勝於治療，關懷據點做得好，後續的長照支出就會少，所以關懷據點從伙食到人力，你們真的必須要很快地把補助金額提高。","我最後一個問題讓你回去想，假如說國家的財政真的沒有辦法支出很多的長照，讓高齡化臺灣可以有一個安定的長照制度來支應老人生活，為什麼你們從來不考慮走保險制、長照保險？或者是保險跟公務預算雙軌，這個我讓你帶回去想，不過我會找一天好好地跟你們討論這個問題，謝謝司長，謝謝主席。"],["祝司長健芳：好，謝謝委員。"],["主席：謝謝楊委員，謝謝司長。","接續我們請劉書彬委員質詢。"]],"agenda":{"page_end":256,"meet_id":"委員會-11-3-26-10","speakers":["蘇清泉","陳昭姿","林月琴","陳菁徽","王育敏","邱鎮軍","林淑芬","涂權吉","黃秀芳","王正旭","陳瑩","廖偉翔","陳培瑜","李坤城","徐富癸","楊瓊瓔","楊曜","劉書彬","劉建國","黃國昌","顏寬恒","張嘉郡","伍麗華Saidhai‧Tahovecahe","翁曉玲"],"page_start":163,"meetingDate":["2025-05-08"],"gazette_id":"1144701","agenda_lcidc_ids":["1144701_00005"],"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10次全體委員會議紀錄","content":"一、邀請衛生福利部部長就「長照2.0執行情形檢討及3.0未來規劃」進行專題報告，並備質詢；\n二、邀請衛生福利部部長就「澳洲進口豬腳驗出含萊克多巴胺，如何加強肉品食安查驗，讓民眾\n放心」進行專題報告，並備質詢","agenda_id":"1144701_00004"}}},"supported_relations":[],"relations":[]}