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11:11:38","會議時間":"2025-11-28T09:00:00+08:00","會議名稱":"第11屆第4會期第11次會議（事由：一、對行政院院長施政報告繼續質詢。（11月28日）二、討論事項：本院財政、內政、經濟、交通、社會福利及衛生環境五委員會報告審查行政院函請審議「中央政府花蓮馬太鞍溪堰塞湖災後重建特別預算案」案等9案。（12月2日）三、11月28日上午9時至10時為國是論壇時間。）","transcript":{"pyannote":[{"speaker":"SPEAKER_00","start":10.274093750000002,"end":11.084093750000001},{"speaker":"SPEAKER_00","start":11.708468750000002,"end":12.29909375},{"speaker":"SPEAKER_00","start":12.383468750000002,"end":15.10034375},{"speaker":"SPEAKER_00","start":15.488468750000003,"end":16.973468750000002},{"speaker":"SPEAKER_01","start":16.973468750000002,"end":17.024093750000002},{"speaker":"SPEAKER_00","start":17.024093750000002,"end":17.96909375},{"speaker":"SPEAKER_01","start":17.96909375,"end":18.27284375},{"speaker":"SPEAKER_01","start":27.53721875,"end":28.49909375},{"speaker":"SPEAKER_00","start":28.49909375,"end":29.02221875},{"speaker":"SPEAKER_00","start":29.207843750000002,"end":29.680343750000002},{"speaker":"SPEAKER_00","start":30.11909375,"end":36.51471875},{"speaker":"SPEAKER_00","start":38.05034375,"end":40.07534375},{"speaker":"SPEAKER_00","start":40.244093750000005,"end":40.26096875},{"speaker":"SPEAKER_02","start":40.26096875,"end":40.68284375},{"speaker":"SPEAKER_00","start":40.564718750000004,"end":45.05346875},{"speaker":"SPEAKER_00","start":45.45846875,"end":48.69846875},{"speaker":"SPEAKER_00","start":49.15409375,"end":52.02284375},{"speaker":"SPEAKER_00","start":52.478468750000005,"end":55.094093750000006},{"speaker":"SPEAKER_00","start":55.431593750000005,"end":59.92034375},{"speaker":"SPEAKER_00","start":60.612218750000004,"end":63.447218750000005},{"speaker":"SPEAKER_00","start":63.750968750000006,"end":65.21909375},{"speaker":"SPEAKER_00","start":65.32034375,"end":73.09971875000001},{"speaker":"SPEAKER_01","start":65.67471875000001,"end":65.77596875},{"speaker":"SPEAKER_01","start":66.45096875,"end":67.63221875},{"speaker":"SPEAKER_00","start":73.11659375,"end":75.66471875},{"speaker":"SPEAKER_00","start":75.81659375000001,"end":77.30159375000001},{"speaker":"SPEAKER_00","start":77.70659375000001,"end":80.08596875},{"speaker":"SPEAKER_00","start":80.82846875,"end":81.53721875000001},{"speaker":"SPEAKER_00","start":82.14471875000001,"end":86.59971875000001},{"speaker":"SPEAKER_00","start":86.83596875,"end":94.86846875},{"speaker":"SPEAKER_00","start":95.45909375000001,"end":98.12534375},{"speaker":"SPEAKER_00","start":98.22659375,"end":127.08284375000001},{"speaker":"SPEAKER_01","start":117.05909375,"end":117.09284375000001},{"speaker":"SPEAKER_00","start":127.35284375,"end":151.55159375000002},{"speaker":"SPEAKER_00","start":151.60221875000002,"end":152.49659375000002},{"speaker":"SPEAKER_00","start":153.17159375,"end":153.57659375},{"speaker":"SPEAKER_00","start":153.94784375,"end":158.14971875},{"speaker":"SPEAKER_00","start":158.47034375,"end":171.73409375},{"speaker":"SPEAKER_00","start":172.15596875,"end":179.56409375},{"speaker":"SPEAKER_00","start":179.78346875,"end":180.25596875000002},{"speaker":"SPEAKER_00","start":180.49221875,"end":186.12846875000002},{"speaker":"SPEAKER_00","start":186.75284375,"end":187.95096875000002},{"speaker":"SPEAKER_00","start":188.35596875000002,"end":189.72284375},{"speaker":"SPEAKER_00","start":190.29659375,"end":193.57034375},{"speaker":"SPEAKER_00","start":193.84034375000002,"end":195.91596875000002},{"speaker":"SPEAKER_00","start":196.27034375000002,"end":200.45534375000003},{"speaker":"SPEAKER_00","start":200.50596875000002,"end":211.35659375},{"speaker":"SPEAKER_00","start":211.39034375,"end":221.51534375000003},{"speaker":"SPEAKER_00","start":221.93721875000003,"end":223.05096875},{"speaker":"SPEAKER_00","start":223.28721875000002,"end":230.22284375},{"speaker":"SPEAKER_00","start":230.57721875000001,"end":244.97159375},{"speaker":"SPEAKER_00","start":245.12346875000003,"end":258.20159375000003},{"speaker":"SPEAKER_00","start":258.75846875,"end":259.24784375},{"speaker":"SPEAKER_00","start":259.65284375000005,"end":263.55096875000004},{"speaker":"SPEAKER_00","start":263.88846875,"end":266.38596875},{"speaker":"SPEAKER_00","start":266.85846875000004,"end":268.36034375},{"speaker":"SPEAKER_00","start":268.64721875000004,"end":280.25721875},{"speaker":"SPEAKER_00","start":280.45971875000004,"end":290.46659375},{"speaker":"SPEAKER_00","start":290.93909375000004,"end":295.05659375000005},{"speaker":"SPEAKER_00","start":295.46159375,"end":295.84971875},{"speaker":"SPEAKER_00","start":296.10284375000003,"end":300.82784375},{"speaker":"SPEAKER_00","start":301.13159375000004,"end":304.91159375},{"speaker":"SPEAKER_00","start":305.23221875,"end":307.13909375000003},{"speaker":"SPEAKER_00","start":307.93221875,"end":308.35409375},{"speaker":"SPEAKER_00","start":309.60284375000003,"end":311.34096875},{"speaker":"SPEAKER_00","start":311.49284375,"end":313.33221875000004},{"speaker":"SPEAKER_00","start":313.63596875,"end":327.92909375},{"speaker":"SPEAKER_00","start":328.14846875,"end":331.40534375000004},{"speaker":"SPEAKER_00","sta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衛福部長備詢謝謝 盧委員好院長好 部長好那我先問一下就是最近我們原住民有要辦兩個活動你大概知道嗎"},{"start":38.049,"end":59.684,"text":"原住民的活動最近在12月有一個世界南島民族運動會在屏東就是12月希望兩位有空去參加第二個就是2026年的Pride Up就是我們的太平洋醫師全球的年度會議是在"},{"start":60.751,"end":81.321,"text":"北台灣舉行還不確定是在新北還是桃園那就是先預告一下那我們最主要今天來講的就是我們今天要講的是我們的醫療平權的問題一而再再而三的還是要講一下我們先回顧一下我們的十大死因其實從我們的七八歲的一個我們所謂的"},{"start":82.679,"end":104.398,"text":"差距如果我們仔細來看一下你看一下我們肝病還有我們糖尿病的一些防治其實多著重在我們的獲利人員或是醫療人員的一些衛教或者是這些比較基層的努力其實可以做改善再看一下我們的癌症的部分癌症的部分大概我們的比較特殊的地方是在口腔癌跟鼻咽癌"},{"start":104.998,"end":129.545,"text":"也就是跟一般國人不太一樣的地方也就是說我們目前看到我們在講的癌症新藥沒有這方面的一些資源可以尋找所以可能這方面可能還是需要國家來努力我們又看到我們目前的我們的GDP的占比是低於韓國大概2%也就是說大概還差就在4000億左右也就是說我們其實我們國家對我們醫療人員的一些虧欠"},{"start":130.405,"end":157.794,"text":"也可以展現在這個數據上面因為我們確實是用了比較低的一個價格在取得很好的一些醫療的服務那我們現在可以肯定國家目前是在我們的ranking裡面很像是全世界第一從2015年的45名進步到現在的第一名不過我們一定要想到為什麼有這些進步那我們就講到一些我們講到我們的醫療的缺乏地區因為"},{"start":158.524,"end":187.491,"text":"我最近在全國跑常常會聽到的就是說我們這個地區沒有洗腎室這個地區如果發生一些急救的一些一個場合的話可能沒有地方可以送所以我們就盤點了一些台灣比較沒有這些醫療資源的地方就是當然就是在花東還有一些比較靠近我們北橫中橫南橫的這些區域那甚至在我們台東的一些就是達人上次我們講的許曹斌醫師的故鄉那我們"},{"start":189.272,"end":210.954,"text":"在走偏鄉的時候有人建議說能不能就是在我們比較靠近都會區的比較區域的中間點設置一些分院比如說比較具體的就是谷關地區因為它可以連接和平區那個廣大的範圍到台中都會區因為如果說你從和平離山"},{"start":211.618,"end":229.743,"text":"或者是環山第一帶如果要到台中市的話大概要四個小時的車程如果中間的話我們講一個折衷點大概就是谷關地區你谷關地區的話就可以順便服務那一帶的我們所有的國人在那裡然後你要發展觀光的話應該那邊也是可以然後南橫的話我們再看我們的"},{"start":231.343,"end":257.977,"text":"距離每一個地區的那個離都會區大概都是一個小時以上那馬下 甲仙 桃園茂嶺 霧台 牡丹這些都是我們所說的醫療缺乏地區甚至有十個區我們看查了一下只有衛生所就是完全沒有其他醫療院所連診所都沒有的是十個所以我們今天我要講的重點就是"},{"start":258.843,"end":263.49,"text":"有很多地區是要仰賴衛生所所以我們今天特別來講這個因為在109年"},{"start":267.206,"end":289.928,"text":"監察院有糾正有糾正提出個糾正文他的正式的公文叫內政0017在109年5、6月通過的有三個監察委員就是余作謙、張武修、王佑林提出了糾正案就是說他的重點就是人力嚴重不足過勞中央督導失職專業人力錯置考評機制不合理那他109年"},{"start":291.782,"end":306.847,"text":"就证已经通过了可是到现在我们看到的国家的努力还是没有看到具体的一些改变我们的业务量还是持续的翻倍尤其是我们COVID-19的那段期间"},{"start":309.639,"end":330.608,"text":"我們再盤點一下我們的醫療我們的護理人力我們常常在講我們希望把衛生所升級升級到什麼樣的規模希望能夠到地區醫院的規模那地區的規模大概我們在想說護理人大概多少大概是200位左右可是後來看了我們現在目前小於20人的衛生所也就是說整個區"},{"start":332.629,"end":343.236,"text":"職業數小於20的還是有17個區也就是在原住民鄉的55個鄉鎮裡面的17個區只有20人不到的護理人員在服務也就是說你要看這些"},{"start":344.279,"end":362.733,"text":"這些地區是幅遠遼闊你看仁愛鄉的區域跟西歐林鄉的區域甚至比彰化縣還要大可是他們的人口他們的護理人員只有這麼不到幾十位的這樣的人口這樣的人員數在弄可見他們的loading是非常非常的大然後所以給我們部長跟"},{"start":364.512,"end":381.215,"text":"院長後一個想法是不是在我們衛生所這個層級上面不能有做一些改變的一個契機因為我們有在推動是偏鄉的優化第二期計劃嗎還有我們的所謂的國家的什麼任性的"},{"start":382.492,"end":407.097,"text":"那個名稱比較難任性國家醫療整備計畫還有我們的健康台灣深耕計畫這些計畫很好可是我們沒有看到你們實際上對我們地方上有要做什麼改變因為人力就是這些人你一直不斷的計畫加進來可是你沒有去把它想要把它整個組織改變或者說你要怎麼把我們的原住民的人才把它"},{"start":409.839,"end":414.564,"text":"來一起服務我們族人我們沒有看到這方面的規劃我想聽聽院長的意見"},{"start":418.364,"end":444.685,"text":"謝謝您特別提到偏鄉確實偏鄉的醫療衛生所是扮演了很重要的角色那也因為過去我們的衛生所的編制主要是在地方不是由中央不像我們的部立醫院它都是由地方衛生局以下去編列的這些編制所以我們在賴總統當行政院長的時候我們特別去翻修了這個"},{"start":445.706,"end":466.415,"text":"整個衛生所的編制表把它大幅的放寬可以用醫事人員的任用擴大同時我們後來也把總員額法把它鬆綁就是醫療機構裡面的醫事人員數不受到我們總員額的限制意思就是說地方都可以依據它的需求"},{"start":466.995,"end":495.031,"text":"去提出它的編制的調整那這個未來如果現在產化法改變之後地方有了更多的財源我們會來push那麼這個衛生局向這個縣市政府要去爭取那麼增加特別是在這些山地鄉那麼這個山地離島地區人力比較不足需要靠衛生所來提供主要的醫療服務的單位去增加它的人員編制我們一直希望是說"},{"start":496.011,"end":513.44,"text":"這邊有講到任性國家這個醫療整備計畫有講到全民 社區我是覺得說如果是按照這個邏輯的話是不是真的是應該是從我們衛生所來升級也有在我們這個任性計畫裡面主要是要去協助這些點能夠去維持它的"},{"start":514.64,"end":530.576,"text":"萬一發生事情的時候可以有一個72小時的這個自行能夠運作的能力包含一些電力啦水電啦這些的那衛生所其實有在我們的規劃我們的任性醫療整備分成三級急救責任醫院"},{"start":531.136,"end":549.404,"text":"社區緊急醫療跟全民的自救所以第二層的部分是有把這些衛生所事都納入一共全國有500個點左右我的意思是說我就是怕會相對又增加他們的loading所以是不是應該人力也要及早規劃進去不然你只把這些計畫放到裡面"},{"start":549.864,"end":567.052,"text":"也說明一下我們現在有一個優化偏鄉醫療的精進計畫第二期目前在執行當中其中就是除了強化在地的一些緊急醫療的量能之外也充實在地醫療的人力問題這個都在計畫當中這個計畫從113會進行到116所以計畫的內容過程我想請部長再跟委員做詳細如果有數字上能夠呈現出來這幾年我們呈現了什麼樣"},{"start":576.317,"end":581.888,"text":"數字的增加這個第二期的計畫執行的成效如何應該跟委員跟國人做更多的報告"},{"start":582.706,"end":608.226,"text":"然後在動線上面我們是希望說你盤點就是比較靠近就是山區的這些如果沒有辦法馬上編制一些新的點的話現有的比如說診所比如說高速或者是說鹽埔這些地區比較靠近原住民地區可是它是在平地鄉那為什麼會提到這個例子呢就是有很多民眾他是在山區工作被毒蛇咬到"},{"start":608.846,"end":623.923,"text":"結果他們送到比如說送到高速的時候高速就會說這種東西他們沒有已經是小醫院了他們就說只能送大醫院我的意思說如果說比較靠近臨線就是臨近的"},{"start":625.144,"end":647.547,"text":"就是平地區可是他是診所或者是小醫院其實我覺得國家應該是要放一些毒蛇血清在那裡不然他們到了那個地方結果沒有辦法處理又要再送其實又是一個時間其實你也知道這些毒蛇啊蜜蜂的咬傷都是時效性非常非常的緊迫所以有人就很多的地方的民意代表就說希望"},{"start":648.167,"end":662.494,"text":"建議就是說沿線的地區如果你沒有辦法 衛生所每個都放因為衛生所可能離部落也很遠所以應該是就近我們找一些點然後我們去盤點一下各個區域的地方可以讓民眾可以就近處理"},{"start":663.527,"end":686.927,"text":"好 鄧委員說明大概我們沒有醫院的地方那當然就是衛生所再來又沒有的話我們有設急救站像剛剛您提到谷關我們就是用急救站像日月潭我們是用急救站因為它這個地方假日 觀光人潮會比較多所以我們會設急救站這個急救站的設置有的就可能跟診所合作也有這種例子"},{"start":687.347,"end":714.619,"text":"那我們再找時間再跟委員稍微討論看還有哪些地方有這個需求 有這個缺乏我們再來評估像北橫的華嶺 拉拉山那裡還有嘉義的阿里山鄉因為他們都是距離都會去非常偏遠的地方然後最後就是我們講到我們的現在的我們醫療人員一些收入就是剛才有提到所謂的免稅的部分我是覺得免稅的部分應該是如果除了他的收入"},{"start":715.961,"end":717.211,"text":"如果確實有增加當然是"},{"start":718.451,"end":746.066,"text":"合理的稅是可以可是他的加班費加班費跟值班費我覺得應該擴大他的免稅的一個級距不然他24小時或者說他根本就找不到人幫他代班他永遠都在值班這樣子的他有點是被迫工作然後被迫扣稅這樣的一個情況應該實際去盤查說這樣的醫療人員有多少好 跟委員說我們根據這個所得費法14條的規定"},{"start":748.743,"end":769.954,"text":"這個僱主這個指使下的這個加班費用是免稅沒有錯那我們醫師呢這個特別是在偏鄉地區他可能的工作時間又更長因為人力是比較少的所以我們已經有在跟財政部在討論那麼也有一些初步的方向那訂出這個加班的這個上限標準然後再加上這個"},{"start":771.074,"end":799.231,"text":"加班的時數的薪資如何計算那如果這邊完備之後呢那希望能夠讓這個我們工作時間比較長的這個醫師也能夠得到合理的稅付為了留任我們的醫療人員去偏鄉服務的話我們的點值也希望能夠不僅是保障一點意願也要給他加成不然他們的收入實在是有的時候其實來的病人沒有那麼多那如果說你沒有加成的話可能也是也可以"},{"start":801.392,"end":821.111,"text":"會減低他們的意願第二就是說我們對針對我們真正原住民的部分他在原住民地區看病的時候不用錢就是說免部分負擔可是他一旦跨過這個區域要到醫院的時候他已經花了非常多的時間交通費結果到醫院的時候就跟一般國人一樣要去繳部分負擔我是覺得這個部分一直都沒有解決"},{"start":821.832,"end":840.243,"text":"然後國家給的是交通補助費可是我們前幾天我們在委員會有討論到它的交通補助費的申請非常的繁瑣它需要單據 需要一張一張的去貼然後衛生所的人是疲於奔命在做這些收集的動作然後一年蓋一次 然後所以那個"},{"start":840.868,"end":857.12,"text":"可以累積到非常多的量然後如果這個個案他非常需要這筆錢他等到好等到全部都核銷完他才可以領到那我的意思說能不能去改變申請交通補助費的這樣的一個方式不是只有單一的方式"},{"start":857.68,"end":879.119,"text":"因為我就說你們現在免負負分擔不可能馬上就完成不過這種你們本來就有的交通補助費應該可以有很多形式來領取而不是只有單一的收取單去這樣的一個這麼古老的方式在做然後還有就是我上次講到的我們的罕見疾病的還有我們癌症新藥這個部分"},{"start":879.799,"end":908.352,"text":"原住民看病跟離病已經非常辛苦而且大部分的人都是從事勞動尤其是很奇怪就是你有特殊疾病的都是發生在這樣的一個家庭所以常常是求助無門然後找我們來幫忙的時候國家的規定就說你沒有符合那個條件那到底是誰去吃了這個大餅呢每次都看到罕見疾病已經從112億現在已經漲到192億可是我卻享受不到這樣子的一個"},{"start":909.652,"end":931.166,"text":"這樣的一個餅讓國人讓我們的族人會想到說到底國家的這些檢視在照顧誰我怎麼都沒有被照顧到這樣子的一個難題希望部長跟院長可以設身處地的為我們的族人尤其是生病的族人著想好 簡單跟委員回覆第一個偏鄉我們的醫院都有家產"},{"start":949.233,"end":949.253,"text":"好謝謝"}]}},"supported_relations":[],"relations":[]}