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我們現在開始開會我們公聽會會議的程序那今天我們立法院衛生委員會舉行台灣韌性醫藥整備計畫公聽會"},{"start":1819.804,"end":1839.131,"text":"是為了本會帶審的緊急醫療救護法及醫事法等相關修法提案的審查準備謝謝各位學者專家及各政府機關代表歷臨指導本市工卿會採探討的議題為提綱為準請自行參閱"},{"start":1850.905,"end":1851.469,"text":"那我舉辦這個公聽會的"},{"start":1856.263,"end":1882.624,"text":"依據是根據立法院之前刑署法第54條各委員會代審院會交付議案舉行公聽會那其中有緊急醫療救護法還有我們的藥事法等等還有當然有蘇勛權等人拟據的陳雪生拟據的羅廷偉等等很多代審的法案那因為台灣最近有"},{"start":1883.88,"end":1905.346,"text":"神經內科醫師急診科感染科都哀哀叫護理人力也告急醫院還有個資外洩這個是等等藥品那更是很嚴酷昨天我們次長林次長在媒體上也有講到藥品的問題所以我們今天舉辦這個會議有非常"},{"start":1910.171,"end":1932.892,"text":"大的意義跟參考那我們現在來介紹在場的委員協助專家行政機關代表來那在場的協助專家跟我們先介紹委員王振旭委員來陳昭志招隊"},{"start":1936.262,"end":1961.034,"text":"我們介紹一位的學者專家我們照報導順序來介紹第一個中華民國學民藥協會理事長陳怡芬好 歡迎中華民國藥師公會全國聯合會的諮詢顧問葉明公他是我們以前食藥署的署長"},{"start":1964.975,"end":1987.484,"text":"臺灣急診醫學會理事長許建欽齊美醫院的主任再來是我們中華民國治藥發展協會常務理事王惠弘臺北中民總醫院胸腔部交病房主任楊光耀"},{"start":1992.148,"end":2014.075,"text":"臺北醫學大學副校長洪冠瑜好 歡迎 歡迎林口長庚外傷急診外科主治醫師鄭取同 歡迎臺灣醫院協會副秘書長詹德旺好 歡迎 歡迎臺灣藥醫藥品法規協會理事長康兆周"},{"start":2020.655,"end":2043.765,"text":"好他是我們的以前食藥署署長台北醫學大學藥學院院長張偉橋歡迎歡迎來待會來再補充再來我們今天行政官員衛生福利部政務次長林靜儀"},{"start":2047.956,"end":2071.158,"text":"醫事司司長劉業平 歡迎食品藥物管理署署長江志剛 謝謝疾病管制署副署長羅一鈞這個台灣女婿中央健康保險署副署長陳亮宇"},{"start":2072.748,"end":2099.802,"text":"歡迎經濟部產業發展署副組長陳全正好 歡迎國家發展委員會社會發展處專門委員蘇愛娟好 歡迎財政部官務署副組長劉麗霞好 歡迎內政部消防署主任秘書張玉忠好 歡迎"},{"start":2102.355,"end":2124.157,"text":"救災救護指揮中心主任周文智好 歡迎 歡迎救災救護署副組長陳世勳好 歡迎環部局局衛情保健處處長曾元生好 歡迎藥政管理處處長曹柏映"},{"start":2130.987,"end":2145.33,"text":"智慧財產局副組長李東秀本次會議"},{"start":2160.512,"end":2170.091,"text":"部會及學者專家所列之相關署名資料都會列入紀錄刊登公報那現在請我們次長報告5分鐘"},{"start":2177.629,"end":2205.053,"text":"謝謝主席主席各位委員女士先生在場的各位學者專家各位夥伴大家早安今天逢大院第十一屆第三會期社會福利及衛生環境委員會舉行台灣任性醫藥整備計畫公聽會本部呈邀列席報告深感榮幸自求台灣醫療台灣任性醫療整備計畫提出報告敬請各位委員不吝指教在我們現在面臨的背景"},{"start":2205.353,"end":2220.095,"text":"把台灣包含面臨颱風地震複合式災難傳染病好重大的一些工商意外這些挑戰那另外全球的產業供應鏈也面臨到全球的一些安全環境的挑戰與不穩定的狀態"},{"start":2221.056,"end":2239.982,"text":"所以對於我國民眾健康跟安全都構成了很重大的挑戰那發展因應複合式極端災難的醫療體系以及藥品供應的韌性是勢在必行那所以本部針對台灣醫療及藥品供應的韌性準備情形簡單說明如下在"},{"start":2241.322,"end":2259.497,"text":"醫療韌性的部分為了配合國家政策同時預先準備面對大型災難或特殊事件時的應變能力以及因應平時大量傷患的醫療需求本部整合國防部軍醫局跟內政部消防署的計畫奉行政院核定自113年起推動韌性國家醫療準備計畫四年期計畫"},{"start":2264.581,"end":2286.602,"text":"這個計畫是一個龐大、整合型、跨領域、跨地域、跨機構組織的全面規劃包含多項的任務跟工作計畫113年度的成果包含急救站的設置、外科備援手術室團隊運作模式以及人力組成、器械、藥品衛材的準備以及部署機制等指引"},{"start":2287.202,"end":2305.548,"text":"另外也製作多項的教材手冊跟專業團體之間一起合作那錄製教學影片跟VR模組辦理多項的專業人員訓練跟民眾的訓練在藥品供應任性的部分在113年12月食藥署預告修正藥事法 藥害救濟法藥品"},{"start":2307.749,"end":2321.676,"text":"藥物樣品贈品管理辦法以及特定藥品專案核准製造及輸入辦法來完善我們的管理法規另外也建立藥品短缺通報系統跟主動監測機制以確保藥品穩定的供應"},{"start":2322.916,"end":2348.941,"text":"建立短缺通報處理流程確保臨床用藥需求可以滿足另外建立藥品供應資訊的公開資料這個open the data來有效的傳遞藥品短缺跟替代藥品的資訊也建置藥品供應監測系統與整合國內大型中盤藥商的藥品庫存資料來供醫事人員查詢各合作藥商的藥品庫存情形確保我們的藥品供應穩定對藥商醫療機構"},{"start":2351.901,"end":2377.325,"text":"药局跟民众提供教育训练跟宣导加强各界对于药品的应对跟知能尤其是药品使用的弹性我们有一些药品可能会有互相替换的需求那另外持续透过多元的方式推广国产的学名药以提升医疗机构及民众对于国产药品的信任另外也同时强化跟鼓励国产的药品那来"},{"start":2379.446,"end":2395.297,"text":"確保我們的國內的藥品供應的韌性那為了避免國內的藥廠因為單一的原料藥來源供應異常而影響藥品的生產我們也持續鼓勵藥廠增加原料藥來源及儲備也鼓勵我們這個醫療機構使用國內的藥廠或使用我們國內的這個原料藥"},{"start":2399.519,"end":2424.961,"text":"本部针对医疗任性的部分期望借由任性国家医疗准备计划提升医疗体系面对大型灾难或特殊事件发生时的应变跟准备另外针对药品任性的部分也持续跟相关的部会、产业界、学术界还有民间团体携手合作研议完善相关药品法规架构跟管理的措施确保药品供应能够稳定"},{"start":2425.781,"end":2446.619,"text":"本部呈大院各委員的指導跟監督在此敬致謝誠並且期望各位委員繼續給予支持謝謝主席 謝謝大家好謝謝市長好我們再補介紹台灣私立醫療院所學位秘書長吳明彥好"},{"start":2450.694,"end":2469.054,"text":"台灣臨床藥學會理事長張玉麗好 歡迎那這個是我們委員會辦的正式公聽會所以這個是錄音錄影永遠純正所以你五年後十年後也可以回來看看"},{"start":2472.106,"end":2481.034,"text":"每位委員花言前為人員花言前先告下列的事項學者專家跟本院委員每人花言時間6分鐘"},{"start":2483.652,"end":2510.548,"text":"為簡報方便發言請至主席台右邊的發言台沿著上由寫者專家先行一遷到順序發言委員如果要發言我們到這邊登記全部人員發言完畢後請行政機關做整體回應那我們大概十點半左右休息一下第一位我們先請中華民國學民藥協會理事長陳一芬表達意見謝謝"},{"start":2520.036,"end":2537.275,"text":"主席還有各位長官還有醫藥的先進們大家早安那麼首先感謝主席這次能夠開這樣的公聽會讓我們有機會可以稍微表達一下那我們中華民國學妙協會有準備了一些資料可以跟大家報告一下"},{"start":2539.589,"end":2553.72,"text":"那麼在這個台灣藥品許可證的部分因為我們有這個食藥署的專家在我就不多說了但是呢我們可以從製劑跟原料藥的這個比例來看大概有兩萬出頭章的藥證裡面台廠占了83%那麼原廠占了10%還有進口學名藥4%"},{"start":2559.665,"end":2582.021,"text":"那相較於原料藥呢 原料藥有85%是進口的 只有15%是我們國產的那這裡看出來一件什麼樣的事情呢就是台廠的藥品許可證 數量非常的多 重複性很高所得到的資源比較少 非常的少那原料藥呢 又太少 多仰賴進口我想這個跟剛剛次長談的部分 有某些是一樣的狀況"},{"start":2583.962,"end":2611.391,"text":"那麼這是第一個要跟大家報告第二個就是我們來看一看原廠藥對於玄密藥用量的比那這些都是有部分是從健保署的這個依例裡面出來的那你可以看到藥品的用量上面quantity的部分原廠佔了三個三成左右玄密藥佔超過七成但是如果以金額來看的話原廠佔了七成玄密藥佔了兩 將近三成的左右那麼這三成裡面還有一半是進口玄密藥"},{"start":2612.131,"end":2636.885,"text":"所以可以看得到在我們臺灣製造的玄冕藥的佔比其實相當的低只佔了藥費大概12%到13%所以看健保署的2020年的玄冕藥認識及國產製藥發展現況調查的部分可以看得到依令來看七成以上是玄冕藥這說明了一件什麼事情就是玄冕藥的數量對於我們國人的用藥健康"},{"start":2637.825,"end":2658.863,"text":"跟保障是很重要 扮演一個很重要的角色但是呢這個國防民生工業般重要的製藥產業卻得到極少的資源那大家可以從這個派裡面可以看得到那麼如果我們以國產玄密藥除了剛剛的現況以外我們要看看我們的在台製造的玄密藥碰到的六大挑戰"},{"start":2659.761,"end":2682.341,"text":"我們也做了一些survey那第一個就是研發與生產誘因的不足那我想這個是一個大環境的問題在政府單位對於這個研發的部分能夠投注多少心力當然會直接關係到我們製藥產業的一個發展那麼所以可以看到第一個是研發與生產誘因的不足第二個是供應鏈的風險大家都在談為什麼會缺藥因為供應鏈出了問題"},{"start":2686.224,"end":2703.942,"text":"那供應鏈出在什麼樣的問題上面每一個藥品可能都不太一樣第三個是醫病的信任度低所謂的醫病信任度低是指我們處方者對於學名藥的品質可能有一定的迷思那麼第四個是健保總額不足的部分那這個是一直以來的問題"},{"start":2705.003,"end":2719.67,"text":"就不贅述那法規障礙的部分當然因為我們法規要跟PIX GMP又要跟上ICH所以合法合規的部分我們的確是在這個藥品的維持上面跟查登上面的確是有一些障礙"},{"start":2720.47,"end":2737.271,"text":"那最後一個當然是備材跟留材我們又要擴建我們又要跟上國際我們又要經營CDMO那麼我們都需要大量的人才但是大量的人才都流失在國外所以這個部分也是我們一個很大的挑戰那接著來看一下我們剛剛六大挑戰的部分最高的就是研發與生產"},{"start":2738.272,"end":2754.746,"text":"又因不足的地方那就是錢不夠的意思所以我們也是希望能夠盡量爭取一些政府可以support我們的一些經費那健保分配不均就是一樣也是經費不足第三個就是醫病信任度低這是前三名的挑戰"},{"start":2756.087,"end":2774.026,"text":"好 那麼接下來就是要跟大家報告就是我們對於這樣韌性計畫的三大訴求這個是我們具體的希望能夠得到這個鼓勵跟能夠support我們在台製造選民藥的部分第一個就是自從賴總統上任以來就提到"},{"start":2774.586,"end":2802.529,"text":"就提出來了健康台灣推動委員會那推動委員會的小組成員裡面其實藥界代表只有一名其他都是大部分都是醫界的代表所以我們也呼籲總統府這邊有關於健康台灣推動委員會的部分是不是可以另外成立一個藥品供應韌性小組我們都知道其實蘇爾園本身是醫師專業然後我們次長也是但是醫師再有專業再厲害沒有藥也是萬萬不能"},{"start":2803.75,"end":2823.838,"text":"所以藥品的韌性就更新重要那麼在這個部分我們希望從原料藥到成品的短鏈供應所謂的短鏈供應就是短距離的供應鏈我們希望可以更多的在地化生產在地化的供應第二個就是訂定韌性供應的目標提高國內主要的原料藥生產這個品項"},{"start":2824.998,"end":2840.347,"text":"也跟江署長討論過有關原料藥的部分我們怎麼樣能夠讓國內生產供應國內的製藥第三個就是提高過專利三桶這裡很快的跟大家報告一下有一個B肝的藥今年4月1號三桶它卻還仍然佔了90%的自佔率"},{"start":2843.048,"end":2866.521,"text":"來到了16億台幣的一個金額這是相當高的有一個止痛藥它佔了70%左右它即將要離開台灣這是原廠藥 還沒有三桶另外一個抗凝血劑是三桶的藥品它仍然佔了將近八成的一個市佔率如果我們讓過專利期的藥品仍然佔了這麼高的比例的話那我們的藥費的負擔當然會很高這個是數據的部分"},{"start":2871.444,"end":2890.935,"text":"再來就是預算的部分 4100億的任性特別預算的部分我們希望能夠挹注健保基金不得低於12% 將近來到500億的部分這可以增進我們藥品供應鏈 尤其是國產的加速健保署規劃中的化療藥的鼓勵第三個當然經濟部有提到的生機醫藥的條例"},{"start":2892.756,"end":2909.645,"text":"希望能夠增加新的一張叫國產製藥專章這個部分希望能夠達成那食藥署跟健保署能夠合作落實臨床藥品療效的不等通報的機制能夠讓醫師在公開場合提到臺灣品質的時候能夠有依據 以上謝謝謝謝 謝謝陳理事長講得非常好"},{"start":2919.267,"end":2929.404,"text":"五百億不夠啦再來我們請葉雲光前署長,是藥事青年會的顧問"},{"start":2932.071,"end":2947.317,"text":"好 非常謝謝主席因為時間關係我就不依這個尊稱各位在座的政府官員因為以前我也是在那一邊那我今天是不是有個PPT可以放一下那很感謝蘇委員能夠召開這一次的這個會議我們全聯會長期來是關注這個議題那個PPT可不可以放一下長期來是關注這個議題啦啊 趙司委員"},{"start":2959.963,"end":2973.968,"text":"所以這個時間不能算,因為這是工作人員操作的時間所以要多一分鐘,因為他現在已經扣掉了所以今天很高興來,我們是在變局中尋找韌性與突破,下一張"},{"start":2975.513,"end":2993.529,"text":"我們在疫情中我們學到重要的一課我們因為國家的口罩對所以在這個危難的時候這個國家發揮重要的這個整合以後創造了這個台灣的安全包括經濟部、國防部、衛務部以及內政部那也創造了這個台灣的奇跡"},{"start":2995.953,"end":3017.076,"text":"那其實台灣任性的醫療呢 藥物的建議很多我想在座的各位都是專家 我這邊提出幾個第一個就是要政策引導 要由高層來統籌因為現在各個部會都有但是我個人一直認為 我們全聯會一直認為缺藥是這個國安的問題尤其我們隔壁旁邊就有一個大老虎 老是要咬我們"},{"start":3017.937,"end":3041.089,"text":"這時候我們的韌性夠不夠這是我們總統高瞻研究提出來但是我們自己仔細盤一下都有在做但是有沒有一個統籌整合的所以是不是國化會這邊是不是能夠政策引導有高層來統籌訂出一個比較周圍的特別法或者怎麼樣來把這個問題來徹底的解決第二個我們要盤點公西使用國產這剛剛等一下我想很多都會講這個"},{"start":3042.19,"end":3064.056,"text":"那這個江處長他也很認真他們也盤了我私下也知道他很用心但是我們也知道我們韌性是不夠的韌性不夠的原因第一個我們原料要這個佔的比很低那國外進口的原料大部分是來自於中國大陸當我們跟他不好的時候他為我們的時候他會給我們原料嗎那沒有原料以後我們要做什麼事情呢所以這是很嚴峻的問題"},{"start":3065.396,"end":3080.771,"text":"再來當然鼓勵國產有很多政策啦但是我這邊要講句實話都流以口說沒有落地問的廠商都沒有收到所以這個是有一點觀音作為甘露灑下去還沒到地就真花光了剛剛林市長講得很好但是我個人覺得啊"},{"start":3082.532,"end":3088.995,"text":"這個都是政策宣導我們這邊也在講 都沒有提到所以這個很重要再來的話經濟部其實經濟部促進國家經濟產業發展很重要的我以前也講過就是說這裡面是不是可能經濟部針對國產藥品給一個特別編制編列的一個專款專用來鼓勵國產的藥"},{"start":3101.101,"end":3124.51,"text":"用本土的一系列的那尤其我們不需要廣撒應該針對國家缺藥像那個醫事師他們針對小兒的用藥就有一個特別的採購的機制來滿足小兒缺藥的問題像這一種是不是很好的我們是否應該要擴大讓國家在真正需要的時候有東西可以用我想這個是需要有一個比較整體宏觀尤其經濟部可以促進整個經濟的發展因為國內廠的發展不只是"},{"start":3128.171,"end":3136.178,"text":"安定韌性的問題他還可以拓展外銷幫國家或許可以打造第二個小護國神山啊"},{"start":3137.674,"end":3161.096,"text":"第三當然財政部對租稅的獎勵長期的支援是很重要因為我們台灣都是中小企業的藥廠你不把它給支持的話往往就是撐不下去了所以這部分如果租稅的負免優待或者說有一些特殊情況的免稅我覺得這個假如是配合國家政策的應該在統籌這邊就要給他鼓勵而不是嘴巴講要實質上他配合國家政策要給他抵稅減稅或者是優免"},{"start":3163.138,"end":3186.266,"text":"再來就是全民參與動員演習內政部我知道動員署各方面但是我們實際沒操演過以前我在軍醫局當藥政署處長我們就要去動員藥廠所有有沒有生產線有沒有東西其實上可能都是缺乏的那真正有事的時候兵荒馬亂所以適時的每半年或一年適當的操演從操演之中去發現問題來徹底的解決問題我覺得這個是很重要的再來當然就是國防部這邊必要的藥品戰備的囤儲我跟那個"},{"start":3192.688,"end":3210.351,"text":"我有去拜會過那個軍醫局局長那我知道他們也很積極他有跟我回應說他們對於國軍有囤儲9萬然後各個地方醫院都有拉高到25%但是是我全面他也有反映一個問題就是我們的這個食藥署跟健保署跟那個"},{"start":3211.332,"end":3232.755,"text":"是不同意的 他比較遵循哪一套那每一套都存的話 那實在是問題所以這個就需要整合嘛 到底是健保署跟食藥署你們這個必要清單 到底是哪一套為本要不然就搞得大家是很辛苦的所以很高興有這個機會 就包括這個長期觀察以來以及各界訪視的 提供給各位參考"},{"start":3234.249,"end":3246.159,"text":"那接近國際的經驗其實印度呢針對這個問題他還是有提出特別的例如說他為了這個問題的話他有福祉國內生產11種關鍵的原料藥目前已經有27座立地原料的藥廠"},{"start":3248.376,"end":3273.647,"text":"日本更是怕怕中國斷了他的藥所以他就針對抗生素提供補助然後向原料廠廠商提供補貼日本政府購買產品的方向是向原料廠支付一定定額的金額讓他安心的做而不是採購這樣子也就是說我們國家需要我們請他做做了我們就是買買了供他是一條邊的所以在真正需要的時候就可以我相信那個那個那個"},{"start":3275.888,"end":3281.755,"text":"醫師師長他們採的這個小兒專用藥是這樣的問題幾年前這個小兒缺藥問題很嚴重後來就是石崇良還有這個我們這個師長他們持續下來現在就解決這個問題小兒缺藥缺這個醫療器材的問題就徹底解決這都是很成功的經驗"},{"start":3295.404,"end":3318.614,"text":"那現在呢其實現況的診斷跟核心症因解我這邊不多講因為等一下大家講的都差不多啦第一個就是關鍵藥呢我們抗感染藥75%從國外進口那我們CDC能幹嘛沒有藥能做什麼而且原料75%是來自於中國大陸這裡特殊製劑呢更是依賴100%依賴國外第二個我們台灣本土的供應鏈是脆弱的他只要圍我們7到14天我們就沒藥了對不對再來是價格結構是失衡的"},{"start":3323.339,"end":3351.923,"text":"那缺藥的原因我們也要提出一些建議第一個全球供應鏈的問題藥品仰賴進口本地生產不足政策法規限制國際政治情勢影響那我們提出來就是預防性參與性跟智能性建議的話就是要籌設國家級的藥品安全的戰情中心然後法規調適的部分跟完善的行政機制要及早的來修訂完成再來就提升國內製藥廠的能力儲備足夠的戰略的藥品然後強化他國合作"},{"start":3353.407,"end":3373.464,"text":"那第一個建議就是建立AI我們總統說要AI嘛所以AI智能疫警我們是不是有多維度的監測平台是不是有區塊鏈溯源的機制再來強化台灣的供應鏈的韌性工程我想等一下大家都會再講再來我們可以有一些法規我們是不是可以先用法規沙盒實驗來解決這個問題再來就是跨域整合因為真正事情發生的時候"},{"start":3380.134,"end":3397.034,"text":"美國也許還會給我們開一條這個航運通道那我們是不是跟日本啊菲律賓或哪裡有簽訂他可以去補我們一些原料這是很重要再來是勇氣發展因為我們現在是自由民主國家嘛成立藥品認證公民會議廣納各方面來形成共識這是"},{"start":3398.305,"end":3410.249,"text":"提議那藥品供應鏈的韌性的建構的話這邊有一個預防性的管理跟危機的應變兩個階段在平時的預防性的話包括戰略儲備的分級的制度我們應該分為戰備級優先級跟常規級還有一個冷鏈還有一個替代藥品"},{"start":3415.931,"end":3443.683,"text":"再來在危機的時候是不是有一個機制在48小時黃金的時候在發生事情的4小時要完全影響評估管制進口藥不能再囤在藥廠或者在港口或者在各自的地方應該國家統籌就徵收了嘛你才能分配嘛要不然大家會搶嘛 對不對再來12小時內開完專家會議發布人事的指引因為到時候藥如果掉波是中央統籌那怎麼置換的藥我們必須要有一套讓人家知道嘛要不然醫生"},{"start":3444.921,"end":3464.256,"text":"這個醫院突然你不給我藥這個沒藥就像這一次的鹽水的事件那我不曉得這個是怎麼樣啊需要一個指引啊醫生才能遵循啊然後同時呢就要完成首批緊急狀況的採購那特殊情況的話在封鎖的時候我們就要啟用預儲原料所以我們要預儲原料哪些是關鍵的品價原料囤多少啊"},{"start":3464.796,"end":3478.981,"text":"因為原料可以囤十年所以有的時候我們就可以給藥廠做假如我們連原料都沒有想要做也沒得做在疫情爆發就要啟動優先分配原算法再來就是要防止這個時候偽藥或者特殊事件的進來以上 謝謝"},{"start":3485.378,"end":3511.926,"text":"你以為我們結婚20歲嗎?我只是感謝林次長還有我們這個江署長因為江署長也針對這個問題也討論過幾次啦那我知道他也很用心盤我也知道我們的韌性真的是不夠啦這個是秘密我們不能講啦國防部也很用心啦 我剛才問他們我這邊再提一個啦 我有跟食藥署講可是食藥署的說叫我不要講"},{"start":3513.413,"end":3529.964,"text":"其實我們真正打仗的時候馬飛是很重要的我們現在馬飛是安捧所以你大時候要使用需要大量的醫生跟護理同仁在國外他們是有那個像我們這個乙島針 筆針一樣的那一個一個就直接打那在戰傷的時候"},{"start":3531.745,"end":3551.073,"text":"軍人或者百姓已經很痛苦了這時候給他配備這種是很重要但是我們國內沒有這種劑型我們國內的馬會製造又只有在食藥署那這個問題我覺得是相對嚴重啦所以是否是可以成立一個專案設計這個來就像以前我又在當那個藥證處處長的時候那時候神經解毒針啊也是買了囤著嘛"},{"start":3554.594,"end":3571.307,"text":"真正要用的時候就撥下去嘛你現在連有都沒有你到時候大量傷患你怎麼辦讓軍人在那邊痛所以是否是有這種單一使用拋棄式的筆針我們應該囤儲在緊急的時候可以撥下去可以減少醫療跟護理同仁的辛苦以上 謝謝好 謝謝 謝謝"},{"start":3575.235,"end":3585.001,"text":"業人工在當官員跟現在不一樣現在都施展開了講得很好 謝謝 謝謝來 接著我們請林業勤委員發言專業學者還有我們的"},{"start":3601.794,"end":3617.686,"text":"在戰略上,藥品跟糧食都同屬我們的戰略物質,台灣當然不可以缺糧也不可以缺藥,這是每一屆大家都知道的事情,可是台灣到底真的有能力確保我們藥品能夠具備持續供應的能力嗎?"},{"start":3618.647,"end":3641.12,"text":"我想剛剛陳理善也提過整個我們的藥品的許可證裡邊許可證的數量比大概就是進口跟國產國產跟進口的話83比17那長期以來我們自己的健保的藥費當中大概學民藥占醫令藥的那個數量大概69%可是卻"},{"start":3643.061,"end":3645.724,"text":"得到僅獲得82%的支付金額其中大13.6%為進口學名藥而且是由122家的藥廠來競爭僅"},{"start":3657.418,"end":3682.224,"text":"以僅14.4%的市場反觀進口原藥廠佔31%卻取得86%的健保支出導致我們長期藥品貿易逆差當然我們今天要談的事實上是整個韌性藥品的韌性就是要保持六個月不缺藥的能力可是如果要穩定藥品供應韌性的話關鍵在於每一季我們的國產學名藥佔率"},{"start":3685.326,"end":3688.484,"text":"能夠是達到50%以上新上市的學民要"},{"start":3690.818,"end":3718.505,"text":"價格呢事實上大概事實上是原廠藥的大概八成的藥價之後就會逐漸下降可是考量到國家的資源來看的話那勢必就要積極來推動我們國產的玄冥藥來取代進口的原廠藥可是玄冥藥如果要到50%要市佔率佔到50%的話並不太容易那許多藥品即使專利過期五年的話能佔有極高的市佔率"},{"start":3719.367,"end":3723.921,"text":"顯示我們現行政策在推動學民藥替代上並不是很成功"},{"start":3726.741,"end":3748.021,"text":"所以我認為策略力大概應該是要獎勵醫師來開立我們的生物相似藥跟學名藥為什麼這麼講實物上市上民眾在使用學名藥關鍵是在醫師是否開立因為多數民眾大概都信任醫生開什麼就吃什麼那醫院的藥局配藥時也不會說出這個藥品是進口還是國產所以我認為就是說"},{"start":3751.003,"end":3776.776,"text":"推動我們的國產學名藥首要工作應該是鼓勵醫生開立所以在我跟朱立委就各位立委關心像今年4月26日公布的健保給付項目之支付標準及價格調整作業辦法裡面明文鼓勵使用生物相似藥跟學名藥那生物相似藥在這政策在去年7月1號就試辦了當時我們的戰率呢在7.3"},{"start":3780.829,"end":3803.421,"text":"7.38%那遠低於國外的50%可是政府加碼以加碼給付醫師150點來鼓勵開立特定藥品果然事實上是成長到13%而且設定三明利達30%所以我期待這項政策不是只有生物相似藥那也能夠擴及到學民藥那策略二我們認為事實上應該要去考量到整個專利"},{"start":3805.403,"end":3817.73,"text":"連結的制度那本月初那個學民要協會要求政府應盡速檢討我們的專利連結制度當年為了加入我們跨太平洋夥伴全面進步協會"},{"start":3819.971,"end":3847.51,"text":"協定經濟部主導我們的設立此制度主要在平衡原廠跟我們的學民藥的權益可是在2019年8月實施將近6年我們的專利訴訟勝率從8.7%升到22.2%反而不利學民藥的開發所以政府除了一個政策說保障首度挑戰打贏的挑戰成功者大概有12個月市場市佔率"},{"start":3848.257,"end":3866.158,"text":"以外就缺乏有效的对应所以我认为政府应该按照我们的学民教学会讲的就是是不是应该要来做一个正面去讨论我们的制度的改革那策略三呢事实上期待的是能不能提出"},{"start":3867.64,"end":3893.515,"text":"學民藥的支持政策來帶動產業向研發的模式來升級因為根據學民藥協會跟製藥工會6月中旬的調查那超過半數的國產製藥廠都期待政府能夠支持研發跟生產升級除了合理的健保支付以外國產藥廠更期盼政府是不是可以從CMO的純代工走向我們的CDMO的委託開發製藥"},{"start":3897.725,"end":3914.342,"text":"那CMO的模式呢當然優點是我們價格競爭力強可是缺點就是95%的開發單位都在國外那我們國內的技術量能有限的話這是必須面對的問題所以我認為政府應該去支持要提出對應的政策來引導我們的產業升級"},{"start":3918.526,"end":3924.312,"text":"我們國內的台廠都很認真可是我們的熬陶廚真的要硬一點因為根據統計的話2014年10月間我們的臺灣的製藥外銷產值從197億增值到608億成長了411億"},{"start":3934.501,"end":3963.384,"text":"可是内需的产量仅大概只有48亿那可是同期健保药的支出的费用却成长到890亿所以政府支持在哪里看不到所以我们觉得全球因应我们的紧张情势的时候都在提升我们的药品自给能力台湾面临更大威胁的话我觉得当然行动要快了最后大家就期待就是能够推动国产学民要达到50%的市占率"},{"start":3963.846,"end":3982.339,"text":"還有擴大獎勵醫師開立生物相似藥跟學名藥還有開啟是不是檢討專利的連結制度的進程還提出臺灣製藥產業支持的政策以上謝謝大家謝謝謝謝您的請問那繼續我們請許建欽臺灣急診醫學會新的理事長齊美燕"},{"start":3992.97,"end":4020.118,"text":"主席 各位委員 各位與會先進 大家好 急診醫學會報告很高興 急診醫學會很榮幸承接衛福部醫療整備計畫 那這個國家計畫相當重要 那急診醫學會主要有三個指計畫 簡單報告那其中一項是設備的韌性維護 主要是地下醫療替代空間的盤點 我們規劃之一那第二 還有醫療量能的整備 那其中包括大型災難或特殊事件發生的時候的應變觀點 還有備援機制"},{"start":4021.978,"end":4039.369,"text":"我們也規劃急救站的設立還有指引第三個子計畫在人員的賦能主要是在非外科醫師還有醫師人員的外傷照護還有民防醫護團隊的訓練還有在大型災難或特殊事件發生的時候的血液供應機制"},{"start":4040.39,"end":4062.724,"text":"那113年我們產出了一些指引還有機制還有訓練那時間113年初步是一個初步的一些指引那根據這指引113年的指引還有專家委員的建議那我們包括教育訓練的回饋那114年會更新再調整這些指引還有機制那雖然急診"},{"start":4063.684,"end":4071.889,"text":"人力有稍微緊張,不過我們集團醫學會還是盡全力把114年的醫療準備計畫來更加完善以上見到報告,謝謝"},{"start":4093.953,"end":4100.257,"text":"好 接下來我們請中華民國製藥發展協會常務理事王惠弘報告那很高興有這個機會來代表製藥業發聲"},{"start":4115.708,"end":4132.933,"text":"那我想剛剛很多重點其實在我的PowerPoint裡面剛剛前面幾位專家學者都已經講過了那我就摘要的再把我認為有需要進一步補充的再跟大家做一個報告那我想我們國內製藥業在2015年1月1號我們就加入PIX GMP的國際組織還有我們的藥品"},{"start":4138.154,"end":4161,"text":"的審查的一個方向還有一個規矩都是依照ICH的一個國際標準所以我們的管理制度目前是跟先進國家都趨於一致那我想我們的產品品質也都符合國際標準那我想就是在從疫情以後就是整個藥品供應鏈接受到了一個嚴重的挑戰那這當然有很多的原因那我們看先進國家如美國"},{"start":4162,"end":4184.431,"text":"他在發現多種抗生素的原料嚴重仰賴中國進口那我想我們這個偉大的川普總統他就推動了關稅的誘因那講是誘因實際上是有一點半強迫性質鼓勵藥品回流美國生產那我想各國也紛紛推動藥品在地化的生產強化供應的一個韌性"},{"start":4185.816,"end":4214.41,"text":"那這個剛剛有提到那其實我們這邊也非常感謝就是食藥署還有健保署在對首批國產的學名藥給予同原廠藥價首兩家的學名藥那另外針對使用國產原料藥跟成功挑戰P4的一個專利也增加了一個10%的一個藥品給付那我想整個在管理方面我們目前也都有"},{"start":4215.33,"end":4239.84,"text":"短缺的一個通報系統譬如說藥品供應處理的一個通報系統那其實我們是建議可進一步再強化因為未來的風險還是很高的那我們了解到的一個問題我們認為國產學名藥目前的一個供應鏈還是算是脆弱那我想剛剛也有提到主要還是原料的一個供應目前的原料供應"},{"start":4241.958,"end":4264.378,"text":"用國內的一個原料藥廠供應生產大概只有佔15%我們大概八成以上都要仰賴進口那中國大陸是最大的一個供應來源但是相對的它的風險也是最高單一最大的供應來源那這個比重有人說三成有人說五成甚至有人說到七成然後我想這個數字簡單講就是非常高"},{"start":4264.958,"end":4287.179,"text":"那另外第二點就有提到說我們的佔比我們的使用量雖然佔了70%但是確實獲得14%的一個健保指數那這個會造成什麼影響就是說我們的廠商在擴廠或增加投資的一個意願還有重要的一個備份產能的一個誘因幾乎就是相對沒有或者是降到最低"},{"start":4287.719,"end":4312.003,"text":"那我们也发现研究的一个显示单一厂商或少数厂商垄断的学民药市场更容易发生长期的供应短缺那我想这一点第三点也就跟大家报告目前我们在生产跟监管的一个机制我想整个食药署的管理就是说我们的药厂对未来六个月的进口跟原料库存我们都必须要同保"},{"start":4312.583,"end":4336.576,"text":"那用專案的核准替代藥品的製造跟輸入那我們國內目前其實我這邊了解到的有必要藥品有關鍵藥品有戰備藥品有這三個藥品那必要藥品以我的了解在2月最新公佈的如果我沒有記錯的話大概是有586項那關鍵藥品我想大概加起來大概有200項吧上下"},{"start":4337.617,"end":4356.164,"text":"那戰備藥品我的了解大概是20幾箱但是這些藥品有的重疊有的交集有的連集都有清單但是我們發覺到對於供貨的優先順序不是那麼明確對於長期戰備的一個制度我們的認為也是還沒有完全建立"},{"start":4357.725,"end":4377.382,"text":"那我們參考一下國際藥品供應韌性的一個做法那我們看一下歐美先進國家他們也都鼓勵在地生產的一個政策如擴大政府採購國產藥品還有補助一些研發那有一個就是蠻重要就是他們也是建立了國家戰略庫存還有減少對外部的依賴"},{"start":4378.183,"end":4386.487,"text":"那美國的學者他另外他有建議就是設定優先保護學民藥的一個目錄建立全國的藥品儲備庫這剛剛葉前署長也有提到那透過一個合約來長期保障穩定的一個供應"},{"start":4394.77,"end":4413.709,"text":"那另外在重要的品項清單的一個機制歐盟及美國對高度仰賴進口或沒有替代品的一個藥品特別關注提供了快速審查輸入管道將關鍵的學名藥優先納入強制備後還有本土生產計畫那當然另外就是針對國產的一個藥價政策"},{"start":4418.214,"end":4438.528,"text":"那他們也就是鼓勵醫院優先採用國產學名藥好那我們有四個建議在現有的藥品清單基礎上明確列出其實這大概有幾個點一個是臨床使用我想這個就是醫院端這個醫院端包括各級醫院包括急診包括各方面再來就是公共衛生的需求可能有一些疫情"},{"start":4438.948,"end":4467.541,"text":"或者有一些緊急的一個需求再來國防安全我想這就是國防部或者其他相關的單位我們建立參考這三個一個項目來列出相關的關鍵品項評估國內是否具備生產能力再來就是我們會建立就是編列預算設立戰略庫存採購國內廠商生產的關鍵學名要譬如說輸液譬如說抗生素等等那政府以特定的價格收購一定量的產品作為備存"},{"start":4468.641,"end":4489.142,"text":"那這個做法不僅可以穩定廠商的收益也確保一定量的藥品可隨時調度那當然我們也建議說什麼事情都要急嘛那目前一直在提到增加韌性4100億我想大家也都有在注意這個部分那其中這個預算特別條例支持產業部分是目前看到是930億"},{"start":4490.723,"end":4519.933,"text":"那另外第三點就是優先支持國產學民藥其實我們可以仿照就是歐美先進國家甚至日本的做法訂定學民藥使用促進的一些政策包括訂定短中長期的一個加量指標那目前日本他們的學民藥使用的一個佔比已經達到80%那我們希望也能夠鼓勵公立醫院跟醫學中心的一個採購那我們相信提高學民藥使用可以增加供應韌性降低缺藥風險那最後一點"},{"start":4520.533,"end":4535.789,"text":"其實我是也是剛剛呼應一下就是那個專利連結的制度因為我們這樣看起來整個專利連結制度從2019實施到目前堪稱上稱順利但是就進一步的角度來看其實專利連結當初的考量"},{"start":4536.309,"end":4556.298,"text":"是要就是一個新藥制裁的一個保護跟學民要進入市場的一個時間取得一個平衡但是這五年來我們可以發覺整個的時間好像偏向會延緩學民要進入市場那這個在歐美也有相關的一些研究也就是說其實這個專利連結制度就是要延緩學民要進入市場"},{"start":4556.958,"end":4575.923,"text":"這個目前在歐美也有一些共識那我簡單的結論就是我想賴總統也提到健康台灣論壇那他的國家十大建言就是要打造台灣成為健康幸福的一個國家那關於多元財務管道的增加健保總額提出的策略之一是檢討藥品政策扶植國家製藥產業那"},{"start":4578.669,"end":4605.226,"text":"最後一點就是鼓勵優質國產選民還是繼續呼籲那面對全球變局我們建議強化產業誘因補助政策引導等方面著手提升本土製藥業的競爭力跟供應韌性如此才能確保未來關鍵藥品的供應穩定守護國人用藥安全以上是我的報告謝謝大家謝謝王惠宏常務理事繼續我們請陳清輝委員歡迎"},{"start":4617.25,"end":4634.399,"text":"主席各位委員各位官員還有在場關心台灣藥品供應任性的各位專家學者大家好我是婦產科醫師所以我深刻的明白藥品是治療病患最基本的工具就像我們打仗一定是需要武器一樣"},{"start":4635.399,"end":4650.348,"text":"那當然最近有發生非常多這個國外的藥物突然就退出台灣導致呢醫生他們在使用的時候必須要被迫打折或者是說可能會引發副作用或療效不佳等等的"},{"start":4650.948,"end":4664.749,"text":"所以醫師在治療病人的時候更要承擔這個風險還有不確定性藥品供應的穩定是一個後勤的問題更是維繫我們醫療品質保護病人安全的一個命脈此外呢在現今這麼國際"},{"start":4666.721,"end":4681.942,"text":"局勢詭譎多變大概都提到了這個川普的關稅問題等等所以藥品的供應穩定不僅是國際議題也是國安的問題還有社會的韌性尤其是當我們面臨傳染病危險啊"},{"start":4682.823,"end":4699.031,"text":"或是災害國際供應鏈中斷時沒有穩健的藥物儲備還有在地的生產能力就會直接衝擊我們的全民健康還有防疫效能甚至動搖社會秩序等等有些藥品是基本的民生物資更是國安的戰略資產"},{"start":4700.251,"end":4719.073,"text":"建構有韌性的藥品供應系統是國家在面對危機時守住人民健康和社會穩定的第一道防線但是大家都記憶猶新嘛去年我們爆發生理食鹽水短缺至今我們還是持續有在採購引發基層醫療和急重症照護的全面的警訊"},{"start":4720.495,"end":4735.676,"text":"不只是生理鹹水其實還有其他的問題都是最基本的醫療耗材卻牽動我們住院藥品稀釋啊清創處理啊外科手術等等多重的用途短缺所造成的影響不只是延宕了我們的治療"},{"start":4736.377,"end":4750.649,"text":"更可能危及病人的性命當然同時影響了這個護理師人力不足的議題之前就有許多護理師反映說他們在現場工作原本是用大包裝的這個書藝結果要一直來更換這種"},{"start":4751.69,"end":4771.908,"text":"徒增的工作業務都是源自於台灣藥品供應過度依賴單一製造來源缺乏彈性還有備援的機制同時政府也沒有及時的去監管掌控到這個問題最終爆發這樣子的困境那當然最近我們也是要跟這個國防外交委員會啊等等"},{"start":4772.368,"end":4797.228,"text":"持續去討論我們這些戰備的藥品到底足不足夠剛剛有聽到很多前輩已經有很多想法了那我們再把視角拉到全球的大環境川普關稅的衝擊至今都還沒有平息甚至有很多不確定的因素先前衛福部針對美國關稅衝擊就有在報告中提到因應全球供應鏈生態改變可能導致生產的成本劇增一旦關稅的影響波及到藥品藥材等等"},{"start":4800.931,"end":4826.337,"text":"上漲是勢在必行的而台灣要思考的是我國健保制度和藥品韌性可不可以因應這樣子的衝擊藥品價格上漲後如果我們的健保制度無法支付有些重要的藥品會不會又更退出台灣的市場這會影響到我們國人病患的健康權益尤其是寒病的用藥癌症的用藥等等又或者在談判的過程中如果美方要求我們要購買更多的藥品"},{"start":4827.737,"end":4840.847,"text":"更貴的藥品恐會衝擊到我們的健保財務這其中的利弊得失要怎麼權衡衛福部的角色還有決定權用到哪一個層級是接下來我們要密切關注的重點面對未來這個全球供應鏈的潛在災難風險"},{"start":4844.249,"end":4847.713,"text":"我建議政府除了建立關鍵藥品儲備清單提供供應預警還有跨部會的協調能力在打造藥品韌性的路上也應該積極的幫助我們本土的藥廠發展不論是給予能夠降低生產成本的政策支持"},{"start":4861.167,"end":4886.983,"text":"比如說付稅的優惠等等的措施也應該肩負領頭羊的角色去幫助台灣廠商到國際上去找市場比如說有一些品質優良藥效好的學民藥可以從中去穿針引線協助台灣的廠商取得代理或更經濟實惠的藥品帶入台灣造福國人的健康真正打造一個具備韌性的健康安全網"},{"start":4888.104,"end":4908.698,"text":"藥品供應穩定是守護我們醫療品質國人健康國家安全的基本從生理時間水短缺一直到全球關稅衝擊我們看到台灣的藥品體系仍存在一個結構性的風險所以我們更應該來強化預警還有儲備機制扶植在地的藥廠拓展我們國際的通路"},{"start":4909.498,"end":4917.3,"text":"並且神聖的應對健保還有藥價談判挑戰一起來打造這個具有韌性的供應才可以在動盪中穩住醫療繼續守護健康還有我們的社會謝謝"},{"start":4934.484,"end":4943.107,"text":"來 接下來我們請台北榮總胸腔科楊光耀歡迎你這個姓 我看沒人問楊謝謝 謝謝趙吉恩的邀請那很謝謝趙吉恩剛剛幫我呈現我的名字沒有印錯是太陽的楊 謝謝"},{"start":4955.799,"end":4963.103,"text":"那我今天是代表那個重症醫學會來參加這個公聽會那很謝謝那個蘇玉璇召集委員跟這個林靜雲次長的邀請那我們重症醫學會今年跟去年剛好是參與了國家熱心計劃裡面有關這個就是醫療人員負能經濟的部分的的整備"},{"start":4976.289,"end":4992.608,"text":"那跟各位簡單報告一下就是在熱心醫療裡面人員的精進計畫裡面外科系的醫療人員其實他們有一套就是外商的訓練計畫可是大家知道真正在發生狀況的時候例如說最近以色列跟伊朗之間的發生的狀況"},{"start":4993.849,"end":5018.982,"text":"很多的道路或很多的建築被損毀的時候事實上外科醫師都在醫院裡面幫忙處理這個外科的手術或其他的止血的狀況那這個在現場都是需要靠非外科系的醫療人員或是其他的Paramedical來協助所以中正學會在這個類似計劃裡面負責的角色是如果訓練非外科系的醫生"},{"start":5020.003,"end":5040.564,"text":"藉醫療人員來參與這個重大災難的訓練跟照護那很榮幸去年我們參與了醫師舉行的這個任性醫療的計畫那這個計畫裡面我們重症學院有舉辦了四場中職教室訓練營訓練了300多個中職教室那也邀請很多各學會的專家"},{"start":5042.165,"end":5067.639,"text":"來舉辦共識營那今年我們繼續在進展這個計畫的時候我們發現了一些未來可能會面臨的狀況跟各位學者專家還有委員還有總監報告一下就是我們發現去年我們在舉辦這個韌性醫療人員負能精進的時候來參加的重要是志願性的就是我們邀請各學會推派代表或各醫院推派代表那志願參加可是未來如果真的發生重大災難"},{"start":5069.232,"end":5091.951,"text":"我們需要的人是遠遠超過我們原來去年訓練的300名中職教師全國有5萬多個西醫師在職業有18萬個護理師在職業那這些二三十萬的醫療人員要怎麼訓練是未來要面臨的一個課題那我們發現訓練中職教師目標是要能夠推展課程可是推展課程必須要有"},{"start":5093.295,"end":5114.09,"text":"學習的學員那怎麼樣子讓這些學員能夠參加我覺得現在的我們的醫事人員的認證裡面我們的證照需要就是患證 患證都會要求要有倫理學分 積蓄教育 兩性 還有前年因為疫情有感控學分可是我真的期待 我也是長官我們這個醫療的未來 患證應該要有一個叫做重大災難的訓練學分"},{"start":5119.594,"end":5138.233,"text":"因為我們國家的情境其實不會屬於以色列我們面對的場景未來會就像現在大家基本上看到的狀況所有二三十萬的醫療人員不只是醫生還包括護理師 醫檢師 藥師或多少可能都需要具備一些重大災難的現場的處理的"},{"start":5141.595,"end":5147.678,"text":"訓練或是一些簡單的一些訓練的經驗在未來在第一線想辦法及時的幫助我們廣大的民眾還有幫我們的同胞在處理最前面的狀況我簡單來說我們在訓練各職類的人的時候我們其實發現很有趣的現象就是我如果訓練非外科醫師我們跟他講止血他可能說我承認"},{"start":5166.485,"end":5191.062,"text":"很久很久都沒有碰過說如何綁止血帶了這可能急診的醫師很懂外科醫師很懂可是對內科醫師對小兒科醫師可能不是那麼熟悉我們要重新再給他們重新像PGY的時候訓練一下重新讓他再做一個模擬訓練可是如果今天面對的是非醫師而已例如說今天是護理師是醫檢師是呼吸治療師那就是更"},{"start":5192.023,"end":5215.953,"text":"要跨過一個很大的鴻溝那我們其實發現自願來參加的訓練的學員的確是滿腔熱血可是未來要推廣是每一個醫療人員都要具備這樣的能力的時候需要的可能不是只有熱血可能除了剛剛講的我們需要在我們的醫事人員的基礎教育裡面加上這個中南災難的學分以外"},{"start":5216.693,"end":5234.818,"text":"可能是不是各縣市的衛生主管機關是不是定期應該要舉辦這個重大災難的訓練課程因為這個不是只有中央來做我們都知道這個真正的民防體系是地方在主導地方有內政部主導的消防署 消防局這已經做得很好"},{"start":5236.078,"end":5260.509,"text":"對 可是我覺得未來在做緊急醫療的時候不是只有消防署 消防局一方面做就可以做得到各個縣市的醫療機構不管是醫學中心或是基層診所其實都會面臨這樣的狀況那如果請各縣市的衛生主管機構來協助整合甚至幫忙代為轉達訓練計畫因為我們學位很樂意辦很多的"},{"start":5263.911,"end":5286.89,"text":"的訓練課程 可是要有就是足夠的醫療的人願意來參加然後讓他們覺得有回饋 這是一個很重要的一件事那最後還是期待就是說 因為這是一個四年的任性醫療計畫我們已經辦了兩年喔 那頭洗下去了不能做到一半 那希望說就是立委還有各位公部門的主管 就是這計畫四年把它完成"},{"start":5288.291,"end":5312.355,"text":"讓這個計畫能夠走到一個完美的境界讓這個計畫要達到目標能夠做得到讓我們所有的醫療人員都能夠在面對重大戰爭的時候都具有基本的就是急救的能力還有能夠處理的經驗讓我們在未來面對即使不面對像現在以色列跟伊朗之間的這樣的狀況我們還能夠有足夠的韌性"},{"start":5316.636,"end":5329.233,"text":"足夠的來源去面對中央 以上報告 謝謝各位謝謝 哇 講得很好耶市長可能在科魯 因為要認證 換證的時候要外産 這個很重要"},{"start":5332.677,"end":5357.246,"text":"我看到一個報導說我們台灣如果打起仗來第一個禮拜受傷的人會有七萬多人七萬多人而且是骨折跟炸裂傷或者是壓傷的所以這個真是我們有那個能量嘛所以這個我是心臟外科所以我常常思考這個問題來我們繼續請台北醫學大學副校長洪冠儀發言"},{"start":5366.803,"end":5389.16,"text":"謝謝昭偉 昭偉各位委員 各位先進 大家好代表臺北醫學大學很高興參加這個會議我想結論兩個 當然比較簡短第一個我想其實如果quot 剛剛各位先進的多元所提出來的思維包括剛剛陳委員所提到的我們可以想一個問題 我個人是在想未來這個世界上的趨勢"},{"start":5390.521,"end":5396.089,"text":"我們的工作人力在減少還有我們的人口在老化病人的壽命在延長這個趨勢會不會變"},{"start":5399.693,"end":5425.763,"text":"如果不會變的話那我們需要從現在開始就做準備不管它叫做什麼計畫我們稱它是某一種韌性也好說它是我們的整個更強化來講所以我覺得這一塊是我們所要做的所以站在一個大學的教育者我個人都覺得就好像我們現在在教小朋友們做數位學習一樣我們過去沒有學這個但現在的大學生都要教數位學習要教新的東西"},{"start":5426.643,"end":5455.062,"text":"所以我們從現在開始如果能夠讓各行各業尤其在醫界的夥伴們包括在藥界包括在國內製藥包括在醫材包括在醫院大家都能夠一起來看到這個問題來做有個共同的一個平台我覺得這是一個很好的決定而且這個決定是我們開始一起走的一個第一步這是我個人覺得衛福部當初提出這樣的一個韌性醫藥的準備計畫我個人是覺得相當的欽佩這是很重要的一件事情"},{"start":5456.523,"end":5480.984,"text":"所以我覺得這件事情其實不是討論要不要做的問題而是我們要討論我們怎麼做以及要做到哪裡那所以在這個呢我就講到第二個我的結論的部分要跟大家報告事實上我想我今天會過來是因為台北醫學大學承接了這個計畫來做一個管理中心那這個vision是什麼這個vision是希望說這個核心core"},{"start":5481.364,"end":5506.525,"text":"是希望所有的醫事人員醫事單位醫院各層級能夠搭在一起能夠有著醫療的一個準備就像剛剛楊主任所講的過去外科醫師我們希望他開刀無盡希望他能夠做微創甚至做顯微甚至做達文西但是在戰爭或者變故或者醫院孤島這些統統無效你必須直接劃開可能是回到最原始的手術"},{"start":5507.365,"end":5523.881,"text":"所以醫師們過去的訓練現在要加新的訓練我想剛剛楊主任也提到了那其他的領域都是一樣包括急救加護包括各種的一個護理人員等等所以如果能夠有一個計畫能夠來持續的推動這個我想很重要"},{"start":5524.341,"end":5538.677,"text":"所以北一做的這個是最重要的核心把大家的東西re-design我們要re-educate我們要學新的skill把舊的knowledge做transform這樣才可能學到新的東西因為你從舊的思維培養不出新的人才"},{"start":5539.358,"end":5555.194,"text":"然後接著外面一圈是所謂的韌性的社區因為醫院不是孤島醫院存活在社區就像不好意思就是像我們昭緯所在的那個高屏地區這麼重要的一個地方我們的民眾的交易民眾跟我們在一起甚至醫療網要怎麼做連結我覺得這才是一個否則我們做的還是一個fragmented"},{"start":5560.76,"end":5584.793,"text":"第三段是要到任性的全民就像我所講的我們教育我們的同仁或者我們的國人到底要教育哪些東西所有所有這些事情要做怎麼做做到什麼程度剛剛聽到各位先進們從不同的領域跨領域的多元我們提到很多需求包括國產要包括一些怎麼樣的政策我想這都是非常非常好的細節上面的政策"},{"start":5585.433,"end":5612.08,"text":"如果我們把它從這個戰術上提升到戰略上來講的話應該就是要先開始建立一個制度而這是第一步有一個平台開始去做那我相信在學校的角度或者個人本身也是一位醫師我覺得能夠一起來參與我想這是很重要的一件事情最後結論兩項再重複跟大家報告一次第一個我認為這個問題不是做不做的問題是怎麼做以及我們要做到哪裡"},{"start":5612.81,"end":5632.026,"text":"而這個關鍵要做到哪裡是看我們投入多少資源那另外從各界的剛剛的發言我雖然沒有聽到後面我相信一樣都是非常寶貴的經驗但光聽前面就會知道一個東西或一個決定可以成為火車頭可以去帶動其他的產業其他的更多的創新"},{"start":5632.987,"end":5655.715,"text":"我相信我們會變得更好這樣的投資源它是一個value這就是價值我個人是覺得如果能夠做這樣促進的話站在一個國人站在一個大學的角度的資金的甚至醫院裡面的一些經營者我個人是覺得非常願意來跟這樣來做配合以及各個領域的的專家跟key opinion leader大家一起來合作謝謝大家"},{"start":5660.243,"end":5680.118,"text":"謝謝洪副校長我是覺得他講得很好就是可能惡務部跟國防部要好好的配合,任重道遠真的打起仗來國防部的量能夠嗎?軍醫量能夠嗎?我真的很懷疑好,繼續我們請陳昭芝委員發言"},{"start":5689.529,"end":5716.659,"text":"主席 各位醫藥界朋友還有各位行政官員 大家好謝謝主席能夠安排今天這個台灣韌性醫藥的準備計畫這樣的一個公聽會我認為這現在非常關鍵也非常的急迫那藥品 以藥品來說藥品不是商品而且甚至是民眾在生命最後一線的一個最重要的一個依靠之一那如果連基本的藥品都沒有辦法穩定的供應的話其他的政策有時候是相當的空談那我今天就三個層面來"},{"start":5718.68,"end":5722.841,"text":"來期待這個計畫這個整備計畫第一個醫療韌性不能失之口號修補制度必須是正式災難管理的一個空窗期必須趕快來做我們從COVID-19的這個疫情有學到如果你平時沒有建立好的制度那個等災難來的時候它不會自動出現所以以醫療資源整備為例目前有個緊急醫療救護法第12條"},{"start":5743.607,"end":5772.432,"text":"雖然他有提到雖然要這個應該要有災難醫療機構及醫療資源但具體去盤點他的這個整合儲備的這個標準還是很粗略的那部會之間的分工都不明確那我的過往經驗去了解很多藥廠其實是想協助備援的很多藥廠其實是想協助備援但是苦無明確的一個政策跟預算的一個機制那也有不少醫院在因為這個在缺藥時第一個時間就想找替代品"},{"start":5773.783,"end":5787.807,"text":"但是因為某一些廠商它可能佔率比較大所以其他廠商根本無法很快的來接應那我想生理食鹽水就是一項很慘痛的經驗這不是個案 是制度的漏洞上所造成的一個這樣的狀況所以我認為要強化台灣的這個醫療韌性除了沾濫時的緊急應變要建立平常就可以運作的一個常設的一個制度"},{"start":5798.13,"end":5813.401,"text":"不光是在這個跨部會的協調我這裡跨部會學尤其要指健保署跟食藥署健保署今天我好像沒有看到有同事有出席好謝謝那他們的牽手合作很重要我也是在質詢台上就請他們邱部長就他們兩個牽一牽手就是這個兩位署長牽牽手要上游下游要合作"},{"start":5820.166,"end":5846.412,"text":"那藥品的分類備援效期的彈性處理這個我稍微會再講效期的彈性處理乃至於物流資訊的整合都需要有具體的法治依據跟預算支持這是第一個我要談的第二個藥品是戰略資源不能只用市場的機制市場的邏輯來治理從永豐的這個生理鹹水缺貨這件事開始我們看到多次的缺藥危機都相同的邏輯反覆出現只要價格太低利潤太薄藥廠就退場"},{"start":5849.093,"end":5877.288,"text":"那你看價格的話只看價格的話醫院就會當然這很自然嘛為了營運就會選擇要價差的藥品那可能甚至選擇性的這個不禁藥最後受害的還都是病人我今年四月有主持了一個健保三十民眾用藥的這個品質回顧跟展望公聽會許多與會者都有指出同樣的問題如果當要價差成為藥廠和醫院之間的博弈工具當地形化的契約制度失靈了當地板架的機制缺位"},{"start":5878.348,"end":5901.453,"text":"那病人真的能夠用到該用的藥嗎那所以在整個藥價結構沒有調整這個健保財務還不能夠還在緊縮的狀況下我們不能再假裝說讓市場自己去找出它的平衡沒有辦法這樣放著我們不能認為這件事是一個好的答案所以藥品應該被視為一個公共資源運用戰略來管理所以我支持政府編列穩定供應的這個備援預算"},{"start":5905.094,"end":5910.016,"text":"但我希望這不是臨時紓困,否臨時紓困的這個方式而是有制度的有架構的一個常態機制第三個我要談的是建立制度的這個透明還有如何去保障病人這個用藥的一個結構跟體系我要強調是民眾不會只關心藥在哪裡他還會關心說為什麼沒有健健保那也會關心說為什麼給付之後我還是用不到呢"},{"start":5929.562,"end":5938.429,"text":"那為什麼價格的估算跟我們理解差距這麼大所以我要特別補充我們辦公室長期追蹤的一個具體問題我要請次長能夠多幫忙衛福部醫院藥品採購強制要求長效期的聯標"},{"start":5945.695,"end":5963.108,"text":"合法合格和效期的藥品被退貨廠商不敢供貨病人也無藥可用我們一年多來過去一年一直在不斷的跟醫福會做溝通也看到八大藥業工協會主動發函建議調整效期標準到五到八個月這件事我也有跟江署長也有做過討論而且"},{"start":5966.73,"end":5971.673,"text":"藥界他們也提供相關的這個退換貨的一個配套專家指出你如果把效期規範太嚴苛就比如說你收藥的時候每個醫院收藥的時候他還要保留多長多長的這個效期可能使得一些生產廠商他會退出市場減少產能影響整個藥品的供應的這個情況那現在也有學者分析你基於公共利益彈性方寬這個效期這個效期不是指那個Label上的效期而是說你在收藥的時候"},{"start":5995.206,"end":6001.631,"text":"這都不會涉及圖利問題因為法律並無禁止但讓人家無法接受是衣服會始終用一些非常奇怪的理由搪塞說什麼遠洋漁業這個要很長很長的效期完全沒有負起主責機關應有的協調跟改革責任我們希望這個部分也能夠好好處理我已經追蹤了很久我想八大工學會聽這個都非常的清楚他們的困難點那我希望整個衛福部能夠統一快速統一政策否則部長上面喊得很大聲"},{"start":6025.029,"end":6045.906,"text":"大家說那下面沒有辦法趕快牽手合作不願意改進那不要再讓病人因為體制的錯亂而無藥可用市長我剛剛在談那個時候您都沒有看我我真的希望那個衣服會的部分謝謝你就是說我們就是一個合理的要求就是說因為現在他們甚至要求校期要六個月以上那這是沒有依據的一個說法"},{"start":6048.248,"end":6057.674,"text":"消息不能任意延長也不能任意縮短簡單來說尊重他的儲存時間所應該有的這個消息國家這個衛福部醫院應該率先來做表率好謝謝 謝謝主席"},{"start":6076.745,"end":6097.691,"text":"主席委員各位與會長官好我是外商急症外科鄭啟同醫師我也是外科醫學會外商委員會的總幹事在這邊代表外科醫學會發言本會是負責台灣任性醫療醫藥準備計畫裡面精進外科系的醫療任性訓練主軸也就是針對外商患者的處理"},{"start":6099.411,"end":6117.74,"text":"大家都知道台灣的外科醫師在很多領域都是世界知名的分科也都很專精包括換肝、顯微手術、大蚊蜥這些大家都常常聽到可是在嚴重外傷的患者因為其實在台灣相對是一個安全和平的國家所以患者數量相對比較少"},{"start":6118.76,"end":6136.093,"text":"其實在各家醫學中心的經驗也比較缺乏通常嚴重外傷的患者會集中在各家醫學中心所以區域醫院、地區醫院他們對這些嚴重外傷患者的處理經驗可以說是非常少通常都是在第一時間穩定之後就往後送"},{"start":6137.634,"end":6151.423,"text":"實際上6000多位外科醫師裡面有外傷專長的只有300到400位左右自從921以來大量傷患的各個事件場景各位應該都歷歷在目但實際上在各家醫院從事重大外傷醫療的醫師是相對的少數"},{"start":6155.166,"end":6175.76,"text":"那韓國跟台灣的醫療環境類似可是韓國在外商醫療在十多年前他們有國家的力量投注很多的資源建立了很多專職的外商中心那近年來已經開花結果那降低外商的死亡率大家可以從Netflix的這個劇都可以看到他們對於這個外商醫療的重視跟投入"},{"start":6176.66,"end":6203.531,"text":"外科醫學會在計畫中是負責建立教材、課程和各項指引希望能夠增加所有外科醫師對於外傷患者的處理能力目前隨著任性計畫的執行已經製作了許多影片、VR教材還有按照期程開設了一些實體課程在今年度也會訓練各家醫學中心的備援手術室人員以期待災變來臨的時候能夠有足夠的能力應備希望各位委員支持"},{"start":6206.759,"end":6223.252,"text":"好,謝謝鄭醫師我跟醫生真的不錯什麼都說完了我就沒這麼快了來,我們請台灣醫院協會副理事長詹德萬"},{"start":6237.791,"end":6258.807,"text":"主席 各位委員 還有各位官員 各位代表醫院協會這裡 前面就審掉 就列了 我只提重點第一個就 因為醫院團體是一個執行的單位那剛剛衛福部的這個報告我是覺得還滿務實的"},{"start":6263.251,"end":6274.151,"text":"從中間會知道是執行單位是我們基層協會辦公室設在北一其實都是很務實的做法中關的整個計畫大概有三個重點"},{"start":6275.407,"end":6294.653,"text":"一個是那個醫療能量就12個醫院的加強這個部分還OK我們醫院可以配合我就直接講了可以配合而且以前也已經在做了所以這是OK的第二個呢關於這個人員整備資能這包括剛剛提到一個重點我們外商醫"},{"start":6295.353,"end":6314.944,"text":"外科外商醫師人力的訓練不足這是一個重點這是一個隱憂另外一個整個所有民眾知識人要訓練這也是要加強的這個部分要在醫院跟醫院協會這邊也是說實在也可以配合就免以配合第三個關於那個設備的維護這個問題就比較複雜一點了"},{"start":6320.527,"end":6349.266,"text":"因為這個醫院的性質然後它的那個地區還有它的那個整個作業其實有很大的差異啦大小規模通通不一樣就這個剛才也提到了我們醫院的作業其實目前中小醫院的能量其實並不足啦那既然做了這個計畫要做一些整變所以我是建議應該整體去考量"},{"start":6350.103,"end":6363.988,"text":"整體去考量不是說我現在只做了這個計畫這個計畫要去看啦其實應該整體拉進來做檢討然後看看整個不只是平時的急診醫療包括你要是說真的有狀況整個作業連起來連動才會好嘛"},{"start":6366.329,"end":6383.629,"text":"所以就這個部分我是覺得可能在因為今年是第二年的計畫執行的前一年設了單位做了這些第二年那就完成了把整個細部計畫列出來然後這個部分就要考慮到經營會的問題"},{"start":6385.517,"end":6406.112,"text":"經費可能要用在設備的維護上面設備維護醫院的補助可能不只是針對這個前套的考量地方所以主要因地制宜考量地方的經費問題這可能要想想看就是在這邊那個衛福部還有那個醫事室長都在我們過去長期以來的這種"},{"start":6408.794,"end":6431.765,"text":"這種交流我覺得醫師師在這上面的反應是非常好的而且中間我們配合的作業績效其實也還不錯這做了好我們應該要肯定一下但是在後續做了後面這一段我是覺得經費上面可能要好好去考慮也就是說我們辦公室北醫辦公室這裡"},{"start":6432.805,"end":6460.044,"text":"在執行或者在離部細部計畫的時候可能我是建議啦要跟相關的團體多多聯繫一下甚至幾個代表性的醫院也邀請過來大家談一下我們務實的去做因為經費有限你不好好地把它去商量把錢放在應該做的地方那就很可惜了啦這是一個另外關於藥品的部分"},{"start":6460.965,"end":6476.926,"text":"今天在座的有一半以上都是我們藥界的代表所以就這部分在醫院裡面藥也是一個部分所以就這部分我們尊重各位先進的意見但是要完成的就是說第一個就整個通報"},{"start":6478.067,"end":6496.501,"text":"短缺通報這個機制這個平臺要讓它真正有效才好啦我們也不要去舉例舉例就傷人啦那舉人更是傷人啦所以就這個部分讓這個平臺有效從醫院跟我們藥廠可以在這個平臺上面看到問題到底出在哪裡我們要怎麼樣去"},{"start":6498.193,"end":6521.412,"text":"來補正這件事情 隨時可以反映出來平時這樣子 要是非常時期 這個更是重要啦所以這一個平壤的建制 我們肯定但是要有效是這樣子啦所以終結就是說第一個因地制宜第二個寬烈經費第三個醫院會絕對配合感謝"},{"start":6526.107,"end":6537.91,"text":"醫院協會全力配合就對了啦好 那我們接著請台北醫學大學藥學院長張偉橋我們請台灣"},{"start":6551.159,"end":6564.593,"text":"醫藥品法規協會法規協議理事長 康兆周 我們的前藥政處處長好 主席 各位行政官員 還有各位委員還有各位醫藥界的專家學者"},{"start":6568.237,"end":6588.552,"text":"我想這個今天我談到這個任性的問題當然有很多是可能是因為重大災害尤其包含戰爭這部分可能要發生什麼事情其實在三年前在曾經到行政院跟政委討論這件事情那其實他問的是原料藥的問題當然其實我跟他講說其實在"},{"start":6591.634,"end":6608.081,"text":"我們可能在病死之前我們可能先餓死因為大家其實都沒有去注意到我們台灣糧食已經很大部分都是仰賴進口所以這個其實是最大的問題"},{"start":6611.022,"end":6631.022,"text":"那針對今天的問題就是藥品的問題其實剛才很多人都談過了我就不再追緒那第一點有幾個建議第一點就是確實要謹慎的要盤點也要台灣製造藥品在必要藥品清單裡面所謂的佔比那剛才聽柯營已經有在盤點但是盤點完之後呢"},{"start":6632.864,"end":6659.798,"text":"到底要做什麼事情其實是比較重要的所以剛才提到也有人提到就是說對於一些特殊的藥品像比如說抗生素或一些特殊的製劑要予以鼓勵研發以及誘因那這個在誘因之下呢其實除了經濟的誘因之外剛才也有人提到就是說產業發展條例裡面去怎麼樣的一個補助其實很重要的一點也是從法規面上來看"},{"start":6660.678,"end":6683.335,"text":"所以必須要制定合理的一個要求 並提升審查的效率那當然最近 食藥署或者CDE這邊其實對外來講說我審查效率很高 其實他用的時間是跟美國或其他國家審新藥的時間來相比其實是覺得很可惜啦 就是說別人審過的東西 我們還要再花同樣的時間來審 其實"},{"start":6685.436,"end":6711.309,"text":"那像美國它最近就前幾天才發布了就是說它針對一些特殊的藥品如果能夠來申請的時候它的審查效率可以從一年減到一到兩個月美國都做得到 其實我們為什麼做不到所以那為什麼要審查效率要提高呢其實對於這些廠商在進入研發開始認為說有一利機要進入研發的時候"},{"start":6712.129,"end":6735.64,"text":"開始做實驗很多的規定然後審查又很慢到最後審查出來可能是三四年以後的那個時候立即就不見了那所以對於這個所以很多的廠商不願意投入研發因為對於這個台灣的法規面上其實自愛難行所以這個其實是要來加強的一個部分那另外一個就是"},{"start":6737.081,"end":6754.394,"text":"剛剛也有人提到就是說我們現在外銷越來越好確實不錯我們的製藥品質越來越好我們也有很多的新藥所以我們的外銷越來越好但是呢很可惜的就是說我們政府並沒有帶動其實在十多年前我們就有一些計畫"},{"start":6755.675,"end":6774.808,"text":"在為了配合南向政府南向的計畫就是跟南向的這些國家的政府的機關保持非常良好的關係甚至打個電話就可以跟對方聯絡到現在結果到六七年前就斷掉了就不再做這件事情了那所以只要廠商呢就到處碰壁"},{"start":6776.569,"end":6794.165,"text":"甚至到菲律賓一個藥證可能要三四年才能出來那這不太可能就來鼓勵這個一個外銷啦那為什麼要鼓勵一個外銷其實貝亞一直剛才提到就是說要給國產的怎麼樣的補助啦等等加強其實我認為說應該要讓他們能夠成長"},{"start":6797.928,"end":6820.796,"text":"比較重要啦不要一直補助啦所以永遠補助不完所以如果能讓他們成長的話其實是應該更好的一個方式所以我們國家缺少了一個很完整的學民藥的一個政策學民藥的政策的重要性呢其實看來各國要鼓勵學民藥的製造就是為了要節省醫療的支出"},{"start":6821.796,"end":6838.696,"text":"把這些全民藥的政策弄好之後其實我們就可以很多的資源可以到醫護人員可以到新藥的引進所以這個其實是一個很重要的一環但是很可惜的就是說剛剛也有提到了我們現在"},{"start":6839.817,"end":6865.307,"text":"就是有很多過專歷的藥五年以上的過甚至到十年的它的藥價還是非常的高它的策略性能夠造成這樣子那健保署一點方法都沒有去讓它這個整個藥價掉下來其實日本的話它其實看到如果說學名藥的佔有率在逐年沒有增加改善的時候它就會去砍藥 直接的砍藥價"},{"start":6866.843,"end":6882.074,"text":"直接砍原廠樣的藥價另外所以他其實他對於這個藥證太多產生紅海市場的時候他也提出一些鼓勵的措施所以這個其實我們必須要有一個那個選民藥的政策"},{"start":6883.769,"end":6908.804,"text":"那當然大家也提到說剛剛有一些人提到說這個全民藥其實佔有率其實不低啦我們台灣已經到75%了75%、25%的一個比例但是就是說獲利不多只有25%的獲利但新藥反而獲利比較高那當然就是說覺得這個藥價太低了但是我個人有不同的看法我覺得這是因為我們國產"},{"start":6910.505,"end":6926.415,"text":"就是藥廠太多了就是藥證重疊性太高量太少 成本太高所以他只能做 而且缺少研發的能量所以就只能賣這些低價的藥品所以當然是一個 那我覺得這應該要"},{"start":6932.319,"end":6940.012,"text":"國家要成立一個所謂的合併的基金然後來提供減免或稅金等措施的誘因來鼓勵我們的藥廠能夠合併"},{"start":6944.113,"end":6960.657,"text":"在合併之外呢但是因為我們現在很多的藥廠其實很多的土地啊這廠房其實已經都折舊光了所以他其實如果說你可以給他一個適當的一個鼓勵的時候他可以就是往比較高價的藥品來研發來開發所以這個可以來解決到就是說這個國內藥廠太多那個都是賣低價的藥品的困境"},{"start":6973.2,"end":6988.735,"text":"那當然剛剛有提到說原料要來取代其實我們上次的言議之下實在是也不太可能啦所以因為我們知道我們現在剛剛也提到了原料要自製只有15%所以要來"},{"start":6992.438,"end":7021.354,"text":"把提升的自治率實在是不太 cover是不太可能的事情就算是印度他已經是這是cover全球19%的一個他在2020的時候就拿出9億的美金來推動三年計畫他也只能推動30個原料藥所以像我們這邊所以我們這邊所謂的每次說要補助都是"},{"start":7023.535,"end":7048.926,"text":"幾億 幾億 這其實是不足的啦 不足於是所以我想這個有很多的事情那謝謝委員能夠召開今天的公聽會那以上一些意見要請大家參考好 謝謝康造州理事長那接續我們請台北醫學大學藥學院院長我先補充 先這樣 先上"},{"start":7050.302,"end":7068.65,"text":"我們補充介紹來賓黃啟嘉醫師醫師前年會常務理事也是前花蓮縣醫師公會理事長黃榮蘭理事長是我們製藥同業公會理事長再來是我們的張宏仁董事長"},{"start":7088.953,"end":7094.134,"text":"主席各位委員各位長官還有各位醫藥界的先進大家好我是台北醫學大學張偉橋"},{"start":7096.823,"end":7117.896,"text":"當我們在談任性的時候一定不是一個歲月靜好的時刻它可能不至於兵歡馬亂但是大概也是雞飛狗跳的時刻什麼是任性昨天在做投影片的時候想到兩句話疾風之盡草第二句話是野火燒不盡春風吹又生"},{"start":7119.321,"end":7147.663,"text":"換句話說你要知道堅韌不拔的草必須在狂風中你要去體驗生命的頑強跟不屈再生的恢復力那必須在野火的情況下所以這個就是韌性韌性就是在內靜當中的生存能力抵禦或是去抵消衝擊的能力第三個部分就是在創傷中能夠迅速恢復的能力這大概就是韌性"},{"start":7149.5,"end":7176.13,"text":"那以前沒有在談任性這幾年不管各個部會乃至於在大專院校裡面大家都在談任性當然要面對的就是全球動盪的衝擊還有要面對幾項威脅第一個威脅當然就是川普的威脅貿易保護主義高關稅的政策再來就是疫情疫情期間的原料要短缺導致的供應斷鏈"},{"start":7177.768,"end":7192.624,"text":"那戰爭這幾年的戰爭烏俄戰爭也好以色列伊朗的戰爭地緣政治的風險乃至於國安危機這是大家現在很擔心的那這幾個衝擊之下呢"},{"start":7194.755,"end":7221.058,"text":"跟我們的醫藥有關的就是缺藥問題去年前年報章雜誌一直在報導有關於缺藥不過缺藥也不是只有台灣發生缺藥英國也在發生缺藥美國也在發生缺藥全世界都在發生缺藥那缺藥問題為什麼這麼嚴重呢第一個它攸關社會穩定它攸關的是民眾的信任的問題"},{"start":7222.119,"end":7240.854,"text":"他在用藥的過程中你要確保他不能中斷不然他會危及生命第二個他要維持國家的醫療體系的運作在COVID-19的時間我們就看得很清楚一旦藥品供應斷裂那會導致醫療體系的崩潰第三個是很嚴肅的國安戰備"},{"start":7243.943,"end":7259.528,"text":"藥品 糧食以及能源它被視為三大的戰略資源第四個 第四個跟經濟有關 跟產業有關我們要扶植我們本土的產業因為製藥業是具有高技術高附加價值的生技產業"},{"start":7261.877,"end":7287.98,"text":"那從我們的藥證主管機關到各個工協會幾位前輩幾位先進都提出過非常有前瞻性的看法其中江志剛署長在今年WHA的一個國際藥品供應鏈的一個論壇裡面他提出一個非常前瞻性的看法這個是其他工協會當時沒有想到過的就是建立區域的供應鏈"},{"start":7289.381,"end":7317.448,"text":"这是一个很好的做法为什么呢我们提到任性的时候实际上任性的一环就是弹性任性的一环就是激动在不稳定的情况下去寻求相对的稳定这种情况下什么都自己做来不来得及有没有更好的方式那署长当时提到的叫区域供应链也就是分工复补资源共享他的目的就是降低对单一国家的"},{"start":7318.668,"end":7334.005,"text":"過度依賴的風險那也提到了用最少的藥物經費來照顧最多的病人在食藥署裡面盤點國內藥品供應是政策的重點希望能夠達到強化供應鏈跟減輕藥物經濟的負擔"},{"start":7337.199,"end":7360.127,"text":"那剛才學民藥學會陳理事長也提到他在今年的4月也提到三項建議也是非常好的建議第一項建議就是衛福部的醫藥韌性計畫應該納入全台社區藥局全台藥廠及醫療廠來打造醫療藥品供應韌性第二個部分是健保署的部分用政策來引導"},{"start":7362.659,"end":7387.71,"text":"國產製藥提升品質建立醫病對於國產藥品的信任那第三個部分就是藥價因為通膨很嚴重必須要適度必須要及時反映藥價的調整全聯會也曾經提出過一些看法剛才葉明公葉顧問也有做了一些說明其中最重要就是兩項第一項是藥師藥師應該要納入社會防衛的韌性體制"},{"start":7391.741,"end":7415.997,"text":"那第二個部分是從COVID-19的啟示而來的社區藥局很重要社區藥局應該可以作為物資儲備以及物資調動的中心提供急需藥品醫療器材還有第一線的藥事服務換句話說把藥師納入社會防衛的韌性體系可以強化國家的健康與安全"},{"start":7417.762,"end":7434.577,"text":"那其實在去年國科會也曾經召開有關臺灣原料藥供應鏈那我是國科會的藥學及中醫學門召集人也參與這個會議當時非常擔心原料藥斷鏈的狀況我們學門裡面有做過一些盤點也提出了幾項建言第一個就是"},{"start":7435.698,"end":7457.519,"text":"推動關鍵藥品國產化可能性評估的產學研究方案第二件是開發綠色環保製藥流程低碳低耗能的新製程第三是導入AI導入自動化來提升本土產能最後一個部分是透過真實世界數據的評估來評估缺藥對脆弱族群"},{"start":7458.208,"end":7470.402,"text":"例如老年人慢性疾病的患者的衝擊那在這張短片我個人提出幾項建議第一項建議就是我呼應署長的想法建立區域供應鏈"},{"start":7471.946,"end":7495.137,"text":"資源共享降低對單一國家的過度依賴第二個部分我們要建立價格市井機制依照品質需求來調整地板價兼顧用藥權及藥廠的合理利潤才能夠穩定供貨第三個部分政策應該要做一些鬆綁我們要有明確的法源依據來做財政的支撐"},{"start":7497.03,"end":7514.437,"text":"應該要善用特別預算或前瞻計畫的經費投入在供應鏈韌性的建設再來一個部分是AI要投入AI跟自動化透過研究計畫這是國科會應該做的或是產學合作鼓勵結合AI演算法自動化設備與實際製藥流程的生產線效率"},{"start":7518.479,"end":7542.942,"text":"那另外一個部分是制定 剛才很多前輩提到的 制定關鍵藥品清單的部分當然羅列這些清單很重要 但是我認為更重要的應該是政府要採取措施 確保穩定工藝 怎麼做呢必須要定期監測存量 要求提報生產跟庫存的訊息及動用預算進行儲備"},{"start":7544.775,"end":7558.081,"text":"再來是政府建立藥品韌性辦公室那這個規格不能夠太低最好是能夠由總統府列管來確保這個議題能夠獲得持續的重視以及資源的投入"},{"start":7559.454,"end":7575.741,"text":"有關於醫院的部分醫院採購應該要保持彈性現行的採購往往強調價格強調成本控制不過在韌性的考量之下應該要導入更多的彈性以及安全係數最後一個部分是教育端"},{"start":7576.361,"end":7601.261,"text":"我來自於學校學校要開立課程現在學校的課程裡面比較沒有評估藥品供應的能力所以在開課的部分應該建議藥學系要開課藥廠製造生產以及藥品流通的管理課程未來當學生踏出校園進到職場的時候他就能夠成為藥品供應任性當中最重要的第一線以上 謝謝"},{"start":7607.412,"end":7631.353,"text":"謝謝張院長我剛才跟大家報告,我們就不休息啦因為進行的很順利啦要上洗手間的人自己想辦法因為待會來休息,爪爪跑掉了人氣就沒了來,我們再來請台灣司令院院所協會秘書長吳明燕"},{"start":7639.827,"end":7657.702,"text":"謝謝委員召開這個公聽會基本上台灣的醫療在全世界評比都這麼好我也常常代表台灣到全世界去先導我們的國際醫療那基本上我們人力很好人力大概基本上不成問題我們人力即使在戰爭的時候以台灣政府的愛心只要足夠的信念我覺得都不是問題"},{"start":7658.823,"end":7683.337,"text":"那我覺得我們現在最大的問題就是錢啦 財務 錢而已 錢沒錢那個等一下再談 那另外我自己 我不曉得今天委員會是只有針對藥品 看起來好像都沒有討論到材料因為藥品大概佔我們醫院25% 材料佔10%那等戰爭的時候 材料也很重要喔這個我不曉得委員是不是另外要討論那另外還有一個議題 我覺得好像可能也要討論 資訊安全"},{"start":7685.938,"end":7712.66,"text":"這個很大我們不要發生像新加坡的總理的資料全部被盜走的時候國家才緊張喔或者是我們哪一天台灣有一個領導人的資料被拿走然後整個公布的時候大家才知道說原來資訊安全很重要或怎麼樣那這個部分我是提外問好那我回到今天的本題我覺得今天第一個關稅的時候還沒有發生那看起來關稅只是錢增加只要有錢都買得到東西可能問題不大當然是"},{"start":7714.461,"end":7734.54,"text":"最大的問題是在戰爭那衛福部這兩年已經有很好的規劃我們的很多協會都接到很多計畫我覺得這都很好都已經在準備了看起來是政府已經有well prepared那從我們醫院因為我們醫院的使用角度來看的話我們的過程其實很短因為為什麼我們要太講究效力了"},{"start":7735.12,"end":7756.26,"text":"我們管理很好嘛,我常常說我們管理很好,我們現在大家都要...管理好就是庫存期很短啊這沒辦法,這個是從頭打血來的嘛庫存期很短的事,庫存量都沒夠啊這個部分也要靠政府來幫忙那另外一個是供應鏈的問題,全球供應鏈每一個國家都可以卡別人"},{"start":7757.52,"end":7773.789,"text":"我們台灣可以卡人家Semiconductor美國也可以用,因為你很多Semiconductor裡面的軟體設計的軟體都是美國的,也可以卡別人,但大陸也可以用C2卡你啊所以每個國家互相有自己的優勢每個人都有自己的優勢,這個變成很麻煩的問題"},{"start":7776.03,"end":7801.743,"text":"那我解決的方案大概有講過了畢竟我們是使用待會我們要的是政府可能要撥一筆錢把台灣北中南都有一個很大的擴展中心這些擴展中心就是說既然要準備就要了結嘛這些準備的東西準備好快過期了就趕快免費的或者是折價給醫院使用那你又買一批新的只能這樣子才維持一個國家的一個韌性"},{"start":7802.924,"end":7819.281,"text":"那另外一個是第二個建議我是覺得政府應該要派一組人到烏克蘭去既然天底下有人花了有人齁公開天安的俄羅斯鳥仔一隻去打戰齁那烏克蘭鳥仔一隻要守護齁這是"},{"start":7821.383,"end":7849.009,"text":"等於是我們因為我們叫做天然的experience人家創造一個機會給我們我們未來可能會發生戰爭為什麼不派一組人到那邊去長期進駐就是像醫生護士長期在烏克蘭知道他們發生什麼該準備什麼那缺什麼那個資料回補所以我覺得政府要花這一筆錢急診的準備一組人到那邊去幫他們那醫院整個長住在那邊半年我相信這個資料蒐集回來對我們會長有幫忙"},{"start":7851.789,"end":7869.774,"text":"那個要保障嘛,你要買保險嘛買保險嘛,買保險這個對我們的資料,蒐集回來才知道說怎麼應變戰爭如果我們台灣以外在的危機這麼大準備戰爭,事實上我還有一個瘋狂的想法當初如果我是小英總統的話"},{"start":7871.77,"end":7896.326,"text":"烏克蘭打戰的時候 台灣出F16的戰鬥員 美國出飛機 我去幫你打為什麼 天然人沒有這麼好的機會訓練F16的戰鬥員這麼好的機會 當然你要買很好的保險 給他很好的待遇天底下我跟你講 只要有錢就是有人願意去冒險這是我們管理 我們那時候愛滋病房沒人要去我們就這個月加五千塊 沒人去 下個月一萬塊有人來登記了"},{"start":7898.414,"end":7919.689,"text":"那是愛滋病法你看看那麼危險喔還沒有藥的時候我們就這樣管理啊田底下只要有錢就是有人願意冒險啊只要你足夠給他買一億的保險你如果過去被他打掉一億那你薪水給他一格一百萬我不相信台灣的F16但是這是最好的機會啊我們台灣沒有你有機會信任戰爭信任我們的F16戰鬥員嗎"},{"start":7921.718,"end":7931.801,"text":"沒有機會啦只有那個機會,那個機會最好而且是符合美國,剛好是拜登那時候剛好要建立更好的中美關係這是題外話,好謝謝啊笑了笑了好我做理事長,他要做理事長所以我可以給他賣,沒關係來,繼續我們請"},{"start":7948.713,"end":7951.434,"text":"臨床藥學會理事長張玉立歡迎主席還有在場各位委員還有各位先進各位專家那今天非常榮幸代表臺灣臨床藥學會來這邊來跟大家報告因為我們在過去其實10年多前食藥署就委託臺灣臨床藥學會"},{"start":7978.141,"end":7996.407,"text":"建立這個藥品短缺的供應資料的一個平台那我們跟食藥署充分的合作那目前這個平台的運作雖然大家可能有很多的期待但是至少這個平台目前其實我們可以講在世界上甚至我們在一些國際的場合"},{"start":7998.867,"end":8025.254,"text":"對我們的這個機制做的一些分享其實很多的國家都對這個方式是非常肯定的那當然這個缺要不是只有平台還有資訊揭露它還有很多這個上游產業整體還有我們這個我們台灣這個大環境的一些限制的問題所以資訊平台的建立非常重要但是很多的環節要一起配套"},{"start":8026.138,"end":8048.069,"text":"那這是一個部分那另外一個部分因為我們臨床藥學會也承蒙食藥署的信任我們也在三年前開始接這個戰備的藥品的一個相關的庫存整備的一個計畫那所以我現在就簡單的跟各位報告我們這些經過這些幾年的經驗我們有一些建議"},{"start":8052.298,"end":8074.72,"text":"那第一個呢 我當然是要 echo 我們陳昭之委員他其實在很多場合講過很多遍 就是我們在資訊的流通的部分 特別是我們政府單位食藥署跟健保署他們之間的資訊的連通的效率其實非常重要 我相信現在已經有很好的機制 但是"},{"start":8075.641,"end":8093.28,"text":"也許在連通的資訊分享的效率上可以再提升因為很多的藥品短缺其實它跟藥品的合價是有一些連結的所以這部分是希望可以再精進"},{"start":8094.673,"end":8110.626,"text":"那另外還有一個部分就是我們在輸液的經驗裡面還有很多藥品可能需要下市的這個決策的過程其實可能依照法規或者安全性做這樣的處置都是我們可以理解的但是因為"},{"start":8111.386,"end":8137.169,"text":"後面在臨床上就可能會有很多應變上節奏沒有辦法搭配的問題會製造很多臨床的一些狀況那特別是輸液問題我想大家是學到非常慘痛的經驗所以是建議在未來在任何的這樣子的決策之前可以跟臨床使用單位有更好的一些溝通在做這樣子的決策以求周全"},{"start":8138.837,"end":8163.68,"text":"那另外就是關於健保核價的部分因為我們知道有一些產品因為我們健保使用非常有效率所以我們的價錢大家都知道可能是世界數一數二的最低價那我們才能用最低的最少的資源完成這麼多的病人照顧但是這樣的情況其實對我們藥品供應是非常不利的所以我們是不是對於這些"},{"start":8165.161,"end":8192.53,"text":"遠低於國際行情核價的這些健保品項我們能夠建立一個主動常態的監測機制能夠及早的預防短缺可能造成的衝擊那對於已經反映不敷成本的品項是不是在健保核價其實健保現在已經會針對這些部分做一些調整但是它的其實性跟效率性是不是也可以再想辦法能夠提升"},{"start":8193.47,"end":8222.509,"text":"那另外就是我們輸液的現在因為已經逐漸恢復比去年的情況好但是其實呢還是還是整體量仍然不足各醫院其實還是特別是可能是中小型的醫院可能常常會面臨就是因為他現在的量其實跟發生這個問題之前他還是有一些差距的所以還是各醫院在準備這個的部分還是有很多"},{"start":8224.151,"end":8242.985,"text":"那特別是現在所有各類醫護人員都短缺的情況之下呢其實這種供應上的壓力也造成這個各醫院的一些困擾那當然也是會影響這些工作人員留在這個醫療系統的醫院所以這部分也是希望我們主政單位能夠幫忙協助"},{"start":8245.609,"end":8269.729,"text":"那另外大家有提到這關於必要藥品清單的這個部分其實因為這個必要藥品清單我們當初是根據27-2條訂出來的那原來主要的目的是針對這個生產或者供應有餘的廠商可以提早通報可是後來因為各界對這個必要藥品清單的認知跟理解還有期待都不同"},{"start":8270.43,"end":8290.347,"text":"那其實臨床應用跟所謂的請廠商及早通報這是不同的目的所以其實外界因為對於這個清單有太多的期待甚至原始的定義定出來的目標其實都不太一樣所以這邊其實希望外界能多給予這個主政單位"},{"start":8291.628,"end":8320.298,"text":"多一些的時間因為目前現在這個清單是要跨部會因為現在連健保都在核架上都會依照這個清單做一些調整所以希望未來這個清單能夠兼顧大家的需求但是坦白講因為每個人的定義跟期待不一樣所以在解讀這個清單上會有很多我們沒有辦法預先想到的一些狀況因為大家知道WHO的"},{"start":8321.354,"end":8344.799,"text":"清單其實跟實際上真正臨床應用上在不同目的上要用的清單其實它是完全不一樣的所以這個部分希望外界要多一些的理解那另外是希望能夠運用AI或者資料庫的管理建立藥品庫存的預警機制因為現在AI很發達所以這些藥品供應狀態的資料庫"},{"start":8347.748,"end":8376.638,"text":"如果我們能夠常態的預先監督分析這個短缺可能的因素然後用這些因素找到及早能夠介入處理當然廠商因為基於商業的關係其實他們法規上要通報的他們會通報但是很多他們也是拖到最後一刻因為怕影響他的市場戰略所以這個通報上還是有一些問題所以是不是有一些主動監控的機制可以介入"},{"start":8377.378,"end":8392.79,"text":"那這些如果它變成一個常態的一個做法也許在未來我們在處理這個藥品供應會更主動更提前找到問題那另外一個部分就跟各位報告關於戰備庫存計畫那戰備庫存計畫這三年其實我們在這個計畫主持人是國防學院李宇勳教授他其實每週都為了這個計畫開會非常認真的在處理所以在"},{"start":8404.378,"end":8432.169,"text":"盤點全國這個戰備的品項還有相關替代品甚至未來應用都有已經有很好的規劃了但是其實還是有一些挑戰那第一個呢我們知道現在這個目前要求209家這個動員醫院儲存的品項是還是十幾年前的版本就是那25項那目前其實已經有一個新的版本出來就是關於這個藥品大概有55項醫療器材有100幾項"},{"start":8433.53,"end":8451.916,"text":"那也就是說我們在過去定義的這個品項跟現在的需求其實已經有出入了所以我們怎麼樣快速的能夠依照現在的需求來準備這些品項我想這是非常重要而不是還是沿用十幾年前的那個要的這個庫儲清單"},{"start":8454.497,"end":8478.662,"text":"那另外呢就是目前這個災難應變期間相關平台協助醫療量能這些都已經有建立了但是在藥品跟醫材儲備的層面呢包括庫存數據替代品建議跟臨床使用回饋資訊都還沒有納入我們整體整備的這個架構裡面所以這個建議可以及早思考能夠"},{"start":8479.963,"end":8502.533,"text":"能夠列入那另外還有部分的儲備院所的反應呢現在儲備清單的部分品項使用率偏低就是剛才前面也有先進提到就是這個浪費的部分那在實務執行的時候也缺乏一些彈性的指引跟配套那這個是目前的問題所以我們有以下四點建議"},{"start":8504.079,"end":8522.747,"text":"那第一個就是要立即應該要依照現在的環境災難還有戰爭形態需求逐步更新現有庫存的品項不是人才採用將近20年前的版本而且這個機制呢應該要有一個常態建立組織單位來做更新"},{"start":8524.315,"end":8539.579,"text":"那另外有關這個特殊戰備品就是之前有這個10萬傷患的這種做法不應該只有公立醫院四大體系應該要涵蓋更多的醫療院所因為我們知道在暫時的時候當真的發生狀況"},{"start":8542.32,"end":8554.253,"text":"這四大公立醫院體系也未必能及時的供應到必要的醫院所以這個應該是更擴散開來的一個準備的方式"},{"start":8555.424,"end":8578.119,"text":"那這樣子才能夠真的在暫時的時候可以發揮這個即時供應的效果而且也可以減輕平時庫儲的浪費因為我們常常有一些品項在單一醫院他的庫存量可能是五年的以上的臨床使用量所以他等於是你預期做這樣的準備就是準備要把那個藥報廢因為他一定是過期的只要沒有發生狀況所以"},{"start":8579.74,"end":8608.179,"text":"所以這個部分是建議可以做一些調整那能夠採取這個滾動式分階段方式來優化這個儲備制度那也許也可以從中重度的急救責任醫院來優先實施那另外就是希望能嚴以建立這個倉儲的資訊整合跟資源調度的機制那未來也可以把這個納入這個災難應變指揮體系能夠及時促進資源掌握還有加速調度"},{"start":8609.912,"end":8625.812,"text":"那第四點就是希望能夠建立儲備品項的操作的參考指引因為這些儲備品項決定以後呢還是要讓臨床第一線的人知道要怎麼處理包括當這個品項短缺的時候它的替代品"},{"start":8626.633,"end":8646.862,"text":"是什麼建議那這個都必須要跟第一線的這些臨床的經驗能夠結合來提升這個我們執行端的可行性跟一致性好謝謝這是以上我們臨床學會的建議好謝謝康理事長那接續我們請臺灣製藥工業同業工業理事長黃榮蘭理事長"},{"start":8662.065,"end":8683.457,"text":"主席、各位委員還有各位今天來參與的一些嘉賓我現在從剛剛聽到現在都是一些關於這些數據的討論學名藥的問題那這一些專家都已經贅述了很多我就不再重新講了我今天所講的就是以製藥這個環節來討論這個藥品供應鏈的問題"},{"start":8688.444,"end":8708.204,"text":"因為在我們台灣政府實施PCCMP還有IQ3嚴肅不存物的一個規範了以後他們講台灣製藥界受到了很多衝擊但是這個制度好不好是很好但是我們在台灣的教育界他沒有"},{"start":8709.085,"end":8722.291,"text":"把這種人才都培養出來這些製藥人才坦白講我前幾次有跟教育部長也曾經開過會我曾經問了我們的教育體系有沒有幫製藥界"},{"start":8724.909,"end":8743.514,"text":"培養一些製藥人才因為製藥界在藥廠不只需要是藥學習他的檢驗科系現在因為PCMP IHH這一些都是很專業的一個檢驗不是用以前的所謂的化工"},{"start":8745.235,"end":8759.45,"text":"畢業的他們就可以做的所以說這一些我們也是希望說政府你可以在交易體系方面多做一些琢磨還有說政府對業者提出"},{"start":8760.39,"end":8778.313,"text":"不缺藥的對象 這我們工會也曾經接受過但對象是有的 但是怎麼解決 沒有辦法曾經以前在原廠藥要退出的時候他要我們的國產藥廠因為原廠藥退出只能靠國產藥"},{"start":8779.494,"end":8807.723,"text":"那靠國產藥你要加強生產他們講這藥品是一個商業行為它當時是也是有某種因素大部分也是商業因素他們要推出因為健保藥太低了所以說國產藥它一生產它進口藥又來了那我們的醫院系統他們有延長藥就一定用延長藥就把那個學名藥就品出好幾家藥廠庫存品一大堆一庫五類"},{"start":8808.604,"end":8828.375,"text":"所以說現在變成了政府說你這個藥品你要怎麼報證供應即使已知藥界我們的看法到時候再說吧因為怎麼樣呢因為現在原料原料還有標準品我們再跟人家買原料我們台灣規模"},{"start":8830.476,"end":8838.592,"text":"經濟規模這麼小人口數這麼少其實我們最難的是我們要找一個原料找到了以後人家原廠開發的你要幾公噸"},{"start":8842.779,"end":8862.634,"text":"一個要含量幾毫克,要幾公噸,我們台灣可以吃掉幾公噸嗎?我舉個例,像我們有一個精華塞,氧化鋅,它是一種皮膚科用藥,坦白講,要找到Z字號的原料,這世界真的很難找,但是找到以後,他問我要幾公噸?"},{"start":8864.696,"end":8893.295,"text":"我一下子慌了我一年頂多用兩三百公斤最多啦但是報價也是我用了四百公斤進口它也是以一公噸的價錢報給我所以說原料藥它已經都上升到真的不是我們廠商可以去平衡的但是我們的健保還是死守著你就是這麼一點那造成了我們廠商會把這個藥品就推出市場"},{"start":8894.655,"end":8917.621,"text":"那在這個方向我們也是希望說政府要重視這一點因為現在的藥政法規真的是太嚴了我們也是希望說可以把真的要求好的品質但是要符合我們台灣的現狀我們不要把我們的制度都搞像全世界最高級但是我們的藥價沒有最高級"},{"start":8923.544,"end":8952.623,"text":"因為台灣都私營企業沒有人可以做得出來這是現在我在工會裡面每一次會員一提到的真的在這個藥事法的修訂各方面真的我們也希望說主管單位可以跟我們研究一下怎麼樣讓品質好又可以繼續生產這才是重要因為大家現在講如果藥品供應院再怎麼樣我狠心的問一下"},{"start":8953.777,"end":8973.951,"text":"如果中國來圍台灣島,坦白講要一個禮拜,原料要百分之九十都是國外的怎麼去處理,至少我們在我們的市場,我們在島內至少我們有儲存一些藥物,因為你們可能不知道製藥的難度在哪裡,我一個煮原料"},{"start":8975.63,"end":9004.111,"text":"某一家A廠原料他不賣給我他併廠了他改地址了我要找B廠的同樣的主原料我要重新來整個檢驗數據都要重新來這真的要恢復到生產至少要一年半到三年時間你說這市場會不會缺藥那一定會缺藥那缺藥了以後市場從坦白講兩三年級就開始在缺藥了一直缺了只是你們"},{"start":9004.972,"end":9016.122,"text":"因為政府單位所看到是健保署的數據健保署的數據是哪裡是健保用價量來看這個是多少其實40%的診所"},{"start":9019.856,"end":9039.333,"text":"藥局它是人民生活必需它要用的一些藥物它在缺真的到時候找到這一種方面的缺藥擴大的時候因為這些藥局的藥都是一些傳統的一些老藥傳統老藥找不到標準品你就不要做了你就撤銷了"},{"start":9041.294,"end":9062.75,"text":"傳統老藥找他現在檢驗規格的提升要最新版本的檢驗規格你跟不上來你的人員技術不行你的儀器不夠你就退出這個市場對不對就像我簡單舉個例就像個Cotine這個糖漿對不對政府因為是"},{"start":9066.226,"end":9088.469,"text":"麻醉處跟外面標過今天你標不到以前美國的那一家你標到荷蘭的回來要我們藥廠新的規矩新的檢驗技術以前美國要驗五個標準標準品那荷蘭的要六個藥廠一定要驗十一個才能通過"},{"start":9089.912,"end":9113.733,"text":"哪有這麼多的人力物力這些都是重複的檢驗還有剛剛有學者講到了一點就是這個效期的問題原料要效期好像10年可能他有點誤解原料要沒有效期10年我們原料要進口是用延長原標籤他寫多少就多少以前我們還在"},{"start":9115.231,"end":9136.889,"text":"標準的範圍之內 合格的範圍之內 我們還可以再延期現在的PCDMP完全沒有再延期坦白講每年藥廠 它竟然沒有用完都是在丟掉都要丟掉 造成很多的浪費這是真的是製藥業的一個困境我希望說政府多多重視我們的製藥產業因為全台灣"},{"start":9139.111,"end":9154.232,"text":"現在製藥產業從以前的五六百家GMP實施以前到現在剩下113家那真正在做製劑的他們講六七十家已經少了現在你們可能很少看到說"},{"start":9156.665,"end":9185.218,"text":"藥局在關門 其實台灣沒人藥廠關門的多喔 真的跟以前都不一樣所以這個產業如果真的有一天消失在台灣我們到底怎麼樣要講這個什麼藥品供應 連什麼都別講連最基本的止痛藥都沒有了 你要怎麼辦這些藥就像剛剛學者講 大部分都是中國進口的你藥能不能用 因為沒有辦法 中國它的抗生素"},{"start":9185.851,"end":9195.815,"text":"它佔了全世界70%,它是生產量,連美國都要靠它所以說我們應該怎麼樣去把自己國內的產業面把它建好,謝謝謝謝黃理事長,這很專業的,所以都沒第一次聽到不過我有看一個報導"},{"start":9211.542,"end":9239.654,"text":"他說大陸如果把原料要第一代第二代甚至一些第三代抗生素的原料不賣給美國的話美國每天會感染症死亡的人會有五千人這個省下機關署我們國民理事給我回答一下真的還假的我不知道這個我看到的所以提出來好再來我們請黃啟嘉理事長"},{"start":9244.78,"end":9273.219,"text":"主席還有在場的所有的醫藥的先進 大家好我發言分了兩部分第一部分是有關我們討論提綱裡頭有關法規的部分修法的部分醫療公會全國聯合會有法規委員會法規委員會的召委是吳欣喜醫師在他的組織下我們對這三項有關緊急醫療救護法第十二條的修正藥事法二十七之二四十八之二的修正我們是正向"},{"start":9274.499,"end":9286.706,"text":"這也表達支持的意思那第二個我想今天談韌性醫療就是醫療資源自主法我們在想有哪一個國家永遠不會缺戰鬥機"},{"start":9288.564,"end":9310.035,"text":"叫做美國因為戰鬥機都他製造還外銷到全世界各國去換言之如果你自己是能夠製造而且還可以外銷的話你就不會有這個資源的匱乏所以醫療資源的自主化對於韌性來講是根本的問題那其實我們台灣有一個最大的制度叫做健保健保其實它是一個"},{"start":9312.237,"end":9338.67,"text":"機會但是也是一個阻礙為什麼說是一個機會呢因為我們有健保的資料庫那個資料庫如果妥善運用我們比全世界其他國家更能夠了解我們的醫療資源的使用跟分配所以我們對藥品的監控是非常容易的但是它也是一個障礙為什麼是一個障礙呢因為健保本身它的資源有限又是一個總額制度所以今天任何一個藥品你要提高的話就會擠壓到其他的醫療資源的使用"},{"start":9339.85,"end":9366.95,"text":"所以我們今天講我們明知道這個藥品可能不敷成本可是我就不敢幫你提高價格因為一提高價格那其他勞務部分的支付標準要不要提高那就變成我們是在一個賽局的困境裡頭所以如何讓健保成為我們的機會而不要成為我們的障礙這是我們大家要去思考的問題那其實對於藥品要不要缺乏有健保的幫忙我們對於供應鏈的監控會更好而且現在可以把AI導入"},{"start":9368.251,"end":9386.385,"text":"那當然我剛剛也非常支持前面有先進講的除了藥品以外醫材要一起討論甚至整個醫療資源的分配包括設備也要一起討論不是只有藥品而已其實在急救的時候藥品固然重要但是其他的設備跟醫材的重要性一點都不輸給藥品所以要討論要一起討論"},{"start":9388.342,"end":9409.749,"text":"那當然最好我們台灣能夠成為一個醫療資源的生產中心那能夠把海外市場開拓利用海外市場來支持我們的體系那我們台灣會更安全這就是一個理想但是也許要達到這個地步的時候是有困難的因為我們不可能把台灣這麼小資源也很有限我們能力也有限所以我們應該可以挑重點"},{"start":9410.809,"end":9426.997,"text":"某幾項藥品或某幾項設備某幾項醫材成為我們的亮點然後我們就做那些那到時候我們資源萬一有問題的時候可以跟其他國家做資源的交換這也是一個方法我不要全面的去包山包海但是我關鍵的東西我要能夠製造"},{"start":9429.161,"end":9445.495,"text":"這個對我們台灣的安全是有幫忙的那再來剛剛其實有關緊急醫療救護法12條要講的就是願計的傳送這個很重要但是我這邊也強調一點到了戰爭的時候台灣有一個很好的特色就是台灣的診所非常多"},{"start":9446.482,"end":9464.057,"text":"如果強化診所的急症照護能力跟緊急藥品的供應也很重要因為路都斷了到處都是殘垣段就是這個建築物都倒塌了那請問車子可能不會動啊那究竟就是診所醫師要出來照顧因為他站在各地嘛"},{"start":9465.474,"end":9481.594,"text":"你路斷了 連可能救護車都開不過去了那這個時候如果真的要緊急照護的話診所醫師強化他的緊急照護能力是非常重要的那我們醫事公會全國聯合會未來會舉辦對於診所的急救重症的訓練再加強"},{"start":9484.728,"end":9510.513,"text":"讓診所醫師能夠替我們醫院裡頭的急診用色經分離讓我們急診不要這麼全部塞在醫院裡頭因為醫院真的是要看更高階的一個急重症而不是一開初級的急重症就往醫院就送了這樣會造成我們醫院資源的匱乏所以未來醫師公會全國聯合會在這一塊人員的教育訓練上會在多所著魔讓我們一起努力好 謝謝"},{"start":9514.893,"end":9519.257,"text":"整首要會包紮會縫合 市長這可能要喔這個是很嚴肅的問題來 接續我們請王振旭委員"},{"start":9537.514,"end":9552.591,"text":"謝謝我們召委主席今天的安排這個公聽會我不知道大家這個對整體的過程感受如何我自己真的很感謝我們所有在場的專家學者提出這麼多的建言"},{"start":9554.153,"end":9574.862,"text":"因為這個任性國家醫療整備計畫是四年期剛剛次長也有跟大家做了報告今年是第二年我們也看到113年已經有執行了一些成果大家可以從這個書面資料看得非常的清楚114年的工作項目也都已經羅列得非常的完整"},{"start":9576.053,"end":9585.412,"text":"我現在想了解的是我們今天主席這麼精心的安排這樣的宮廷會那專家學者提供這麼多的建言"},{"start":9586.414,"end":9600.044,"text":"我們的四年結尾怎麼來調整如果根據這些專家學者的建言還有如果在整個處理過程裡面有辦法還是有需要繼續進化能夠達到當初賴總統所警覺到的我們必須要有這麼好的整備計畫那未來的三年裡面"},{"start":9610.891,"end":9626.048,"text":"包括今年有沒有需要再做調整那如果調整的話應該要往哪個方向去調整那我在國會裡面會持續來監督這些內容那也期待大家繼續提供建言給我們做參考"},{"start":9626.989,"end":9654.82,"text":"那我相信韌性是非常重要這個是大家可以理解而且是持續要去做準備的部分那我就針對兩三個重點也跟大家做報告那其實學民藥的部分一開始陳一芬理事長就告訴我們這個學民藥平常就要有的東西而且一定要台灣要自己準備好不然你賭到平常都不夠用"},{"start":9655.76,"end":9683.331,"text":"碰到緊急狀況當然那個困境會更大這個部分我相信大家也都非常清楚所以困境有六點那邊就不再結束我們可以往下看怎麼樣去準備這個有關於藥品韌性的發展的建議我們繼續往下看相關的再往下再來再來再往下再往下這個流打挑戰"},{"start":9684.331,"end":9701.048,"text":"那針對這部分呢 大家其實都講得非常清楚就是要強化資源的投入 納入這個韌性特別條例跟預算那這博文其實4100億的這個預算裡面我們辦公室也試著希望能夠再加強有關於除了"},{"start":9704.431,"end":9723.301,"text":"200億的健保的相關資源的投入以外那針對健康尤其是在醫藥的部分能不能夠也有機會納為這個4100億的預算的一部分那這部分基本上就是希望能夠提供給我們的這個衛福部有一些彈性"},{"start":9724.522,"end":9740.737,"text":"把這個部分也可以納進來那其他包括關鍵藥品跟原料要清單等等大家都已經講得非常清楚最後一項就是國家整體戰略規劃跟長期的資源挹注這個今天的這個整個公聽會其實重點都是"},{"start":9741.698,"end":9761.126,"text":"在這個地方那當然最重要是要跨部會這個的確不是衛福部要把所有的重責大任都承擔起來一定要大家互相來幫忙互相來過好幾個月讓他能夠直接執行不過還有兩個部分沒有提到我們往下看就知道疫苗"},{"start":9762.427,"end":9773.625,"text":"當然疫苗是不是屬於這個韌性計畫裡面的一環我認為非常的重要所以疫苗的部分呢台灣可能有一些自己特殊的狀況需要針對於國產的疫苗也要能夠適度的"},{"start":9777.35,"end":9794.652,"text":"除了在經費的使用的投入以外我們也希望它的研發可以針對台灣的這個特殊狀況做一些準備這是疫苗我們希望能夠大家對這個疫苗的了解跟在準備的韌性上也能夠提供相關的資源"},{"start":9797.352,"end":9820.588,"text":"那除了這個藥品醫材以外 疫苗還有就是血品製劑今天比較沒有提到血品製劑血品製劑我有跟我們的這個國醫局的蔡局長講了好幾次就是說台灣目前對於這個血品製劑有沒有一些比較好的準備方案"},{"start":9821.728,"end":9846.963,"text":"軍醫局如果真的面臨這樣未來在不管是特殊狀況包括大型的災難或者是戰爭的時候那這個學品製劑如何能夠有效的去從他的準備還有他的應用都能夠達到好的一個流程跟必要的一些戰備準備那他很有信心他說他們都準備好了所以大家不用擔心"},{"start":9848.564,"end":9876.345,"text":"大家將來在處理的時候可以信賴目前的準備當然我們也要去驗證它那面要驗證我們希望有機會多了解以後能夠把這個準備也做得更好那我們再往下看就是利用這個機會我們也知道其實113年那個時候並沒有川普有關於關稅的這些造成的影響就是我們自己本來就是在準備的功課"},{"start":9877.426,"end":9905.803,"text":"那剛好又有這個關稅的挑戰情形之下如果能夠化危機為轉機這是我們可以來面對的那這部分我相信等一下我的老師張宏仁老師可能也會做壓軸的報告因為這個選在這個張宏仁老師前面就是希望能夠把這機會在壓軸的部分請這個張宏仁老師給我們的一些建議還有一些指導"},{"start":9906.423,"end":9931.3,"text":"不過基本上建立本土產業鏈來這個整合進這個全球供應鏈的部分真的非常重要那剛剛也提到醫療的產業基本上應該要把它納入為這個經貿的戰略那要分散供應來源那講是很簡單可是剛剛也提到將署長針對這個區域供應鏈的想法我們也曾經討論到"},{"start":9933.41,"end":9958.368,"text":"有一些我們也知道其實現在原料要都依賴中國跟印度我們有沒有機會把我們的鄰近國家能夠跟他們一起來討論來整合理念相近國家也好或是民主制度國家也好比如說韓國日本或者是菲律賓南向的這些國家我們大家來分析一下"},{"start":9960.209,"end":9982.37,"text":"原料藥的製造基本上這是一個對環境衝擊非常大的一種狀況所以我們自己的假設以抗生素為例或者是以很重要的某一些的原料為例我們有沒有機會跟這些國家互相的交換哪一些國家準備A哪一些國家準備B哪一些國家準備C"},{"start":9983.251,"end":9999.847,"text":"那在這個準備這個原料料的過程裡面怎麼樣去評估對環境的衝擊這個A國家是不是在準備的時候他們的環境比較能夠容許這樣的環境衝擊然後在台灣當然我們需要經過很完整的"},{"start":10000.848,"end":10025.447,"text":"準備還有對環境的衝擊我們也希望能夠用高科技的方式來減少也要讓民眾知道為什麼原尿藥這麼難準備對環境的衝擊如何能夠得到民眾的支持也得到大家的共識那如果能夠透過這樣的區域整合的話對原尿藥我們就不會太依賴在某一些國家我們也期待這樣的模式這個是需要"},{"start":10026.407,"end":10040.582,"text":"納為一個經貿戰略的同時那也是一種對於醫藥的這個供應上的一個戰略的這種處置的需求所以我們很期待國家整體戰略規劃跟長期的資源的挹注都非常重要那這部分"},{"start":10042.043,"end":10067.931,"text":"當然這個特別條例的預算如果能夠成立的話相信對未來的資源的應用就會更有助益那很感謝今天的專家學姐提供給我們這麼多好的建議讓我未來在問政的時候可以針對大家所提供的意見也給我們的這個主管機關在未來執行上我們會持續的去掌握到各種的進度再度感謝大家 謝謝"},{"start":10073.078,"end":10088.147,"text":"謝謝,謝謝,謝謝王委員特別條例,全力支持來,想不到齁,外賓、協助專家,最後一個張宏仁董事長這叫我感慨,這叫我感慨"},{"start":10097.711,"end":10120.576,"text":"主席各位先進剛剛大家都講很多了實在是也不知道要講什麼我就講一個重要的觀念就是韌性韌性是resilience那resilience有兩大component那一個component叫做search capacity"},{"start":10121.553,"end":10133.142,"text":"Resilience其實分平時跟暫時,我們今天可能大家講的平時跟暫時這個觀念還是要把它理一理平時的Resilience跟暫時的Resilience是非常不一樣的概念"},{"start":10134.332,"end":10161.206,"text":"那暫時我想這個我們羅一軍在這裡就是說防疫勢同作戰的時候那個surge capacity出來的時候大家就會開始亂所以他在講的就是突然間一個一個暴衝上來的capacity一個大災難突然間一個什麼東西過來然後很多很大量的傷亡有點像八仙塵暴這樣子的概念那我們怎麼去"},{"start":10161.866,"end":10186.371,"text":"用我們的系統去處理它的第二個概念叫做redundancyredundancy中文叫做冗餘冗就是冗源的冗,餘就是剩餘就是多redundancy的反面就是浪費所以剛剛也有先進在講就是說你今天要redundancy你才會有儲備"},{"start":10188.231,"end":10204.077,"text":"儲備本身就是一個浪費這個是很簡單的概念所以一個韌性的醫療體系要做到這一點它一定要有浪費我們的健保體系是全世界最沒有浪費的地方因為我們把大家壓到"},{"start":10206.118,"end":10231.639,"text":"就是說 駕動率是extreme就是駕動率 這個是指平常在operate但是以capacity來講 其實我們是有redundancy的如果我們去看這些中小型的醫院 其實它的站床率是很低的所以它本身就是一個reserve像我們很多藥廠 它的駕動率也是很低的所以它就是一個redundancy"},{"start":10232.399,"end":10259.904,"text":"所以redundancy那以藥品來講 大家也講很多我們在講清單 就是說平常的缺藥跟暫時的缺藥也是兩個不一樣的概念你不能夠用平常這一套去處理暫時因為暫時還跟你分什麼原廠藥 進口藥你有藥吃 你就沒辦法你缺的是血液 輸注液 各式各樣的輻尿如果你是糖尿病 你是要打胰島素型的"},{"start":10260.484,"end":10283.267,"text":"那你有餘導數就有餘導數,你沒有就沒有啊,你知道為什麼要替代你能替代就替代,你不能替代就不能替代所以他那個清單要問的是說,那什麼叫做most critical當我們國家進入一個緊急狀況,那我們要sustain三個月甚至現在是三年,那我們要儲備什麼?那其實比較容易儲備的東西都是原料啦"},{"start":10284.148,"end":10304.596,"text":"你說臨時要去製造原料那個也都是欠債公共你都有上游下游所以儲備原料比較沒有所謂的有效期限的問題那以TFDA來講TFDA應該跟業界跟學界好好的有一套就是說那在暫時的時候檢驗那麼多幹嘛要給我硬要做什麼因為我們平常檢驗是檢驗一堆"},{"start":10308.517,"end":10332.047,"text":"要保證這個品質是到達一點點risk都不能tolerate我舉個例子來講我們常常檢驗的東西是很minimum的致癌性嘛對不對所以我們去去說所以這個原料裡面絕對不能夠含什麼東西這一些跟暫時的時候你哪有時間再得癌症啊對不對你沒藥吃你說不定"},{"start":10334.428,"end":10362.813,"text":"所以暫時用什麼簡化的方法很快的讓我們的capacity可以用我們儲備的原料藥來營養這是兩件事情跟我們平常缺藥這是兩件事情那什麼東西我們有辦法製造什麼東西我們沒有辦法製造我們要做這個清單是很重要的因為食藥署在江蘇港來之前當時用的清單是WHO的essential drug list"},{"start":10363.973,"end":10378.899,"text":"這個是低收入國家在用的一個list它講的是平時它講的其實不是暫時所以我們應該把這個觀念比較弄清楚所以清單本身是學問我們專家都非常的多了所以簡單的講就是說"},{"start":10381.74,"end":10406.376,"text":"我們要因應的就是說我們需要有一些redundance那redundance要放在什麼地方以便有search capacity的時候我們可以因應那最有名的例子當然就是就是這個國防體系嘛軍醫體系裡面當然它都還有那種這個叫做野戰醫院"},{"start":10407.697,"end":10430.925,"text":"就是一旦來的時候他帳本一打開裡面就是一個臨時的operating theater所有的東西立刻就可以當急救使用那這種是另外一種儲備這個當然你只要看到大家在打仗的時候所有這些地方前線立刻要開醫院跟你平常在用的系統也是不太一樣所以所有的這些東西呢簡單的講"},{"start":10432.946,"end":10453.651,"text":"有當過兵的人就知道所有這些東西都寫在我們當兵時候叫做衛勤體系衛勤就是Health Logistics System就是後勤系統那你只要去把那一段因為我們在軍中讀的那一套就是美國人美國那一套把它翻譯過來的所以你只要把"},{"start":10454.952,"end":10471.901,"text":"請國防部把那一項拿出來再看一看你就知道美國人在做整備的時候是怎麼樣以上請大家參考 謝謝好 我們協助專家及委員都發言完畢那我們請行政機關做整體回應"},{"start":10479.451,"end":10483.393,"text":"你先說啦你先說啦謝謝主席也非常感謝我們今天所有的委員還有所有專家那也首先還是先肯定再一次也藉這個機會謝謝也感謝我們所有在場我們的各個合作的團隊專業團隊還有醫藥界的夥伴還有昭緯謝謝昭緯的安排"},{"start":10505.882,"end":10522.883,"text":"那也讓我們行政單位有機會知道就是說在這段時間我們跟各位的合作是沒有造成各位太大的負擔而且各位肯定我們可以繼續跟各位推動下去那剛剛也感謝藥界的夥伴跟我們提醒到了很多我們在目前的藥品政策或者是檢驗相關的這些議題"},{"start":10525.166,"end":10550.965,"text":"那衛福部會持續也持續的跟各位繼續在精進目前現有的計畫那再做一些更細緻的修正那剛剛其中我們很多的這個專家也提到說包含了原來藥物的藥品的一些制度以及現有在醫事相關整備上面基層的連結或基層這一邊那這個部分我們也正在規劃當中那也到時候在相關的這些計畫尤其是"},{"start":10551.765,"end":10564.07,"text":"任性以及我們的這個醫療任性準備的相關的預算還有計劃也麻煩大院這邊可以全力的給我們支持我們會繼續努力謝謝大家謝謝謝謝謝謝市長市長您剛剛要說要說嗎國民理事要說嗎我們請經濟部產發署來報告一下"},{"start":10580.31,"end":10583.101,"text":"沒有來了就要留紀錄 因為這個是完整的"},{"start":10589.347,"end":10612.408,"text":"主席各位那個業界先進還有衛福部還有各位長官大家好那產保署這邊說明一下兩件事情我們分兩個方向講第一個是台灣熱心醫療整備計畫這部分我們會再跟衛福部通力合作來完成整個計畫那第二個部分是剛剛藥品的部分我們剛剛有講說那個我們產保署在"},{"start":10613.289,"end":10640.041,"text":"協助藥品發展的時候包括有分幾個階段一個是通用所有的藥廠都是一樣我們那個我們的產業條例的那部分都會有投資抵檢的一些協助那另外的部分就是生技條例這邊對於那個新藥品新進行新技術的部分我們是希望有業界可以發展新的東西所以這個是兩個階段那第三個部分就剛剛大家有講到學名藥那部分學名藥部分其實我們也有發現說其實台灣的"},{"start":10641.121,"end":10641.161,"text":"來 再來請國花會"},{"start":10670.357,"end":10672.399,"text":"蘇專民委員接續財政部、內政部還有國防部,國防部好好報告"},{"start":10682.253,"end":10699.763,"text":"主席還有委員還有各位專家學者代表先生大家好那我們國安會是掌理國家發展政策的規劃協調審議跟資源相關的分配會來協助各部會推動主政的業務那衛福部主管醫療藥品的相關的一個主管業務為了"},{"start":10701.023,"end":10715.436,"text":"面臨不可抗力的天災或人為的災害建構台灣的韌性發展提到的相關政策計畫我們都會來統合協調協助那爭取必要的協助後續衛福部如果要修正這個韌性國家整備的醫療計畫我們也會來緊迫的來協處以上謝謝好謝謝那接續我們請財政部"},{"start":10725.936,"end":10740.741,"text":"沒有要報告 都免稅出去都加碼出去要退稅 進來免稅再來內政部消防署"},{"start":10748.955,"end":10773.435,"text":"主席各位與會專家學者大家好那內政部報告那內政部會積極配合這個衛生福利部韌性國家醫療的準備計畫那我們目前已經是開始推動那大概有主要有三項那第一項是辦理戰術的緊急傷患救護訓練那目前113年已經完成1000多人那未來到116年我們預計可以達到16000多人的一個訓練那第二個部分就是"},{"start":10778.859,"end":10795.925,"text":"充實消防機關救護人員的防護裝備我們未來也會在三年內會強化救護人員的裝備包括止血袋、輕量型的單架等等第三個就會充實民間救護車的通訊器材未來在115到116會構置無線電通訊設備432組"},{"start":10803.668,"end":10828.3,"text":"以提高我們就在救護指揮中心跟救護車醫院的一個有效溝通建立有效的到院前醫療防護網那我們消防署會持續跟衛生福利部合作精進推動到院前緊急醫療的一個整備作為也感謝委員跟各位專家學者的支持謝謝謝謝謝謝張祖密那來最後一個我們請國防部經濟局"},{"start":10834.462,"end":10835.211,"text":"你準備好了嗎"},{"start":10839.029,"end":10864.783,"text":"主席 各位先進 與會的各位專案學員 各位長官我是國防部軍醫局藥真書創 曹白映那國防部說明如下那本部配合這個全社會的一個防衛任性任性國家醫療整備計畫還有這個全民防衛動員準備法及藥品醫材儲備動員管制辦法等規定我們完成這個各國軍醫院的重要外商用的藥品醫材一個儲備的作業"},{"start":10866.024,"end":10882.104,"text":"那另外因應這個敵情的威脅為求快速反應及減少暫時第八類軍品一個運送的風險我們有規劃增強這個金門馬祖還有各作戰區一個戰備藥品一個囤儲的一個作業那以增加這個基層官兵暫時站上一個救護的一個量能"},{"start":10882.725,"end":10893.332,"text":"那另外暫時國軍衛情部隊一個藥品需求的矩增那本局所屬的三軍衛彩供應處它的囤儲量難以滿足所需那所有每年會跟這個民間的工廠實施這個軍需動員工廠一個轉換一個簽證作業"},{"start":10899.156,"end":10914.379,"text":"那透過這個工廠的一個協力生產戰傷救護的一個藥品醫材那遂行一個國軍域的醫療任務以維持這個戰力那114年度已經跟人人製藥等36家民間廠商完成簽約那意外在戰時的時候會生產這個軟帶補償注射劑等86項一個戰備藥品醫材一個作業儀"},{"start":10921.041,"end":10946.939,"text":"以應應這個暫時一個需求的部分那也感謝主席委員還有各位專家學者的支持以上報告 謝謝好 謝謝光部的報告 繼續來 我們做以下結論依據立法院職檢刑署法規定委員會應提出公聽會報告送交本院全體委員及出席者"},{"start":10947.959,"end":10974.381,"text":"宮廷會報告作為審查特定議案的參考我們會把各位的寶貴意見及書面資料匯編成冊分送給本院的全體委員及今天與會的政府機關代表跟學者專家參與今天非常感謝各位的出席並提供寶貴的意見我今天學了很多本次宮廷會到處結束 散會"},{"start":10991.894,"end":10992.355,"text":"謝謝大家"}]}},"supported_relations":[],"relations":[]}