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醫師背景學者專家我們按照這個上面的排序不是按照簽到順序我們牙醫師工會全國聯合會理事長陳世悅秘書長曾士哲"},{"start":1718.594,"end":1743.964,"text":"監事會召集人林順華私立愛靈綜合長照機構執行董事陳雅光世人口腔衛生學科主任林怡靜北醫口腔衛生學系主任陳立生中華牙醫學會秘書長葉劍陽"},{"start":1749.181,"end":1774.957,"text":"更新口腔衛生與健康照護科主任洪文綺中華民國護理師護士工會全國聯合會理事李英芬行政機關代表衛生福利部常務次長莊仁祥"},{"start":1777.83,"end":1796.121,"text":"口腔健康師師長張英明教育部高等教育師專委吳志維考選部綜合規劃師專委洪宇儒請衛生福利部代表報告"},{"start":1806.044,"end":1825.021,"text":"主席 各位委員 女士先生今天大院衛福委員會召開口腔衛生人員法立法公聽會本部呈邀列席報告生涯榮幸之就本議題提出專案報告進行各位委員不吝會議指教一 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後續推動規劃本部課證委託股價衛生研究院辦理相關研究計畫收集國內外制度發展經驗延期口腔衛生相關人才培育從業現況及醫療實務需求等情形"},{"start":1953.266,"end":1981.665,"text":"最後來政策評估參考本部呈大院各委員之指教及監督在此禁止卸陳並期各位委員繼續予以支持謝謝本次會議部會及學者專家所提供的相關書面資料均六日記錄刊登公報與會人員發言前請先宣告一下事項學者專家及本院委員每位發言時間六分鐘"},{"start":1983.126,"end":2010.163,"text":"為簡報方便學者專家發言請至主席台右邊的發言台原則上有學者專家先依簽到順序發言委員如要發言請到主席台登記我們會依委員登記發言順序及學者專家發言順序交錯安排進行全部人員發言完畢後再請行政機關做整體回應暫定10點半休息10分鐘現在請第一位林英芬理事發言"},{"start":2021.079,"end":2022.222,"text":"法定人數不足"},{"start":2024.178,"end":2051.07,"text":"我們醫療的好夥伴們那所有的牙醫還有我們口腔衛生的學校的相關老師大家好那我是代表護理全聯會護證法制的副主委來報告關於今天參加這個公聽會在我們護理全聯會裡面的一些相關的討論跟意見那這邊是由我李英芬來代表那整體來說"},{"start":2056.87,"end":2074.743,"text":"那我們很本會尊重政府部門因應我們人口變遷健康政策隨時來做一些調整那這樣子在高齡社會裡面呢口腔健康促進跟長期照護的需求那如果有需要培養專業人力的部分"},{"start":2075.365,"end":2103.835,"text":"進行規劃跟立法那這個這相關的制度呢我們抱持的是尊重的一個態度但是呢考量到口腔衛生人員他畢竟是一個新設立的一個醫事人員那他相關會不會他未來的立法之後呢他的一些職業範疇那他會不會跟我們既有的醫事人員的這個權限裡面有一些些的重疊或者是會去互相影響"},{"start":2104.515,"end":2125.033,"text":"那這個部分是我們比較關切的部分因為我們也要保障既有的所有護理師們的一些權益所以針對的這個部分我們也做了以下的一些些的想法跟意見提供在這一邊首先呢就是如果涉及醫事人員業務範圍的一些重大政策"},{"start":2125.458,"end":2148.213,"text":"那一樣就是希望大家可以更多一點的跨專業溝通跟共識那畢竟這一個口腔衛生人員法它涉及的是口腔衛生人員的整體的一個職業範疇那大家都很清楚我們在醫療現場裡面是需要做團隊分工的那彼此互相尊重而且能夠互相合作"},{"start":2148.713,"end":2174.686,"text":"那針對大家不同的專業來進行共同為病人的扶植招向所以也希望是在這部分即便不管未來它的變化是什麼大家能夠持續秉持著這樣子的一個精神那所以呢如果我們衛福部如果要針對這個做立法或者是後續有些的相關辦法那勢必這個所謂跨專業團體的溝通機制呢一定要有"},{"start":2175.106,"end":2195.722,"text":"那同時我們也看過了所有的這個設置標準裡面那在牙醫的照護領域裡面護理也有相當的角色那也一樣那不要影響我們既有人員的一些的權益還有他們的職業那再來就是在界定口腔衛生人員跟其他醫事人員的一些業務範圍裡面"},{"start":2197.903,"end":2217.855,"text":"能够明确清楚那草案里面其实有写到那当然也提到护理人员有依法执行的一些业务范畴不在这个不受限本法那这个部分呢那我们也是抱持着肯定的态度只是草案当中所谓的医疗辅助行为都还没有很明确具体"},{"start":2218.271,"end":2243.669,"text":"那這部分未來要怎麼分工其實也是我們關切的一個議題所以如果主管機關呢要訂定相關的辦法也建議要多做討論再來就是不要因為新制度的影響然後影響到我們醫療機構依法配置的護理人力跟醫事人員的運作那這個才不會影響到既有我們護理人員目前職業的一個感受"},{"start":2244.409,"end":2265.099,"text":"那特別很多醫院都設有牙科部門那包含了住院照護手術麻醉恢復感染管制病人安全等問題大家知道高齡者有很多假牙他有引發很多的一些安全問題那這個也都需要有專業資格的醫事人員依法執行那希望這一點也能夠在"},{"start":2266.455,"end":2279.686,"text":"與會的過程裡面表達跟所有的專家來做這個表達那當然如果有這樣子的科系畢業生已經要到我們的臨床現場來服務那彼此之間怎麼銜接的一個培育機制"},{"start":2280.626,"end":2310.312,"text":"那在草案當中其實我們也有看到口腔衛生人員的一些應考資格只是未來這個專業人員的制度建立呢還是要考量到整體發展跟跨專業的合作那特別是應屆畢業生轉嫌到臨床現場裡面呢那有沒有一些必要的一個臨床訓練我們知道學校教育是有的但教育跟實務執行之間的gap怎麼銜接其實是也是我們在意的"},{"start":2310.694,"end":2339.666,"text":"因為已經在現場服務的我們是已經是有經驗的那如何在這個跨專業合作當中能夠兼顧專業能力跟病人安全還是我們一貫的考量好那最後一個就是有關於教育訓練那我們還是非常強調病人安全機制特別現在在社區居家長照也都有很多這樣子的需要應用的場域那相關教育訓練是非常非常重要的尤其是在病人端"},{"start":2340.146,"end":2359.789,"text":"怎麼兼顧品質病人安全還有一些緊急事件的一個處理那以上是護理全聯會在針對這一次呢來參與這樣子的公聽會提出來的建議謝謝好謝謝林英芬理事第二位我們請四人醫專主任兼助理教授林益靜"},{"start":2369.575,"end":2393.796,"text":"各位委員以及各位先進大家好我是樹仁醫專口腔衛生學科的林怡靜主任那同時其實我本身也是高雄醫學大學第九屆的口腔衛生學系畢業的校友那今天在這裡呢我希望我來做的是為我們自己的專業發聲那其實呢在我們的教育養成裡面我們花了四年學習了很多跟牙科的臨床輔助還有病人的衛生教育"},{"start":2394.364,"end":2415.077,"text":"還有高齡者長輩的照護那我覺得在於我們現在的一個角色呢就是我們有了完整的培育但是我們在未來工作的情況下我們卻沒有一個實質的身份那有人會說那牙科助理呢但是呢在現行的牙科助理在臨床上面很實際面遇到的是他可能從事的是牙科醫療輔助行為"},{"start":2417.438,"end":2436.503,"text":"雖然說在過去有韓式的一個訂定但是其實我們都可以知道牙科的一些處置包含手術它都是屬於侵入性的今天牙科臨床的輔助人員他在做的時候到底有沒有相關的資格的規定以及教育訓練的完整制度我覺得這是現在需要被考量的"},{"start":2437.603,"end":2458.801,"text":"另外一個在過去我做研究的同時也遇到了新住民的家庭或是小朋友以及高齡者的口腔長輩那不免俗大家一定會想要問的是怎麼樣才可以讓我的口腔更加健康但在我們的學生甚至是我自己在執行相關的衛教或者是相關的工作的時候我會懷疑的是我的身份到底是什麼"},{"start":2459.542,"end":2483.755,"text":"那在護理師的修法上面牙科醫療輔助還有衛生教育其實都是護理師的工作職責那當我今天去做刷牙的指導跟護理的口腔照護的一個說明的時候我是不是有違法的疑慮我相信這都是現在身為口腔衛生學系畢業的學生或者是現行的牙科助理他們會面臨到的一個威脅那"},{"start":2484.635,"end":2513.345,"text":"為什麼需要口腔衛生人員法第一個是牙科輔助人力其實是一個灰色地帶雖然說有韓式12條列出但是我們都知道牙科的很多輔助行為或是非醫療輔助行為它其實很模糊那這也因應到剛剛護理師全聯會這邊提到的那到底在於未來立法要怎麼樣去訂定它各自該做的一個工作職責我們也是希望在立法的過程中可以把它明文的列出來"},{"start":2514.065,"end":2529.398,"text":"那另外一個是其實現在在全台灣裡面有很多間學校都設置口腔衛生學科系但是呢有了教學但是我們遲遲沒有考試那這一群人在畢業之後到底我要以什麼樣的角色來執行我的工作職責"},{"start":2530.399,"end":2552.691,"text":"那我覺得這對於台灣的教育來講是非常可惜的政府投入了大量的資源但是呢我們現在沒有相對應的制度那很多我們現在看到畢業校友他們選擇到國外去執業是因為國外承認台灣的口腔衛生學系的畢業證書那並且可以參加國考我覺得這是對於台灣的一個制度上面需要是被再一次的去檢核"},{"start":2553.471,"end":2569.885,"text":"那另外一個是高齡者跟特殊需求的口腔照護隨著台灣高齡化的一個社會高齡者長輩的口腔照護這件事情到底誰來做還有誰要給予專業的指引這也是政府需要去仔細思考的那"},{"start":2570.285,"end":2584.418,"text":"在過去的草案裡面我們提到了口腔衛生人員的資格我們目前在草案裡面規劃是需要參加國家考試成為口腔衛生師或是那相關的規定的話大家可以參考相關的一個資格裡面都有明文的去訂定"},{"start":2585.239,"end":2608.677,"text":"好那在目前全台灣的口腔衛生人才的培育裡面目前有兩所大學六所的專科那招生名額每年會有393位的人那我們目前的培育教育人數已經來到了將近3000名那還是一樣的問題有有完整的教育制度但是缺乏考試制度跟法律的保護那到底這一群人在畢業之後他的職業資格是什麼對好"},{"start":2610.97,"end":2627.198,"text":"那另外一個是我覺得需要提起來的是其實到現在我們最近一次設立是在民國111111年所以在教育部設立這個科系的時候是不是應該要考量是這群學生在畢業之後他到底的"},{"start":2627.714,"end":2650.056,"text":"明文的界定他的工作範圍是什麼這些都是政府應該在設立科系的時候就要去思考的那口腔衛生室的工作職責在法案裡面提到的是健康管理的評估口腔健康管理的評估跟訂定那至於細則的部分我也是相信在政府訂定相關辦法的時候應該要去明文的列條列他到底應該做什麼事情"},{"start":2650.556,"end":2677.196,"text":"那口腔衛生師呢其實在世界各國他扮演的一個非常重要的角色是所謂疾病預防跟健康促進隨著台灣的醫療趨勢我相信治療不再是一個為主而且我們要去思考的是如何讓疾病不要發生跟做預防還有疾病發生的時候怎麼做照護在口腔在牙科是需要專責人來去做的好那還有口腔保健的指導諮詢以及口腔的臨床輔助行為"},{"start":2677.876,"end":2701.79,"text":"在牙科裡面是有很多的手術的拔牙手術也好指牙手術也好在目前的所謂的韓式裡面他所提到牙科助理能做是所謂吸口水但血水呢還有牙科的在宅醫療他明文的規範要有醫事人員陪同那如果牙醫診所裡面都沒有相關的醫事人員的指燈那誰來做這件事情呢那特殊需求者的口腔照護這些"},{"start":2703.171,"end":2716.822,"text":"那當然未來口腔衛生室的工作職責他必須要是在牙醫師的指示下行之當然護理人員也是在牙醫師指示下他還是可以去做的他並不會說他還需要去考額外的證照他當然就是可以執行的一個"},{"start":2717.543,"end":2746.752,"text":"医疗人员那职业登记呢口腔卫生师他永远一定是要在职登在牙医师的职业医疗机构所以他绝对不会有独立职业的可能那我们今天呢设立这个法案不是要让牙科助理没有工作而是我们应该要把工作去做完整的区分然后符合大家不会有违法的一个疑虑好那当然我们也让希望有更多的牙科助理他可以透过特种的考试一起加入口腔卫生人员满足我们目前的需求"},{"start":2748.117,"end":2763.557,"text":"那最後再一次強調制度的一個安全法在口腔衛生室成立之後這個工作團隊還是由牙醫師負責指導那我們只是希望讓團隊的工作更加明確然後不會獨立執業而且必須要在牙醫師的指示下來去進行所有的牙科醫療輔助"},{"start":2764.585,"end":2790.147,"text":"口腔衛生的指導以及口腔衛生照護的部分那當然建制後的效力除了我們畢業口腔衛生學系畢業的人另外一個對於政府來講我們對於居民來全民來講口腔照護長照的或是從整個生命週期裡面的人大家都應該要擁有的是這一塊的一個資源那最後呢就是我還是要提到在10年前這個課系可能剛設立甚至是我剛進入口味課的時候"},{"start":2791.567,"end":2819.573,"text":"我們提到了口腔衛生人員法大家給的指示是等你們人多一點再來說吧但現在其實我們已經來到了三千多人了那我站在這邊同時是我自己是口腔衛生學系畢業的學生同時我也是培育現在下一代正在參加口腔衛生工作的這一個老師那到底這一群人畢業之後他的工作職責是什麼還有身份是什麼我認為這是在目前的國家的相關規定裡面應該要去做相關的條列的"},{"start":2819.993,"end":2841.804,"text":"好 以上是我的報告 謝謝好 謝謝林怡靜主任我們補充介紹衛華委員會林業勤召委邢天公恩主公醫院牙科部主任范甘信台灣特殊需求者口腔專科醫學會顧問蔡鵬飛"},{"start":2846.909,"end":2862.023,"text":"德育護理健康學校口腔衛生照護系副教授藍文謙新北市牙醫師公會前任理事長徐環瑞現在請第三位蘇勛選委員發言"},{"start":2875.508,"end":2893.878,"text":"謝謝主席這個法案這一次是我提的所以我要跟大家說明一下第一點我就先講驗光師因為驗光師這個是十幾年前我們立法院第八屆立委"},{"start":2896.318,"end":2917.038,"text":"劉建國委員 吳益生委員 黃昭順委員 還有蘇清泉我們四個人把它合推過去那這個法通過之後這十來年我覺得是非常正向 是對的是怎麼說呢以前我們去北京行 配北京 還是說那些孩子"},{"start":2918.905,"end":2937.941,"text":"拍眼鏡,起都是什麼?師徒製,一個眼鏡行,對眼光,不知道是什麼身份,就把你撒在裡面,把你赤赤的了,然後你就飛了。我這隻眼鏡,最近去小林眼睛換,我一進去看到兩個眼光師,"},{"start":2940.014,"end":2955.024,"text":"非常專業,跟我講說學長好,我扯到他說燕光司法就是你通過,所以我要報告大家,一個法要通過是很艱難的燕光司法在立法院搞了一二十年,但是那一次我們四五個委員,包括王金平院長"},{"start":2970.614,"end":2993.28,"text":"一天要二讀三讀的時候,給外國人抗爭,是眼鏡工會來抗爭這牽涉到眼科醫學會,還有眼鏡工會,還有學校這邊的產官學大家都會角力喔,那這個今天套在這個hygienist口腔衛生師,有一點雷同"},{"start":2994.195,"end":3014.27,"text":"那這些驗光師,有的驗光師,有的驗光生嘛學分補足,那不管如何,我覺得他們很專業然後呢,可以給你微教,然後講得頭頭是道然後最主要是,這個眼鏡行,小林眼鏡很尊重這兩位"},{"start":3015.373,"end":3017.775,"text":"眼光師這就是地位尊嚴我們台灣已經到現在這個階段國民所的三萬塊四萬塊的階段我們口腔衛生是在日本在美國已經實施了多久啦我看二三十年有啦我們這邊還一直一昧的抗爭不要當那邊的事第二個那個時候"},{"start":3045.339,"end":3068.684,"text":"眼鏡公會的還到我東港立委辦事處要給我勸給這我一輩子給他記著但是過得好啊那口腔衛生師現在在EIE裡面我第二個要訴求的就是我們長照3.0我們的那個召委很注重的400幾萬的65位以上的老人長照3.0"},{"start":3072.401,"end":3077.422,"text":"裡面口腔有問題的,五十幾萬人啊這些人誰要照顧啊我們偏鄉三十幾個鄉,鄉,天地離島,沒有牙醫師啊這邊啊,牙醫師死去就這樣年齡,都到哪裡去啊所以沒人就是沒人,所以衛福部才有一大堆配套但是抗爭很厲害,這個我不談,這是另外一個issue"},{"start":3099.335,"end":3113.383,"text":"再來就是口腔衛生室現在已經有將近三千人那他們現在的角色定位就像他們講的學校的產官學的都覺得很痛苦所以也該給他們證明"},{"start":3115.72,"end":3135.875,"text":"證明的時候 所以這個是我們要嚴肅的面對 不能因為的抗爭你把這些人當做牙科助理 牙科助理在做什麼?在掃地 藥品掃 還是在做助理 還是每天都要做這不對 一個牙醫診所 像現在每一家都弄得非常非常棒"},{"start":3136.716,"end":3147.459,"text":"那每一個牙醫師該做的事情,謝謝,護理人員該做的事我倒是要跟市長你講,這一定要給他們的崗位正面表列"},{"start":3148.683,"end":3162.646,"text":"你不要負面表列,要正面表列,他們可以做什麼都可以做什麼都可以做什麼,這樣亞裔師都不會怕,他們自己說他們不可以離開亞裔師的職業地位,不可以自己去開業嘛,開業還得了,陳時中政策我跟他們溝通,他說他沒有問題,他贊成,但是不能做視野的工作,他跟我說一項,但是應該是多一項啦,"},{"start":3177.029,"end":3201.357,"text":"那所以說他們的工作要正面表現才不會護理全聯會也在擔心會不會去侵犯到護理的工作權益所以這大家都說說話讓他們是一個團隊讓我們醫療的整個品質跟安全要提升所以就是我們要一起來正視這個問題那牙醫師現在人數才一萬六千多人嘛"},{"start":3202.95,"end":3225.527,"text":"一萬七啦那事實上我們這些因為隨著聯合國老化這些一大堆問題像我們現在我現在在跑要雙管病嘛所以要找行程我們現在跟他說四年四萬塊要讓人做雞翅膀要負荷電修、拍手電修或是牙關牙鞘全口吃的、部分吃的"},{"start":3226.499,"end":3234.945,"text":"都讓你做,結果反正到鄉親給我回饋什麼呢?那些藝術,全部都沒有啦一個半夜都約不到人,約不到空檔每一個藝術,忙忙忙忙,忙什麼齁忙著做智慧還是怎麼樣,我也搞不清楚啊這口腔,這也是一個四萬五萬,也是智慧呢又沒這批,這是"},{"start":3252.363,"end":3258.626,"text":"還價,鄉親給我回饋,我今天就拿出來給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,給你吃,"},{"start":3278.277,"end":3289.146,"text":"第二個四歲以下的小孩子你的眼睛眼睛很不能碰就是要給眼睛眼科專科醫師看完之後才能弄那這個是"},{"start":3290.049,"end":3316.343,"text":"保障跟界定都很清楚我說驗光師 驗光生這個法是對的當初常委員大家一起合作讓他通過我是覺得是正向所以今天這個法我特別要跟大家說順便表列市長這就對了 以上 謝謝好 謝謝崔清泉委員接下來請陳雅光執行董事"},{"start":3333.104,"end":3351.078,"text":"還有與會各位專家學者大家好我今天來的訴求是我們長照3.0的部分關於口腔衰弱這個區塊然後跟現實的狀態讓大家稍微理解一下"},{"start":3352.839,"end":3381.008,"text":"那我本身有在經營住宿型的長照機構然後我107年、108年我就設立了10日據點一直到現在大概幾個機構我現在可以服務長照的長輩大概有300多人到400多人那現階段的狀態是什麼我只講住宿型的部分給大家稍微理解一下下一張可以嗎"},{"start":3388.839,"end":3403.65,"text":"現在住宿型來講我們需要大量的人力,這個不是工廠,我可以一個人照顧一百台機器都沒有問題現在衛福部也規定大量的人力,就是照服員要1比5,護理人員要1比15"},{"start":3405.083,"end":3423.952,"text":"那我的住宿型要供三餐要給他們睡覺所以他的口腔機能的部分有可以到正常飲食的那是失能者那一直到軟食、泥食、餵食、鼻胃管固定鼻胃管、插著管、餵牛奶這個都有那現階段呢"},{"start":3425.372,"end":3452.551,"text":"誰能夠來幫他們延緩失能我從本來正常進食、軟食、凝食這個區塊就可以介入來讓他們少一點餵食少一點鼻胃管的人身這個是我們希望能夠來幫忙的部分那第二個就是說他們的吞嚥的訓練要一對一的這樣子看著然後避免他們嗆嗑"},{"start":3454.252,"end":3474.602,"text":"因為他們一個嗆殼我們更麻煩那目前呢 場域裡面的護理師的工作其實護理師真的很辛苦 1比15真的也不夠但是連1比15的最基本的要求有時候機構都請不到這些人"},{"start":3475.302,"end":3495.263,"text":"所以大家可以看得到,所以從他們的進來以後,這些護理照護、藥物管理、感染控制、健康管理、醫療的協調、照護的部分,這個隆隆總總都是護理師在幫忙的部分,但是1比15,真的不夠。"},{"start":3496.155,"end":3519.704,"text":"何況請不到人要誰來做好那我們再來看我們還有1比5的照護員的工作那他的生活照護當然第二項幫忙洗牙刷牙有的沒有的工作但是他們的工作也很辛苦因為臥床的病人我們包括每天"},{"start":3520.987,"end":3545.325,"text":"我們大概就是一個禮拜幫他們洗三次澡那光這些洗澡所需要的人力搬床拍背SUSHING什麼的這些的事情來講的話本級照護服員也不夠用而且也沒有人願意來淪三搬錢再加再加再加更多也沒有人來我講白了那"},{"start":3546.68,"end":3566.155,"text":"這個部分我們真的是人力不夠,但是我們的病人是滿床的我講一個白的,是滿床的因為我的機構在長庚旁邊,每天都有長庚說我今天要送出一個三管的你那邊有沒有?抱歉沒有,我們就一直推"},{"start":3567.401,"end":3581.766,"text":"那失智尤其麻煩失智長輩你如果一旦要進入到鼻胃管人身他會幫你拔掉他不是會乖乖的讓你插著他從來了進來的他就拔掉第二個"},{"start":3584.639,"end":3610.097,"text":"我們長照中心從我剛才在講他不是住一天兩天就像一般住院三天五天出院他們一住有的我已經到現在有住兩年多三年多他從衰弱一直到很衰弱現在的人都有職牙我有兩個病人他的職牙是他很好的狀況之下去職牙結果牙橋把他做一排"},{"start":3610.745,"end":3638.243,"text":"好 他現在不太能刷牙了他沒有辦法自己照顧口腔啊一直在溫燒 一直在溫燒送醫在送醫他是要推著推著病床去就醫這樣子去到那裡開藥回來再繼續吃藥要把他吃到腎壞掉嘛這些口腔照護那也拜託了一些牙醫師有沒有辦法幫他們"},{"start":3639.364,"end":3659.364,"text":"去好好刷牙,拍血,或者鋸掉,把它拔掉。他的臥床的情況,沒有辦法接受。他的臥床沒有辦法這樣,我們high speed這樣子去切啦,去那個,誰有辦法,誰敢,哪一個牙醫師敢。光到時候嗆咳,到時候吸入性肺炎,沒有辦法。"},{"start":3661.414,"end":3689.641,"text":"那我們這些我們要增加人力從護理師的培訓能不能再多一倍的護理師或者是說語言治療師或者現在一直在談的從其他國家引進專業人員這個是護理師的現狀我們不要騙自己或者我們現在有一個口味師能不能被我們用我們也期待的這個部分大家如果去看到"},{"start":3690.934,"end":3717.765,"text":"失智長者吃一餐就要被我堵一次那種辛苦的狀態如果是你的家人你不會答應最後因為時間剛剛好我也是希望這個口腔衛生師有他的角色有他需要的部分為什麼我們要去引進外勞為什麼我們本國都已經在授訓這些人為什麼不讓他在"},{"start":3718.945,"end":3732.674,"text":"職場上大家可以接受的範圍裡面讓他進入到職場這是我的疑問 謝謝好 謝謝陳雅光執行董事接下來我們請陳立生主任兼教授"},{"start":3741.615,"end":3756.49,"text":"主席還有各位委員還有各位先進大家好我是台北大學口腔衛生學系的現在系主任陳立聖為什麼需要口腔衛生人員法我們先看目前社會需求就是國人口腔健康現況"},{"start":3757.951,"end":3782.681,"text":"我們也知道說我們的其實驅使的防禦一直是我們在台灣醫療很少是不是世界第一但是我們這個的確還是世界第一我們是落後的世界第一我們一直追WHO的目標但其實我們的驅使的指數我們其實還是落後大概10年那我們要追趕這10年其實當然衛福部這邊盡了非常大的努力但我們還是有大的努力空間"},{"start":3784.022,"end":3810.292,"text":"第一個是很重要的就是在國人口腔疾病第二個大概比較大的就是亞洲病那亞洲病的目前的腎型狀況大概有到快八成左右那已經到這個生成亞洲囊帶這個有問題的大概亞洲病的腎型也到35%所以這個部分如果不照護其實它蠻可能就是未來就是會有缺氧或者是影響到這個心臟或者糖尿病等等這些慢性病的這個部分"},{"start":3811.857,"end":3838.079,"text":"那我們到了年紀大的65歲以上我們現在已經高齡了所以我們的無牙率大概是目前是11%但我們的老人的比例一直增加所以我們的無牙人口大概也是接近50萬左右那這些沒有牙齒並不是代表說完全不用照顧其實他還是有很多的這種細菌堆積的風險其實會影響後面可能會有肺炎的可能"},{"start":3839.52,"end":3865.982,"text":"那我們知道這個日本在推這個8020就是到了80歲還是有20顆自然芽那過去他們在1989年其實剛開始推的時候這個比例只有7%也就是說80歲以上有自然芽20顆以上只有7%不過經過他們30年的努力他們可以達到大概有快六成就還是能夠保有這個自然芽的狀況所以這個預防不是不可能只是說我們目前還沒有很大力道去做這些事情"},{"start":3866.863,"end":3885.681,"text":"第三大疾病的口腔癌這也是我們非常少見在我們已開發國家是一個非常癌症盛行的地區主要還是因為煙冰酒我們目前的煙冰的人口大概是280萬這280萬除了目前我們做非常好的口腔癌篩檢之外"},{"start":3886.701,"end":3913.434,"text":"戒冰戒煙的這些的衛教推動其實還是非常重要好那這幾個疾病當然跟我們牙科非常相關但我們攤開這個十大死因第一個癌症心臟疾病第三個是肺炎其實這三個部分都是還是跟口腔保健有非常大關係那特別是在心臟疾病剛剛有提到牙齒後面的預防那在肺炎其實也是非常大相關現在已經來到這個第三大死因"},{"start":3914.585,"end":3935.579,"text":"那因為這個年紀大了有非常多的這些的共病的問題我們有非常高比例這樣的一個老人處非常多的專家已經提過所以長照人力或者是這些的口腔機能維護還有這個所謂的口腔照護其實目前的護理人力說實在還是真的是不夠"},{"start":3937.199,"end":3954.326,"text":"好 那我們在這個草案裡面提到這個口腔衛生人員他的這個職業的這樣子一個服務範圍那當然除了這個口腔臨床醫療輔助行為剛剛有提到說我們還要特別正面表現提訂之外那其實很多事情其實還是非常需要"},{"start":3956.166,"end":3983.252,"text":"這個我在這邊列出的不是這個臨床醫療輔助的項目就是說在高齡跟長照的部分我們如果介入的話他其實是可以降低這個肺炎改善生活品質那在住院口腔照護裡面我們很少現在住院病人特別是這個中風或者是ICU的病人會去給予口腔照護的介入這個護理人員也沒辦法做所以也沒有特別的己夫在做這件事情但這個做了其實"},{"start":3983.952,"end":4005.155,"text":"很多的這個實證已經證明它是可以降低這個住院天數也可以改善這個所謂的這個肺炎發生率那再來當然特殊需求的包括生長這個就是我們也是目前政府非常大力在推動要照顧這些的口腔照護那還有社區口腔健康這些都是非常優先而且人口是非常多的"},{"start":4006.448,"end":4022.246,"text":"那其實預防剛有提到亞洲病預防還有口腔癌防治這些都是很重要需要工作那我們看這個口腔癌目前有這個戒菸衛教師這個衛教師推廣除了醫事人員之外還加入了公衛師跟社工師"},{"start":4022.867,"end":4037.336,"text":"關於是社工是目前都不是醫事人員但是我很可惜口罩口味的人到底可不可以加入這一塊做這個接驗的方式那當然現在很多新科技啦所謂的數位口腔的這個輔助跟職涯相關的這個輔助但這部分"},{"start":4039.357,"end":4066.858,"text":"還沒有在這個談的這個範圍但是這個是可做的工作也不在健保的範圍裡面那我們在這個所有的這個口腔衛生介入之後我們不管在預防兒童或亞洲或者是住院照護或者是廠商照護我們精算一下大概其實可以約略可以省每年健保56億元由於這個口腔衛生的介入那這些錢省下來還是可以回到我們的這個健保在雅各總額這邊再做這個更好的分配給這個"},{"start":4067.859,"end":4091.126,"text":"牙醫師能夠保障這個1.1元我們能不能在疾病發生之前阻斷這些疾病那給我們一些空間來去做這些口腔更專業的這樣的一個介入那目前我們在牙醫診所的牙醫師數大概是1萬4但我們看到會員員其實在牙醫診所有登記大概只有379位其實這個比例大概是40比1"},{"start":4092.046,"end":4117.702,"text":"那跟我們現在的牙醫輔助人推估1.3比1至少要有兩萬六千位這兩萬六千位其實跟護理人員比在診所裡面大概五十比一其實這個我們非常想要協助這個部分那當然這個口味師還是目前的世界趨勢那我們這個已經講過這個畢業人數現在已經達到快剛才提到這個兩千多人"},{"start":4118.662,"end":4135.949,"text":"我們現在畢業學生很可惜他們大概只能當牙住就是牙住或者牙科相關產業很可惜他們很多我們的學生會輸出到他國去做口味師我很遺憾說我們自己培養學生沒辦法在台灣做服務"},{"start":4136.806,"end":4160.227,"text":"那當然長照身障學校機構這我們也沒辦法進去那當然我們也知道韓式的十二項的這個非醫療行為是我們才能做的那這些的事情其實對廣大雅筑來講我們也不想違法因為現在還是有刑責牽涉到這個醫療輔助行為那未來如果有口腔衛生師我們也不想當民醫也不想違法因為這本來就不是我們想要做的事情"},{"start":4161.028,"end":4181.951,"text":"好 那這個教考用教考用我們有學系 我們有希望有國家考試以後能夠職場任用那這個職業場所可以討論啦必定要在診所我們可以現在這個醫院或牙科醫院或者是有這個特殊需求或到宅的這些的牙科診所我們是可以去支援所謂的身障"},{"start":4182.772,"end":4206.206,"text":"長照學校機構那或者是偏鄉或烏鴉漁村的這個衛生所我們可以用所謂的公會培養或者是我們去設立一個制度讓他們能夠去那去做這些口腔衛生照護的事情好那這個時間非常有限那我還請懇求各位能夠給我們一些空間那以照顧這個國人的口腔健康為主謝謝大家 謝謝"},{"start":4207.358,"end":4211.979,"text":"我們在場的委員還有在座的專學者 大家早安我想口腔健康"},{"start":4233.015,"end":4253.893,"text":"不是只是牙齒的問題而是像是全身健康的起點我覺得今天要談我們超高齡社會的確去年已經進入到超高齡125年會進到極高齡的社會要問我們到底準備好了沒為什麼因為我覺得臺灣的口腔健康"},{"start":4254.795,"end":4282.573,"text":"的狀況會針對於我兩個很關心的一個課題什麼意思過去我每次在出席我們的牙醫工會或全聯會的活動的時候我都說非常感謝牙醫為什麼我最關心兩塊一個是兒少一個事實上是我們的長輩那特殊需求的孩子的確牙齒非常的重要還有一個就是長輩尤其事實上是失智症因為我在"},{"start":4283.473,"end":4301.261,"text":"立法院的後生會有成立一個失智症委員會那也針對這一塊呢口腔事實上跟失智甚至聽力跟失智都有很大的關聯性所以我也特別留意到國內的一些研究像咀嚼減少會降低海馬回跟前額葉的活化"},{"start":4302.011,"end":4325.622,"text":"那直接加速認知退化而且長輩如果牙齒缺到14顆的時候呢 罹禍阿茲海默症的風險是增加10倍那輕度認知障礙的風險會增加5倍那的確看國內我們國健署的調查我國65歲以上長輩呢大概每10人就有一個人呢患有輕度以上的吞嚥困障礙的問題"},{"start":4327.875,"end":4347.642,"text":"那日本的研究也可以看到是,如果是口腔衰弱的话,它的身体有很大关联性,包含身体衰弱的风险会增加2.4倍那失能的风险增加了2.3倍,那积少症的风险会增加2.2倍,毕竟没有营养输入"},{"start":4348.752,"end":4373.107,"text":"蛋白質沒有進入的話那他急早症的可能性就會變得更高還有風險會增加2.2倍所以從這些數字來看長者的口腔健康我覺得牽動的不只是牙齒而是認知功能身體的機能甚至事實上是存活率那因為台灣我剛剛提過已經邁入到超高齡社會長輩的一個口腔問題如果沒有妥善處理的話"},{"start":4373.792,"end":4394.905,"text":"就會演變到我們很嚴重的後果尤其臺灣事實上我們的不健康的漁民事實上到8.16年臥床要到8.16年芬蘭現在在拼兩個禮拜我覺得臺灣不可能拼兩個禮拜可是至少我們應該是要往前比如說降到6年降到4年而不是現在平均8.16年這麼樣的高所以"},{"start":4397.206,"end":4413.821,"text":"怎麼讓他的口腔健康我覺得事實上是非常重要的那當然我們就要提到了那人力呢那怎麼去透過我們口腔今年的一些訓練介入來讓這個減緩的話那我當然也非常支持長照3.0的預防口腔衰弱的社區推廣先導計畫讓醫師跟專業團隊進入到社區為長者進行衛教跟口腔衰弱的評估"},{"start":4422.529,"end":4435.494,"text":"一旦發現高風險的一個個案呢即刻能夠轉接到醫療院所來接受治療那我覺得這樣的做法呢事實上可以找出社區的潛在的風險的高風險長者那這個計畫目前還在推廣階段中期目標事實上是到2030年的話我們的衰減"},{"start":4445.29,"end":4449.995,"text":"那個篩檢的縣市可以覆蓋率達到90%當然很樂見希望能夠趕快達到可是我也看到這背後的人力的需求剛才也有長照機構講說長照機構有需要那事實上社區也有需要那"},{"start":4462.509,"end":4489.378,"text":"怎麼去把現在政府在推動的口腔保健的政策檢視現在現有的專業人力思考如何他們被運用加入現有的團隊那因為口腔技能評估應該是由醫師跟相關專業人員主持組成而我國每年大概有數百名的口腔衛生科系的畢業生投入職長這大概是政府要去正式的一個資源不過我覺得建議政府輔導這些畢業生加入評估團隊"},{"start":4492.02,"end":4508.569,"text":"對的時候要能力要讓能力真正能夠投入到社區現場回應我們持續成長的篩檢需求同時我當然也很同意剛才我們的中華民國護理師護士工會全國聯合會的李英芬李是談到"},{"start":4510.683,"end":4530.456,"text":"如果有另外一個專業要導入的時候可能要去注意到的就是說不得影響現行依法由該有各一市人員執行的法定業務這個是非常重要的那除了社區端的口腔衰弱篩檢之外我們的長照的機構的"},{"start":4531.777,"end":4558.137,"text":"口腔保健相同的也非常重要因为口腔照顾不好除了牙齿健康受到影响以外可能会引发营养不良的问题所以像社区有整合型的一个口腔的健康计划那当然我们觉得也把推动我们的住宿型机构的口腔照护辅导列为重点的工作项目"},{"start":4558.898,"end":4576.977,"text":"針對我覺得住宿型照護那護理之家的這些機構我覺得已經辦理工作人員的口腔照護的教育訓練而且並定期的進行我們的輔導訪查那目前的制度是由機構的第一線人員直接提供我們長輩的相關的服務"},{"start":4577.918,"end":4593.464,"text":"可是剛剛也提到說人力不夠的地方那怎麼去的確長照現場工作強度非常的高人力的流動流動率也非常高而且如果再讓照護員去照顧我們的口腔照護到底恰當與否"},{"start":4594.434,"end":4620.457,"text":"真的應該要去做評估所以我覺得重點不是到底是誰來做到底有沒有人來做而且能不能確保我們住行機構的長輩他的口腔能夠是被照顧健康那當然日本也有一個我們當然也可以參考日本的做法是有此科衛生室要在牙醫師的指示底下去執行業務那他們在這種介護保險的制度裡邊此科衛生室"},{"start":4621.017,"end":4646.12,"text":"會定期到長照機構也可以到民眾家裡去做口腔評估幫忙做口腔清潔還有觀察吞嚥功能有沒有問題不過這是日本的方式那到底台灣適不適合我覺得要考慮現在的現況到底是什麼所以我認為應該要去了解是目前到底台灣甚至這個服務的給支付制度的這些東西到底做不做得到"},{"start":4646.6,"end":4664.814,"text":"我覺得這事實上是衛福部要去做考量的至少我覺得大家可以學習的有三個方向也就是定期進入到我們的機構跟居家去及早發現然後第二個我覺得應該跨專業合作來建立我們完整的口腔健康管理"},{"start":4665.444,"end":4684.621,"text":"所以剛剛蘇清泉委員也提到是說偏鄉沒有牙醫剛剛我們的臺北醫學大學的口腔衛生學系的教授也講到說偏鄉沒有牙醫可是偏鄉沒有牙醫師難道就有另外一種那我覺得那不是也是欺負偏鄉嗎因為我對弱勢這一塊我自己有不同的看法"},{"start":4685.141,"end":4709.604,"text":"如果只是因為那沒有牙醫 那政府應該想辦法而不是說如果沒有牙醫 我們另外一個那為什麼都市的人可以有牙醫來照顧偏鄉又不是 這種說詞我就不見得是非常的支持而且剛剛蘇委員講到說 驗光 驗光是過去很多跑到那個眼鏡行去驗光那我們要走路到更專業 讓人家接受"},{"start":4710.188,"end":4739.743,"text":"那可是最好的像我小孩我都還是帶到先給我們的眼科醫師確定整個狀況之後那眼光再交由眼光師可是醫師如果這樣講的話那醫師的價值就不存在了所以就大概就是我覺得口腔健康這個不只是牙齒的問題跟我關心的失智衰弱這些都有高度相關所以我們希望未來在社區走到機構都有穩定的人力那日本的經驗我覺得可以考量"},{"start":4740.202,"end":4759.789,"text":"可是要怎麼做我覺得還是不要去違背掉我們當初其他各醫事人員的一個法定的業務所以我們大家一起今天我也想聽取大家的意見有沒有更好的方法如果人力不夠的時候怎麼去做可是不是人力不夠用另外一個我覺得還是要專業訓練的人力"},{"start":4762.121,"end":4784.073,"text":"所以我說我不否定說今天要不要去推動我們的口味師可是如果要推動真的要等到台灣整個狀況很成熟然後呢到底有沒有需求要評估我就要請政府部門做評估以上謝謝好謝謝林營請在位的發言補充介紹我們中華牙醫師公會法治委員會執行長劉玉祥"},{"start":4788.699,"end":4805.177,"text":"國家衛生研究院所長邱鴻義接下來請第七位更新專科口腔衛生與健康照護科主任洪文綺"},{"start":4821.006,"end":4842.186,"text":"主席 各位委員 各位先進 大家好我是來自根興健康管理專科學校口腔衛生與健康照護科我們科是在民國106年成立主要當初成立也就是有鑑於口腔照護的一個重要性還有高齡社會的一個趨勢去成立的"},{"start":4842.907,"end":4868.31,"text":"那所以呢面對這個高齡社會還有慢性病的人口的快速增加那我們認為說口腔衛生人員可以被定位成我們的高齡照護或者是慢性病的管理跟長照體系裡面不可或缺的一個預防的一個人力那首先呢台灣已經正式進入我們的一個超高齡的社會那"},{"start":4869.651,"end":4892.087,"text":"內政部的一個統計在去年的時候我們就已經65歲的一個人口就有達到670467萬人口以上那佔總人口的一個20%那已經符合超高齡社會的一個定義那這代表的就是未來失能失智或者是那個吞嚥困難"},{"start":4893.347,"end":4909.581,"text":"營養不良還有慢性病 共病的人數會持續的增加所以口腔健康不再局限於是牙科單一的一個問題更應該是納入這個高齡健康還有長照整個政策的一個整體的規劃"},{"start":4912.199,"end":4941.128,"text":"那其次呢就是口腔的一個疾病本身就是一個高度普遍的一個公共衛生的一個問題那全球呢有37億的人都受到口腔的一個疾病的影響那口腔的一個疾病雖然都可以預防但是會造成一些疼痛功能的受損或者生活品質的下降甚至影響全身的一個健康所以說呢這些資料顯示如果單方面的只靠"},{"start":4942.088,"end":4959.742,"text":"治療端其實難以來因應所以更需要一些預防教育追蹤或者是社區的一個介入來作為核心來建立我們的一個口腔衛生的一個人力的制度"},{"start":4960.402,"end":4983.715,"text":"那再來就是我們的一個良好的一個口腔衛生的這個照護其實是有助於高齡者的一個人口的一個吸入性的一個肺炎或者是相關的一個照護的一個風險然後再來就是我們的一個口腔照護的一個口腔的一個疾病口腔的一個健康呢跟我們全身的健康也都有密切的一個關聯"},{"start":4985.476,"end":5000.232,"text":"因為我們的一個口腔的一個疾病本身像牙周病本身就是一個慢性發炎的一個狀況所以呢對於這個全身的一個疾病也有造成影響譬如說糖尿病心血管疾病等等"},{"start":5001.433,"end":5024.474,"text":"因此如果口腔衛生人員可以跟牙醫師還有醫療團隊在這樣子的一個指導下協助我們的慢性病患來進行我們牙周的一個保健衛教還有口腔的自我的一個保護追蹤飲食還有結壓的一個行為的管理然後甚至建立必要的一個轉接制度其實都是非常有幫助的"},{"start":5025.074,"end":5045.731,"text":"然後最後就是我們的口腔機能的一個維護應該是作為我們高齡照護的一個重要的一個內容那口腔衛生人員其實是可以在社區的一個據點經過我們的一個好的一個訓練然後在照護日照的一個中心居家服務"},{"start":5046.491,"end":5068.782,"text":"還有住宿型的一個機構當中來協助我們口腔的一個清潔指導假牙的一個清潔還有或者是口腔的一個保濕啦咀嚼吞嚥的相關的衛教甚至是一個招呼者的一個訓練還有呢轉介的一些建議等等讓這個口腔照護可以從醫療院所來延伸到我們的一個生活的一個場域當中"},{"start":5071.415,"end":5096.56,"text":"那所以因此口腔照護人員口腔衛生人員在超高齡社會的一個功能不應該只是限於我們牙醫牙科的一個輔助人力應該被定位成口腔健康促進口腔機能促進或者是慢性病預防保健還有長照的口腔照護的一個專業的人力那透過比較制度化的一個建制"},{"start":5097.54,"end":5118.834,"text":"讓我們的口腔衛生人員可以來協助來降低我們的吸入性肺炎的風險來改善我們的慢性病的一個照護的一個品質來提高我們高齡者的一個營養甚至是一個生活的品質然後來補足我們的社區居家還有長期的一個缺乏口腔照護人力的一個制度的缺口"},{"start":5119.96,"end":5138.553,"text":"好那所以綜合上述我們的一個制定我們口腔衛生人員法不只是一個牙科專業的一個發展的問題其實更是因應我們的高齡化慢性病還有長照需求的一個公共政策我也把這個口腔衛生人員納入正式的醫療還有長照的一個團隊才能夠落實我們的預防為核心以社區為基礎以健康老化為目標的一個口腔健康的一個照護體系"},{"start":5150.662,"end":5155.126,"text":"主席 各位現場的先生女士大家早安我是牙醫全聯會秘書長曾氏者"},{"start":5173.1,"end":5200.232,"text":"剛剛聽了很多我們委員跟我們專家學者的一些意見首先我先表達一下個人的看法我們牙醫界完全會支持提升國人的口腔健康推動預防醫學以及包括為了因應未來的長照高齡社會的一些醫療的一些處置牙醫界絕對全力支持可是大家要思考一點增加一種新的醫事人員就能夠真的解決所有的人力的問題嗎"},{"start":5201.904,"end":5220.124,"text":"增加一種醫次人員就能夠跟改善口腔健康跟提升口腔照護水準能夠拉上一個等號嗎因為剛剛聽那麼多的意見其實大家都聚焦在一個就是人力的不足人力的不足大家有沒有先想到我們的制度面上面來講有沒有什麼地方需要去做調整"},{"start":5220.805,"end":5237.979,"text":"不是沒有人要去做而是你制度上面你就沒有辦法去讓這些人可以去做讓這些人可以去經過訓練之後就去做這樣這些已經在牙醫的職業現場裡面就已經在駕輕就熟的這些我們的牙醫助理們去做而是制度上的問題第二個"},{"start":5238.88,"end":5255.085,"text":"偏鄉巡迴或者是特殊醫療在近幾年政府的一個大力的支持之下其實牙醫全聯會我們做了非常非常多的努力這些成果也得到很多的肯定我想這個你不能夠抹殺我們牙醫全聯會牙醫界的整體的努力今年"},{"start":5256.124,"end":5280.845,"text":"口腔師他有推了所謂的一個偏鄉精進的一個設備的一個計劃這個就是完全就是要支持我們的偏鄉計劃讓我們所謂的無牙醫鄉或者是我們的偏鄉的居民能夠得到更高的一個醫療水準的一個最好的一個幫助所以人力的問題並不是說你今天設了一個新的口腔衛生人員就可以全部都解決"},{"start":5281.585,"end":5287.072,"text":"大家先從制度上面去看那除了制度我們要看一下法律上面的層次法律制度面的疑慮這我想剛剛也是很多專業學者有提到了業務範圍不清那目前"},{"start":5298.786,"end":5309.412,"text":"目前的現況我們牙醫的職業現況牙醫師已經有到1萬7千多人每年大概有500位的牙醫師在成長護理人員有35萬那實際職業的人員只有19.8萬大家有沒有想為什麼"},{"start":5313.925,"end":5342.21,"text":"明明有這麼多的護理人員那為什麼實際上職業的護理人員只有大概20萬大概不到20萬也是因為制度的關係所以近年護理師公會在爭取的所謂的護病比還有一個加班費還有一個適當的給付就是在改善我們醫療現場一些人力不足的一個狀況的努力那壓計師有3000人牙主我這邊特別要提提提牙主有6到7萬"},{"start":5343.83,"end":5369.383,"text":"這些都是現成可以提供我們最好的一個醫事環境的能力的一個工作人員那另外一個包括像長照照服員大概有10萬所以在不管在我們的牙醫的院所內的服務或者是說像偏鄉特殊醫療院外服務甚至像剛剛所提到的一些長照的一些服務其實人力上來看並不會說不足"},{"start":5370.183,"end":5398.66,"text":"只是說你制度上有沒有讓人能夠讓這些人充分的去發揮他們的所長或者是說讓他們能夠久待這是我們政府要去思考的也是我們大家去思考的你增加一個新的醫事人員剛剛口味的那個代表那個素人醫專的代表也有提到一年大概有300多位口腔衛生的畢業生300多位跟我們現有的6到7萬的牙住這個比例應該差很多吧對不對"},{"start":5399.46,"end":5423.181,"text":"所以怎麼樣在制度上面來講在給付上面來講能夠讓我們精進這個我覺得是最快解決我們現在所謂人力不足的一個最好的解方另外現在的醫療行為醫療輔助行為跟非醫療行為都已經明確分工其實大家就只要遵照這樣子的一個法律層次的一個要求其實就不會有什麼所謂的犯法違法的問題"},{"start":5426.345,"end":5455.648,"text":"那我們看一下現在口腔衛生人員法的草案裡面它所定定的所謂的業務範圍現在是三項大家看前面第一項跟第二項其實它就是照抄我們的護理人員法只是把它更侷限在口腔對不對那我相信護理人員在整個培養的過程當中護理人員他是以全人的整體健康來做考量請問我們的口腔衛生人員我們的口腔衛生學系在整個培養的過程當中"},{"start":5457.133,"end":5481.574,"text":"除了跟护理人员差别在于就是说我们可能加入比较多一些所谓的临床的牙医的一些行为的一个介绍跟一个实习这也是我们牙医界所担心的因为之前106年所提出来的一个口腔卫生草案的时候其实它就是包含了像蜗沟图佛像洗牙这些口腔卫生人员他们想要去做这些事情一直到现在你在他们的一个就业的"},{"start":5482.674,"end":5497.424,"text":"招生的網站上面其實也是可以看到這些東西這就是讓牙醫界會擔心你的全責不分你侵犯到其他的醫事人員的一個工作類別最後責任誰來負還是一樣啊在整個口腔的一個醫療環境裡面來講牙醫師還是要負最大的責任"},{"start":5499.499,"end":5512.258,"text":"在長照的部分衛福部106年的一個函示其實也跟教育部說其實在長照相關跟口腔有關的一些照護的工作其實並不需要醫事人員的身份因為如果以剛剛的邏輯來看長照"},{"start":5514.702,"end":5534.29,"text":"他更跟全身的那個整個的照護有關係那我是不是也要讓長照當作另外一類的醫事人員如果長照都不行的話你口腔衛生人員其實就是在牙醫師的指示之下或者是說做一些所謂的非醫療行為的這些工作其實就可以就可以提升整體的一個口腔照護的水準"},{"start":5535.902,"end":5551.805,"text":"另外像這種常識疾患的像一些把管這些其實都已經有現有的一些醫事人員都已經能夠各司其職把這個自己的工作做好了富謙科醫師 耳鼻科醫師 神經科牙醫師跟語言治療師這些大家都已經現在都做得非常的好"},{"start":5552.967,"end":5576.757,"text":"所以我們不兼想到你立這個法你的另一面的疑慮雖然說可能有人說你牙醫助理可以來上課然後來取得這樣子的資格未來就可以比較沒有違法的疑慮可是要想想看這6到7萬人的牙助你要在10年之內那不管你是80個小時或160個小時的教育訓練去參加考試那這樣對整個牙醫的職業生態是會造成多大的不穩定"},{"start":5578.196,"end":5582.798,"text":"在這種不穩定的情況之下我們的一個醫療品質能夠再繼續像現在一樣維持嗎所以我們要思考一下必要性在哪裡你是不是有經過明確的授權是不是會破壞既有的分工是不是已經會侵害到既得醫事人員的一個業務範圍"},{"start":5595.339,"end":5613.351,"text":"外國的法律可不可以加以本國的制度日本有很明顯有很明確的所謂的牙科駐底制度跟牙醫的那個口腔衛生人員的制度先有牙科駐底的制度完善之後你再去談口腔的那個衛生人員制度這我認為是合理可是在目前來講"},{"start":5614.872,"end":5629.22,"text":"這個我們沒有辦法去接受所以重點就在於說我們這些醫師需要什麼樣的輔助人員來做我們這些工作這些工作哪些是需要念了大學四年的人來做哪些只要經過熟練的操作教學授課訓練考核就可以"},{"start":5630.902,"end":5651.802,"text":"所以我們還是強調要有一個共識沒有共識的情況之下你就強推這個法案就從106年開始就會一直造成牙醫界的一個衝突也會造成整個社會大眾對整個牙醫界的誤解這樣子我相信不是大家所樂於見到的然後最重點就是說立了這個口腔衛生人員法有什麼是牙醫生命的助理以前不能做現在可以做的"},{"start":5653.777,"end":5675.129,"text":"107年陳時中部長當時是就有才賜了為了降低大家的不信任感所以說一定要有共識先把醫療行為跟醫療輔助行為還有非醫療行為這些細項先訂定好然後之後再來設魔法的一個設定所以在我們113年剛剛蘇偉雲他有提到他的一個草案其實在亞裔界來講也是沒有共識的"},{"start":5677.695,"end":5699.17,"text":"這個就是我們113年全國各地方工會的理事長還有115年7月10號就在前天應該說這個禮拜天我們全國各地方工會的理事長針對這個議題他們也是全部表達一個很大的一個反對沒有共識你來談立法這是完全不合邏輯的事情這是我們整體各地方工會的意見"},{"start":5701.394,"end":5727.403,"text":"最後我再重申 牙醫界絕對支持口腔健康政策可是在制度沒有釐清以及沒有取得世界各界的共識之前我們反對口味人員法我們希望口味目前的一個畢業生能夠加入我們整個牙醫醫療環境的一個大家庭讓牙醫師 會理人員 牙醫助理 牙醫技師跟我們的長照 照服員能夠為整個國人的口腔健康而努力謝謝"},{"start":5729.039,"end":5733.961,"text":"主席還有各位委員還有各位在場的所有的女士先生們大家早安大家好首先很感謝這個我們委員來召開這個這個公聽會那我想呢牙科其實在"},{"start":5755.027,"end":5775.554,"text":"聯合國說2030年要達到口腔全面覆蓋其實我們五年前早就達到了我想雅醫界在民眾的滿意度來講應該是服務的滿意度應該是達到96.3我想這是非常高的一個民眾滿意度那當然其實在取此的防治上面其實我們也是降低了很多那非常抱歉"},{"start":5775.814,"end":5790.463,"text":"因為我們今天沒有時間準備我其他那個slide因為我們剛剛大會才剛過那我們大會真的兩天很忙而且接待了很多國外的貴賓在此沒有書面的意見跟大家抱歉但是這張其實就是我們的"},{"start":5791.018,"end":5813.559,"text":"我們的最重要各地方公會的意見第一個我們要表達的是現行其實現行的牙醫體制非常完整醫療行為已經分為牙醫師應該親自為之的醫療行為就是牙醫師不得指示其他醫事人員為之像診斷處方然後手術病歷記載麻醉牙齒美白洗牙屠佛握溝豐田"},{"start":5815.521,"end":5839.362,"text":"體檢的口腔S光這些都是用牙醫師親自為之的而在牙醫師指示下由護理師護理人員來為之的醫療輔助行員如注射、藥劑、外傷處理、打針這些還有口腔裡面的照護這些都是屬於護理人員要為之的那非醫療行為就由牙科助理來執行"},{"start":5840.183,"end":5858.357,"text":"所以呢我們現在表達是說各專門職業人員呢有各定的法令限制他的業務範圍那是不是需要在立法在牙醫師跟護理人員之外呢再立一個口腔衛生人員法這是我覺得牙醫界來講是覺得是沒有必要的"},{"start":5858.677,"end":5873.338,"text":"當然如果說大家可以溝通我覺得剛剛祕書長講的很好就是說我們牙醫界其實是可以開放溝通的但是大家先把大家要的業務範圍講清楚到底口味師你成立以後你要做什麼業務範圍你們到底要做什麼"},{"start":5874.219,"end":5898.394,"text":"我覺得這個要先大家表達清楚然後大家溝通好然後再來考慮立法問題而不是先從立法來然後在立法成了以後再來告訴大家您要做什麼那現在其實現在就是說現在護理人員其實剛剛有看到那個表格其實有接近10萬人他沒有回到護理的專業上他即使他考上執照幾乎沒有回來那就是制度上有什麼要考慮的"},{"start":5899.395,"end":5921.747,"text":"那再來就是說口味師現在口味系現在其實有口味系也有口味科在招生那他們的招生的簡章裡面就有很多就是有侵犯到牙科的治療行為像洗牙 像屠夫 像窩溝封點這些都在教學的內容之中那我們牙醫界就會疑慮說那你到底要做什麼你是要來找對牙醫師的業務範圍做呢還是說你們要做護理師的範圍呢"},{"start":5928.45,"end":5956.823,"text":"那我覺得這個東西大家就要講清楚了那我想目前我們牙醫師已經有1萬6千多個1萬7千個 而且診所有7千家了那護理人員其實他考照超過35萬我剛剛講錯了 大概有15萬的沒有回到護理專業所以我覺得這個東西呢我們大概要把這個所有的內容要想清楚請問口腔衛生人員法立了以後口腔衛生師要做些什麼"},{"start":5958.271,"end":5979.918,"text":"當然你們要做公衛的部分我們沒有反對但是如果說你要侵犯到牙醫師的職業範圍或是侵犯到護理師的職業範圍那我想這個大家都會反對我想我們從秘書長剛剛講的可能就是我們的共識第一個就是配套不足溝通不足"},{"start":5982.967,"end":6004.593,"text":"配套不足 然後溝通也不足應該先試辦完整的配套措施跟實行辦法再來討論口腔衛生人員法的立法然後第二個就是職業工作範圍沒有正面表列立法如何避免工作範圍之擴充第三就是工作範圍要明確那新增技術人員成為密的可能性那過去呢"},{"start":6008.704,"end":6017.198,"text":"多元取材的方案我們在上次協商的時候被刪除掉了所以才亞裔界才那時候才大反彈那立法實際上是維護那個"},{"start":6019.284,"end":6036.73,"text":"招生的利益而已啦我們覺得啦因為現在其實說一句實話啦口味系現在畢業的學生他就業並沒有什麼問題啦他們幾乎在大三大四的時候早就被預約光了啦所以在學生來講只要口味系畢業在亞裔界在希望能得到"},{"start":6039.827,"end":6068.362,"text":"口味系畢業生來診所服務的其實我們都很困難能找得到的所以我覺得對他們的出路是沒有問題的那是不是需要再立一個特別的口味師然後再讓這些人們成為職業人員就是醫療人員我覺得這個大家要審思那在最後就是說我們牙醫界的立法"},{"start":6072.472,"end":6094.614,"text":"對不起我看不清楚這個字牙醫助理人員的立法與現行牙醫職業的需求叫口腔衛生師為高啦其實我們牙醫助理有六七萬人其實我覺得要把這些人如果要怎麼樣讓他們正名化我覺得這個在整個議題中要多考量就在此報告 謝謝"},{"start":6097.082,"end":6098.244,"text":"主席 各位委員 還有在場的長官"},{"start":6114.776,"end":6134.677,"text":"剛才理事長跟秘書長已經講得很清楚了那我覺得以台灣的需求如果拿國外的資料來套用不一定合適因為台灣是一個島國它範圍並不大那你國外地區有些像美國還有日本它面積都非常大所以他們的覆蓋率應該是"},{"start":6135.618,"end":6160.76,"text":"沒有台灣那麼明顯台灣的牙醫師1700個現在醫師人口比已經超過先進國家已經到1比1000多表示一個醫生只能照顧1000多個民眾所以牙醫師的人力是沒什麼問題那今天立這個法我們要立為某個職業團體立法的時候是不是要考慮說這個職業團體是不是需要大家有沒有共識而不是一味立法那"},{"start":6163.089,"end":6184.008,"text":"台灣現在目前來講的話 剛才有做三個方面一個偏鄉生長偏鄉生長的話我們亞伊斯在健保制度以及我們亞伊斯全聯會的推廣之下偏鄉以及生長的執行率每一年都在上升而且我們亞伊斯也全力配合我們政府去做這方面的事情"},{"start":6184.688,"end":6211.043,"text":"那對於剛才一直強調說口腔衰弱口腔衰弱的話我們現在目前有社區型包括我回我們醫學院的院長和董事長們他們對於口腔衰弱是非常的重視他們希望說能夠從醫院端先去處理診斷好然後有發展到各個診所去那台灣目前台灣的牙醫診所已經比7-11多了"},{"start":6212.944,"end":6229.39,"text":"一條街上面的牙醫診所大家走過去看已經密密麻麻的那偏鄉大家也是去像我們新北的巴黎教養院各方面只要教養院或是有長照團體有需要我們牙醫師我們工會都會派出醫師來那是不是說"},{"start":6230.603,"end":6254.4,"text":"你要搭配口腔衛生室去這個目前來講並沒有產生這個問題然後第三個診所方面哪些哪些診所助理能夠做的事情我們在107年的時候已經經過衛福部已經通過了非醫療行為那剛剛講醫院裡面的護理師在醫院的牙科部生態跟醫科不一樣醫科他看診門診是一個醫一個醫師就要配一個護理師嘛"},{"start":6258.183,"end":6277.883,"text":"那我們牙科部的話在我實習 包括我兒子現在三種牙科部就是一個護理師 兩個護理師準備東西那也沒有需要每一個醫師旁邊要需要人跟診因為有很多實習生實習生在旁邊跟診他受過正規的牙醫教育跟診一定比口腔衛生師好"},{"start":6279.284,"end":6304.014,"text":"然後他們順便可以跟那些資深的醫生學習技術這是一舉兩的所以說口腔衛生師的設立是否大家有共識是否牙醫有這個需求不要強加就是有一點感覺上我們牙醫師一定要需要口腔衛生師在沒有他們我們對口腔衛生的和民眾口腔衛生的照顧上是有問題的"},{"start":6305.535,"end":6325.044,"text":"那在國外的制度有各種制度啦 像我到歐洲去看歐洲的口交衛生師是不由政府去認證政府不列冊 也沒有去做國家考試他們是由民間團體 所謂民間團體一定是他們的亞裔全聯會啦然後做一個上課以及認證 有點計值訓練啦"},{"start":6330.487,"end":6350.288,"text":"那現在台灣的政兆滿天飛那這個政兆過度繁榮的時候第一個剛剛理事長有講過了你在診所裡面像我看過很多口腔衛生學系的簡介裡面有說我們洗牙齦上結石請問大家有沒有能力去查他的洗的是洗牙齦下侵入性的一個牙齦上"},{"start":6350.788,"end":6372.586,"text":"大家沒有這個能力嘛那你是徒增密醫的行為而已嘛對不對他們在教屠佛 溝通這些牙醫師都已經做到大家搶著做的事情所以說我個人是希望說政府在立法的時候必須要考量牙醫師的需求我們牙醫師現在能不能做到這些事情剛才講的那些事情我們牙醫師都在做"},{"start":6373.587,"end":6388.01,"text":"那包括我們PGY訓練的那個開業前的訓練我們也必須要到社區去做一些一些社區的行為口腔衛教行為或是指導還有到偏鄉去學習怎麼去做"},{"start":6389.071,"end":6412.609,"text":"這些醫療行為所以說希望各位長官能夠考量說在實習上面的時候在各種立法的時候應該是要跟牙醫界不是先把立法以後再強加牙醫界再跟口腔衛生學區去商量而是先大家有個共識再開始以上 謝謝"},{"start":6414.599,"end":6424.056,"text":"谢谢林顺华召集人待会在叶剑阳秘书长发言完休息十分钟接下来请叶剑阳秘书长"},{"start":6431.15,"end":6453.848,"text":"那個委員們好 還有在場先進 各位大家好那個人認為 這個立法後一定有人得利啦 一定有人不得利啦但剛剛那個有委員說找不到牙醫師看診跟去為了這個設立這個法那個我其實覺得基本上是兩碼子事啦 這個我應該不需要贅述"},{"start":6454.548,"end":6472.753,"text":"有的時候不見得衝出立法它就是個萬靈丹還是要以台灣的這個實際的需求為主啦才會有大家想要看到的效果那前面說的那個利弊得失其實都相當多那我就簡單表達站在以中華藝術學會牙醫界教育的這個立場來看"},{"start":6474.253,"end":6493.821,"text":"其實對牙醫教育的這一塊教考、訓用合一的這個長遠發展來看如果要準備好設置這個口腔衛生人員法的話除了在推動專業分工之外其實我們應該更著重在台灣實際上的一個需求以及這個未來這些人才的這個"},{"start":6495.261,"end":6518.699,"text":"長遠的職癌的發展的一個規劃那我想這都是相當重要的一個考量所以呢我簡單來說就是以牙醫教育立場對該法的一個態度來看如果想要完備這個口腔的照護體系促進專業分工的這個態度上來看其實在學會的立場基本上我們是表示認同但是"},{"start":6519.259,"end":6546.496,"text":"要建議對立法應該要有三個重點那前面也都有說過就是說第一個要明定業務範圍然後嚴守醫療的這個界限然後再來就是確保病人的安全我想這樣子才能夠有效是保持我們醫生護理師口腔相關輔助人員這個共榮的一個狀況那也希望在場大家都能夠集思廣益才能真正達到相互相成的"},{"start":6548.357,"end":6555.922,"text":"這個政策效果 以上謝謝葉建陽秘書長那我們現在休息十分鐘"},{"start":6573.135,"end":6573.796,"text":"你休息一下"},{"start":6586.493,"end":6587.033,"text":"谢谢大家"},{"start":6606.203,"end":6636.203,"text":"謝謝"},{"start":6636.403,"end":6638.526,"text":"嗯嗯嗯"},{"start":6653.301,"end":6653.502,"text":"謝謝大家"},{"start":6675.748,"end":6677.829,"text":"沒了沒了 放在裡面"},{"start":6703.181,"end":6711.328,"text":"會不會 我覺得你後來講說我的參議院可以解釋一下我等一下把他拒絞 你們叫我報告一下你們叫我報告一下你們叫我報告一下"},{"start":6721.496,"end":6722.117,"text":"我覺得這樣比較好"},{"start":6751.917,"end":6753.138,"text":"昨日早上"},{"start":6774.173,"end":6775.234,"text":"太忙了啦"},{"start":6796.691,"end":6798.774,"text":"這個人力確實是有力的"},{"start":6813.913,"end":6814.533,"text":"後期後期"},{"start":6839.901,"end":6850.525,"text":"好玩好玩 這一些來 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙 因為有報紙"},{"start":6866.572,"end":6868.153,"text":"現在年輕人現在年輕人"},{"start":6892.265,"end":6894.247,"text":"今天一定要出席"},{"start":6916.885,"end":6918.866,"text":"剪輯剪輯剪輯剪輯剪輯剪輯"},{"start":6945.52,"end":6959.991,"text":"謝謝觀賞"},{"start":6962.754,"end":6963.555,"text":"我先家裡"},{"start":6992.714,"end":6992.875,"text":"謝謝大家"},{"start":7008.997,"end":7010.657,"text":"我坐在这边"},{"start":7034.224,"end":7062.295,"text":"謝謝觀賞"},{"start":7065.33,"end":7067.531,"text":"三個月的年齡是這麼大"},{"start":7086.262,"end":7093.625,"text":"所以都不像我們常常會做的事,就代表自己要做的事所以都不像我們常常"},{"start":7118.067,"end":7120.148,"text":"11點差不多這樣回去剛剛好2點剛剛好這樣就不那麼趕謝謝你"},{"start":7127.967,"end":7138.795,"text":"那便当的部分要几个,你再问一下主任啊,谢主任他们要几个人去啊,这样可以准备便当,叫我老婆那边准备啊这样其他弄啊,谢谢"},{"start":7154.4,"end":7154.761,"text":"鸡腿"},{"start":7163.436,"end":7164.156,"text":"謝謝大家。"},{"start":7205.631,"end":7205.651,"text":"現在繼續開會"},{"start":7219.431,"end":7225.912,"text":"我們請第12位徐煥瑞我們新北市公會前任理事長"},{"start":7229.838,"end":7256.152,"text":"主席還有我們與會的專家學者還有先進大家早那我想這個口腔衛生人員法這個部分我想大家在我們牙醫界裡面掀起了一點波瀾那我想大家應該全民多了解提升我們整個口腔醫療服務水準大家應該都認同包括我們全年會這個我們毫無問題那這些年來牙醫"},{"start":7257.993,"end":7283.299,"text":"慢慢在這個社會越來越受到重視那大學聯考的成績越來越高這個是有目共睹的但是要設立這個口腔衛生人員法這個制度可能我們必須要多方面評估包括我們教育容量的一個分析健保支付配套及事辦的一個計畫及證據充分也形成我們整個社會的一個共識以後我們才"},{"start":7284.419,"end":7303.019,"text":"進行檢討立法的必要性那我首先歸納成九點我想大家應該都有一些表達我想我可以歸納成九點那第一點就是我們立法應該奠基在完整的人力需求評估目前尚無具體的一個數據可以支持要立這個法"},{"start":7303.459,"end":7325.287,"text":"那任何一個新醫事人員專法的一個制定必須要以實證醫學為基礎那具體回答是不是有人力缺口有沒有缺口規模有沒有未來長期的一個需求三項核心的問題那截至目前為止我找到的資料沒有針對全國性牙科口腔衛生能力的一個推估"},{"start":7326.891,"end":7343.227,"text":"關鍵的專業報告那這個專業報告也必須要涵蓋未來的十年需求長照社區健保公共衛生等面向那因為欠缺商開的這些數據茂然立法可能會衍生能力資源配置的一個失當"},{"start":7343.948,"end":7370.941,"text":"第二點少子化的一個趨勢下應審慎評估學生的一個來源跟就業市場第一個我國面臨嚴峻的少子化這個問題學齡人口持續的下降大宅院校招生普遍困難當立法通過後相關學系未能獲得充足的一個穩定的學生來源那畢業生就業市場有限薪資跟升遷制度不明恐將形成有這個專法"},{"start":7371.901,"end":7391.312,"text":"但是欠缺人才不僅浪費我們的教育資源也沒有助於解決我們實際的一個招呼需求那這個是跟大家做一個報告那第三點就是職涯的一個發展跟支付制度尚未明確難以吸引人才投入以目前的一個草案對口腔衛生人員的職業範圍健保支付獨立職業與否"},{"start":7396.475,"end":7420.03,"text":"的一個編制 長照體系定位等經過具體的規範那學生選填這個志願大部分都是以什麼就業保障發展前景為首要考量那如果相關的配套措施多沒有的話即使你立了法也沒有辦法有實質的一個工作機會那我想沒有辦法有效的導入人力的投入"},{"start":7420.53,"end":7437.495,"text":"那第四點需求增加不等於一定要新增這個醫事職類那我們優先評估現有的人力在訓練機構的一個機制那高齡化跟預防醫學確實是需求這個是事實的但是為"},{"start":7438.895,"end":7462.199,"text":"我們必須是不是一定要新增這個醫事人員專法因應這個還有討論的空間那我們建議優先評估現有的牙醫師牙醫助理護理師長照人員及公衛的護理師透過一個教育訓練職能擴充填補這個照護缺口那先行的體制如果可以改善就更不需要立這個專法的一個迫切性"},{"start":7462.759,"end":7483.291,"text":"那第五點 外國制度不宜直接移植 應該考量我國健保跟醫療生態的一個差異那支持者我們常常立法希望引用有日本 韓國 美國等國的制度但是各國的一個醫療保險制度在牙醫助理養成職業模式及人口結構 均跟我國不一樣"},{"start":7484.011,"end":7501.07,"text":"那制度的移植應該要審慎評估健保財務醫療文化及職業環境等在地因素不宜直接複製直接比照那應該要評估它原有的一個教育制度職業授權醫療責任支付制度及人口結構是否可比擬"},{"start":7502.091,"end":7517.366,"text":"那第六點 人口結構變遷將影響我們的牙科需求應該併入我們的政策評估台灣自115年開始人口下降呈現負成長那未來的牙科相關業務需求是不是"},{"start":7518.367,"end":7533.416,"text":"還會增加我是持懷疑的態度在整體牙科市場有可能萎縮的趨勢下若同時新增這個醫事人員供給恐造成人力過剩影響既有的牙醫師職業環境跟醫療資源配置的效率第七點"},{"start":7534.176,"end":7549.279,"text":"支付制度為立法成敗的一個關鍵不如延宕規劃那目前來講草案沒有併同健保長照公共衛生體系具體的一個規劃所以我想這個立法還是有困難那最後一點大概"},{"start":7550.08,"end":7573.109,"text":"第八點就是應該明定醫療責任歸屬確保病人安全我想所有的牙醫醫療行為都是涉及診斷治療計畫感染控制醫療責任那這個是均去高度專業化是要由於牙醫師來處理那第九點就是應該檢討現行制度是否有真的不足再評估是否立專法"},{"start":7573.869,"end":7603.329,"text":"那現有牙科體系多年來已經有牙醫師護理人員牙醫助理相關跨業人員提供口腔照護服務那健保牙科總額這歷年的評估我們的一個體制下是優等的那幾乎都是優那而且我們民眾對牙科的一個服務態度滿意度是達到95%那我想目前的一個服務制度是沒有問題的我們不需要再額外擴充這一方面最後"},{"start":7604.009,"end":7632.729,"text":"口腔健康促進是為了國家重要的一個衛生政策那也還接向來生的積極參與跟支持但是以目前涉及醫療體系交易資源財務支出病人權益等多種層面影響深遠在少子化跟高等教育招生困難的結構挑戰下更應秉持審慎的態度先完成完備的評估跟試辦再行立法這個路徑那期盼貴部跟各位委員"},{"start":7634.171,"end":7644.8,"text":"專家學者 以證據為基礎 以病人安全為核心 領據社會公式為國家醫療資源配置做出最樸實的決策 謝謝接下來請第13位 蔡鵬輝顧問"},{"start":7663.033,"end":7685.739,"text":"主席 各位委員 各位專家 大家好我是台灣特殊需求口腔專科醫師的顧問我先講我的背景我們這個學會是2005年成立的所以成立起來已經有21年了 第一個第二個呢 我是在2006年不是 2006年到日本去學習我念了子學博士"},{"start":7691.7,"end":7714.45,"text":"也了解到日本對口腔衛生室口腔衛生室的制度在日本是怎麼樣的完整然後我們講就針對這個議題來講事實上這個議題106年之前早就開始一直在醞釀但是每一次都是很不好的結果為什麼都沒有得到事前的溝通"},{"start":7715.37,"end":7726.18,"text":"我可以在這裡跟各位講我記得那一次是107年還是106年在台中開全國聯合會大會那個時候各路人馬接在我手上的LINE裡面都告訴說我們要做什麼做什麼甚至有"},{"start":7737.185,"end":7754.477,"text":"有所謂違法的醫療行為那這樣是告訴我們什麼就是說他們沒有事先溝通全國最大亞伊斯公會代表團體是全國聯合會你到全國聯合會要提一提可以你就來講"},{"start":7755.731,"end":7772.256,"text":"都不講 都是這樣偷偷摸摸 這樣拱一下 拱一下這種情形對我們的制度的建立是不對的 是不對的 第一個第二個 我們知道制度要建立 一定要評估我想剛才很多與會的都講過了 很好"},{"start":7773.612,"end":7787.577,"text":"我還是提一點我們要正確的溝通溝通越清楚越完整他的責任制度越清楚那這樣子醫生也安心大家也安心那醫療制度就完整"},{"start":7788.618,"end":7813.841,"text":"面對這個我們這個學會成立二十多年來我們每一次都要求各方的學者來與會參加可是我講最簡單有沒有口腔衛生師有沒有口腔衛生學系的畢業學生來完全沒有你口頭講一套事實上做一套這是不對的所以就是放下你的身段然後好好跟牙醫師談"},{"start":7816.072,"end":7827.899,"text":"我最後再講一句 這個制度是要建立的 但是不是這樣建立的是要完整的建立 這樣才會對得起像今天主席召開這樣的公聽會那以上就是我的報告 謝謝好 謝謝蔡同飛顧問接下來請第14位范乾信主任"},{"start":7840.783,"end":7860.328,"text":"主席 各位現場嘉賓我們是代表台南法蘭恩祖公醫院牙科部但我現在的身份也是台灣特殊需求者口腔醫學科專科醫學會的理事長現任的理事長 我們是專科醫學會的理事長那我們先講就是我們站在我們學會立場我們是支持制度的建立那因為最終受惠的一定是病人"},{"start":7861.028,"end":7888.451,"text":"我們在我們學會裡面其實也做了蠻多的偏鄉醫療服務以及很多的居家牙醫療服務全台灣現在有大概162位的居家醫療服務的牙醫師在我們學會就佔了將近4成以上我們的學會辦了很多的活動 課程我們也去跟日本的老人口腔醫學會還有聲音障礙學會做姐妹會的一個交流這部分都是在我們學會裡面都是希望我們把我們這些對於高齡照護偏鄉弱勢以及"},{"start":7889.451,"end":7910.844,"text":"這些特殊需求的病患的一個弱勢族群的一個照護品質做到最好那所以任何的醫療制度的改革最終都是應該以提升我們的口腔醫療為的目的為主要的一個最重要的一個部分那目前我們台灣的醫療需求對於人口老化慢性疾病的增加還有口腔照護人類的需求是增加了非常的多那我們必須要建立在專業的分工"},{"start":7911.284,"end":7928.623,"text":"那提升醫療品質的制度才是我們必須要推動的一個主軸的一個部分而團隊的分工合作不管是增加不是增加某一個職業而是有一個好的一個團隊像我們在醫院裡面我們不管要照顧吞嚥照顧的病患我們都是一個組成一個團隊那我們定期都會開會我們會有meeting"},{"start":7930.945,"end":7951.076,"text":"跨領域的一個合作一個報告的部分這些都是讓我們的整個團隊完善那所以只要我們是支持制度一個建立的支持的部分那任何制度必須完成三件事情第一個就是病人的安全能夠有保障那業務分明能夠有法律責任清楚的一個部分那我們支持是口香"},{"start":7951.716,"end":7975.288,"text":"提升口腔醫療的健康 支持增加照護的能量也支持跨專業團隊的合作 也支持人才的培育我們更支持在安全的一個品質之下我們對病患的照顧是不能夠妥協的我們在台灣現在有一萬七千牙醫師在日本有十萬五千名牙醫師他們的口腔衛生師目前大概是三十三萬人所以大概是一比三"},{"start":7975.808,"end":8003.76,"text":"那我們在台灣如果需要這樣的人力的話我們大概要一萬七千個牙醫師大概要有五萬個口腔衛生人員才會足夠那目前的量能其實也是不太夠的所以在這個部分可能要再請教育單位還有我們的那個指導單位能夠在教育培育的部分能夠多多幫忙那我們其實在醫院端我們其實也長期跟口腔衛生學系合作我們有跟仁德還有新生以及更新我們有成立"},{"start":8005.32,"end":8031.353,"text":"專班的部分也是他們畢業之後就可以來我們醫院做很好的一個實習然後他在就學當中呢他每個每個學期會來當志工那我們會給他一個很好的一個教育訓練那當然這些都是為了我們在醫院我們在的病人的安全還有專業分工的情況之下去合作的那當然在在學會立場我們最終還是以病人的安全為優先的考樣那我們也是支持這樣的一個制度的建立謝謝"},{"start":8034.48,"end":8039.543,"text":"好謝謝方剛縣主任接下來請第15位藍文謙副教授"},{"start":8050.691,"end":8076.187,"text":"主席 各位委員 各位先進 大家好我是德育護理健康學院口腔衛生照護系主任藍文謙我們其實在106年的時候已經討論過這個法已經討論過很多的一個部分所以在接下來這幾年的部分其實我們整個口衛的相關的這些科系老師 學者我們都在做每年的共識 共識營"},{"start":8077.688,"end":8099.655,"text":"那相關的一些像醫療技術或各方面的部分我們都是尊重牙醫師的一個配套所謂的指示下來做這些行為的所以沒有所謂的這些醫療行為的問題包括洗牙、撥過風點在我們的招生檢查裡面也都不會提到像這樣的一個訴求來吸引學生"},{"start":8100.475,"end":8122.295,"text":"那我們也確認說這些共識營的內容也是希望說當未來的口味師或者說口腔衛生人員的部分是否能夠有一個更好的機會跟我們的牙醫師共同的合作那立這個法的一個部分也是希望說剛剛很多學者很多專家也提到很多的需求端的部分跟所謂的這個現實面的一個問題"},{"start":8124.637,"end":8136.648,"text":"那亞歷斯的部分希望他們應該說希望亞歷斯人正面來看這樣的一個專法的醫事人員法的部分是協助我們亞歷斯來做更好"},{"start":8138.117,"end":8158.493,"text":"保障我們病人安全跟保障我們這些民眾的一個健康的部分包含了現在的健康促進跟預防醫學的部分在我們學校端的部分我們學校有護理系有高齡照顧那這樣的一個部分也是希望維持或者建立我們國人的健康的一個角色"},{"start":8160.735,"end":8178.896,"text":"那口味的部分其實在我們的這個學生畢業之後其實他們也有一點茫然就是在口味師這樣這個部分一直沒有辦法確定那也讓在協助醫師的這個部分他們也是會有一些疑慮"},{"start":8179.597,"end":8207.451,"text":"那我們剛剛也聽到很多亞伊斯公會的前輩提到的所謂的這個牙注的部分牙注的部分其實在我們的一個這個建制下其實我們是希望說可以讓它更合理化不要再侵犯到所謂的這些所謂的這個灰色地帶那也希望說未來的部分在口味施法的這個建制之下可以維持病人安全跟這個民眾的健康以上 謝謝"},{"start":8211.253,"end":8216.378,"text":"謝謝藍文謙副教授 接下來請第16位 劉育翔執行長"},{"start":8251.386,"end":8265.487,"text":"各位好我是那個全國聯合會法定制度委員執行長劉育祥那我先講幾個大方向大方向是先講到我想先定義一下"},{"start":8266.741,"end":8292.263,"text":"牙科雖然有一個校外叫做牙醫師不是醫師啦但是我要講的是即使我牙醫師的執照一個醫科畢業的學生也沒有辦法來做我牙科所以我在醫師法裡面我們是一個算是一個專門科別那今天談到口腔衛生師我想請可能要請政府請立法委員思考給我們一個解釋他是不是牙科護理師"},{"start":8293.325,"end":8318.843,"text":"他如果是牙科護理師因為現在我們看到各個草案的工作範圍其實工作範圍長照的部分是非常新的東西先講醫療工作範圍是所有醫事人員最重視的在立法裡面最重視的舉個例子所謂的醫事人員應該是碰得到患者的醫療從業人員醫療業務的話自然有去定義"},{"start":8322.793,"end":8349.017,"text":"那當時在我們牙科看到的牙體技術師法裡面牙體技術師在立法的時候我們就曾經質疑過牙技師碰得到患者碰不到患者他要以死人的身分我就以這個做例子碰得到患者所以我們牙醫師不得已在當時牙體技術師法的工作範圍裡面我們寫了四個字叫做在口腔外"},{"start":8350.871,"end":8373.15,"text":"所以各位可以從這裡只看到工作範圍今天要談到口腔衛生師的話他share了我們不要想說搶奪他分享了share了其他什麼樣的醫事人員的工作範圍我們可以看到在最近的版本蘇清泉委員提出的第15項工作範圍裡面他幾乎是照挪用的護理人員"},{"start":8374.091,"end":8397.83,"text":"護理人員法第24條護理人員法第24條就已經可以堂而皇之再延伸出一部專科護理師在醫師監督之下的業務法規那一個口腔衛生學科系的要來做牙科護理師他在護理上面的訓練有多少那這是第一個我要提出再來第二個就是"},{"start":8399.209,"end":8423.096,"text":"再來第二就是我們看到這一張這張是剛剛我們秘書長有報告過衛福部治寒教育部簡單來說就是說屬個案身體照顧照顧之服務非屬醫療業務行為所以口腔衛生學系的學生們畢業之後如果要進長照你考照顧研就可以了"},{"start":8425.406,"end":8442.163,"text":"剛剛有陳主任提到說公衛司法因為在口衛法立法的這個過程裡面我們很緊盯著其他的一些立法的這個案例公衛司法立法的時候他避開了醫事人員他不是醫事人員"},{"start":8445.186,"end":8462.266,"text":"再來就是我們希望立院衛福部剛剛提到人數的問題立了法 希望這些學生們口腔醫院學系的學生一年大概以400人左右成長牙醫師一年大概也差不多是400人"},{"start":8462.966,"end":8480.098,"text":"經過超過30年的培訓現在亞伊斯社會1萬7千人當然這中間有年齡的新陳代謝所以我們可以估計從106年立法之前號稱10年10年那時候成長的口腔衛生學系的人員當時好像還沒有一些其他的比如說新生素素人有了"},{"start":8481.212,"end":8504.93,"text":"在這樣一個人口成長的人數成長的情況下立了這個法招募一個不到五千人的部隊想要去囊括長照想要去囊括不要講長照講醫療我們的我們出估五六萬人的助理這個汰換率即使你可以做醫療輔助行為我覺得人數上先講人數那為了"},{"start":8506.229,"end":8511.588,"text":"五千人不到的一個小部隊去立法立了法之後如果你不照常照我這個法可以撤的回來嗎"},{"start":8514.335,"end":8541.901,"text":"那這是我要講的所以我希望衛福部如果要討論到牙醫醫療這一塊的話請先召會勞動部依照現在牙醫院所醫院診所所投保的勞保人數初估全國大概有多少牙住如果你都不知道你會影響到多少人那你要來談立法先不要講共識我覺得在量上面在quantity上面先給我們一個答案"},{"start":8542.501,"end":8565.646,"text":"先給我們一個調查好這是第一點再來的話好這個106年的時候立法其實是軒然大波那個時候考試委員周玉山他就曾經講過這一段術本席直言這就是國考氾濫國外的口腔衛生室能夠治療病患內容為洗牙拍攝X光臨時甲殼製作牙周病基本化除素等"},{"start":8567.57,"end":8592.481,"text":"目前我國的牙科助理其實我們現在已經把牙科助理因為他非醫事人員所以我們已經把他的工作範圍已經非醫療行為已經訂出來了那我就請問口腔衛生學系的工作範圍在衛福部開會的時候有一個東西叫做叫做輔助放射線治療依照現行的韓式規定即使是護理師也不能夠在牙科拍片"},{"start":8593.697,"end":8617.534,"text":"你要談到X光的話他在魏福珀解釋是一個X光是拍攝屬連續性行為也就是說從擺片調整機器到成像都是要醫師或放射師去做那請問在我們的醫療場域裡面口腔衛生學系要如何突破這一關這就是我們一直在聲明的"},{"start":8619.294,"end":8642.824,"text":"部長在跟我們牙醫溝通的時候說在106年107年的時候跟我們溝通的時候說以前能做的立了這個法之後以前能做的以後還是能做以前不能做的以後還是不能做那為什麼牙醫師你怎麼能夠期望牙醫師會有一個共識在一個現況沒有改變的情況下去支持這個立法"},{"start":8644.256,"end":8661.735,"text":"那再來的話這一張我們希望能夠看到的是這是106的時候我們看到所謂的對學校的好處這些學分是要錢的但是牙醫助理以他們的學經歷坦白講會念書大概也不會想當牙醫助理考試不會過超過50%的錄取率我們認為達不到那"},{"start":8665.822,"end":8678.761,"text":"5到6萬人的押注考不過口腔衛生師10年條款之後又只有口腔衛生學系可以考這不是招生利益這是什麼所以我們要強調就是周玉山委員講的對"},{"start":8682.531,"end":8699.106,"text":"這個國情不同橫向移植國外的制度忽略收費與工作內容台灣與歐美差異甚大是否適當本行程歸納影響民眾權益越高者市值越高者以及利益團體越強者國考的硬考及格門檻也越高草案的口腔衛生是"},{"start":8701.629,"end":8720.644,"text":"對病患權益並無影響牙科助理的薪水也很難因此提升主要是以國考之名提高特定團體的收入顯非國考的目的國考為國舉財不是讓利益團體發財請立法院在意這個是當時周玉山委員所說的那"},{"start":8722.779,"end":8736.086,"text":"再來就是講韓式95年的時候說屠佛是醫療輔助行為106年軒然大波掀起之後衛福部趕快發了一個韓式洗壓屠佛無辜奉田依舊是屬於醫療行為"},{"start":8738.533,"end":8763.401,"text":"那這個我們真的是這剛剛已經聲明過了所以以上先談到大範圍我們希望能夠幫我們調查人數能夠告訴我們他是不是牙科護理師然後能夠跟我們說在我們的醫療場域裡面立了這個法有什麼東西是我們身邊的助手以前不能做以後可以做的 以上謝謝"},{"start":8767.924,"end":8778.109,"text":"好,謝謝劉玉祥執行長的發言學者專家及委員均已發言完畢請行政機關做整體回應我們先請考選部綜合規劃師"},{"start":8794.069,"end":8815.15,"text":"謝謝主席 還有各位好 聽了這麼多學者專家的發言那本部是直視那個國家考試的單位那如果衛福部在經過跟各界協調之後 之後有確立說有口腔衛生師法會設立的話 本部會依職責來辦理考試 以上"},{"start":8818.905,"end":8823.712,"text":"好 謝謝我們黃玉如專委接下來請教育部高等教育師專門委員吳志維"},{"start":8833.238,"end":8854.524,"text":"主席各位委員先進大家好那有關今天這個口腔衛生人員法的立法公聽會下一步主要是針對人才培育的部分來做說明那目前呢在大專校院設有口腔衛生學系或學科的總共有"},{"start":8855.725,"end":8866.524,"text":"台北醫學大學 高雄醫學大學美和科大等七所大專校院每年大概培育400名左右的學生"},{"start":8870.27,"end":8884.382,"text":"基於教考訓用的這個原則有關這個醫事人力的這些人力供需主要是由這個目的事業主管機關那以醫事人員"},{"start":8885.903,"end":8910.953,"text":"為例的話那就是衛福部部裡面在核定相關系所或增設系所或調整系所以及核定招生名額都會徵詢開會的時候也會邀請這些目的事業主管機關一起來開會那有關這個今天討論的這個口腔衛生人員法"},{"start":8911.653,"end":8923.591,"text":"的這個相關事項本部尊重衛福部的政策規劃以上說明好謝謝吳志偉專委接下來請國衛院健康科學研究所所長吳鴻義邱鴻義"},{"start":8936.366,"end":8958.325,"text":"主席還有各位專家還有那個次長大家好那國務院目前有接受國家市的一個委託我們會執行一個口未濕的未來的十年的人力的規劃一個計畫裡面那在這個計畫裡面呢大概我們會做三件事情一件事情就是我們會去review國內外這個制度目前執行的狀況"},{"start":8959.366,"end":8963.551,"text":"剛剛聽了各位的一些意見我們會針對這些狀況裡面有怎樣的配套以及當地的環境以及跟臺灣之間有怎樣的差異我們需要做一些比較整身的評估所以我有聽到大家覺得直接落地到臺灣是不合適的所以我們會特別注意這件事情"},{"start":8978.61,"end":8982.712,"text":"那第二件事情就是國內過去接受惡戶的委託其實執行了臺灣包括西醫的各大專科甚至連福利體系的設公司我們都有做能力的推估那這個推估的模組目前在"},{"start":8994.919,"end":9014.868,"text":"整個理論模式上還蠻完整而且推估出來在這些西醫的專科上面大家也都覺得這個正確度蠻高的所以未來我們也會針對這樣的模組裡面去評估假定這個以長遠十年內我們對於國人口腔的健康的需求上面來講這樣的人力的需求大概差不多是多少"},{"start":9015.888,"end":9043.051,"text":"那第三個最重要就是我們會跟各Stakeholder比如說牙科口味以及法政界這邊大家好好討論一下就像大家今天談的他的職長在哪些希望能夠多收集意見把他們的職長在大家的最大共識下能夠呈現出來那我相信這樣的一個計畫的執行下面未來對於是否推動這個立法以及立法是否要通過我想大家會有比較"},{"start":9044.272,"end":9069.878,"text":"一個好的科學證據擺在前面那我希望國會能夠協助在推動國人健康的這塊事情能夠盡一點力量也能夠讓所有關心或者是在照顧口腔衛生的所有的職類呢大家都能夠feel comfortable然後覺得說這件事情是大家願意一起來執行的這是以上國會的報告 謝謝謝謝邱鴻義所長接下來請口腔健康師師長張雍敏"},{"start":9080.334,"end":9103.485,"text":"主席及各位莊次長還有各位與會的專家學者大家午安我想口腔是這邊就三點報告第一點當然是感謝召委舉行今天的公聽會因為今天的議題涉及到人民的健康醫療品質專業非公及人力培育是一個非常重要的公共政策值得大家充分討論這是第一點第二點"},{"start":9104.225,"end":9126.585,"text":"當然我們也了解我們今天也聽到了各界對口腔衛生人員制度仍然有不同的看法譬如說口腔衛生學系希望說能夠建立專業制度然後再來第二個牙醫界他是關心專業分工職業責任還有一些醫療品質護理界當然也是關心是否跟既有的護理議題有重疊我相信這些都是非常重要公共議題我們也都聽到了"},{"start":9127.566,"end":9148.903,"text":"再來第三點其實對衛福部來說我們最重視的是讓如何讓國人的口腔獲得更好的健康照護我們一定會尊重各專業團體所提出來的建議我們這些建議剛剛國務院邱首長也講到我們都會指我們已經委託國務院做了一些研究計畫我們這些研究計畫都會讓國務院也都聽到我們都會好好的充分討論"},{"start":9150.004,"end":9172.901,"text":"然後最後其實口腔衛生人員的制度他到底要不要建立要不要建立或是如何建立絕對不是單一專業的勝負我們應該回到如何要我們真正我們應該是要回到以國民口腔健康病人安全為最重要的依歸當然實證基礎是很重要社會共識那但是應該我們我們就要首要的考量以上謝謝張師長接下來請衛生福利部常務次長莊仁祥"},{"start":9184.029,"end":9210.075,"text":"主席還有各位專家委員大家好那今天非常感謝教委召開今天的一個會議讓我們各個相關團體可不可以一起表達這意見所以未來我想外部也會扮演類似的角色希望能夠增加雙方的對話還有一些相關的團體大家一起針對未來我們的希望的這個法是不是要繼續執行去立法"},{"start":9210.595,"end":9236.594,"text":"那我們當然現在有國務院這個邱所長這邊會幫我們針對國外的一些經驗然後來跟國內現況狀況做一些規劃那未來我們希望說大家可以坐下來針對如果真的要立法的話那針對這個工作項目還有這個工作場域的部分大家可以再好好的談一下那往就是有共治的方向進行 以上謝謝謝謝中央次長"},{"start":9237.415,"end":9263.625,"text":"委員王睿敏所提書面資料列入公報記錄做一下結論依據立法院之前刑事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公聽會報告作為審查特定議案之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以及與會的政府機關代表學者專家參閱"},{"start":9265.127,"end":9270.402,"text":"今天非常感謝各位的出席並提供寶貴意見本次公聽會到此結束 散會"}]}},"supported_relations":[],"relations":[]}