{"error":false,"id":["152001"],"data":{"IVOD_ID":152001,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/152001","日期":"2024-05-02","會議資料":{"會議代碼":"委員會-11-1-26-14","會議代碼:str":"第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議","屆":11,"會期":1,"會次":14,"臨時會會次":null,"種類":"委員會","委員會代碼":[26],"委員會代碼:str":["社會福利及衛生環境委員會"],"標題":"第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議"},"影片種類":"Clip","開始時間":"2024-05-02T09:13:36+08:00","結束時間":"2024-05-02T09:24:13+08:00","影片長度":"00:10:37","支援功能":["ai-transcript","gazette"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/6f015fe8e6787db166eac3e41394593ed575e50b9cd8685a55be169921a0a7172c3008b14a89fbfd5ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"陳昭姿","委員發言時間":"09:13:36 - 09:24:13","會議時間":"2024-05-02T09:00:00+08:00","會議名稱":"立法院第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議（事由：審查\n一、委員王育敏等19人擬具「全民健康保險法第六十二條條文修正草案」案。\n二、委員蘇清泉等28人擬具「全民健康保險法第六十二條條文修正草案」案。\n三、國民黨黨團擬具「全民健康保險法第六十二條條文修正草案」案。\n【以上議案，如經復議則不予審查】）","gazette":{"lineno":160,"blocks":[["陳委員昭姿：（9時13分）謝謝主席。有請部長。"],["主席：好，請薛部長。"],["薛部長瑞元：委員好。"],["陳委員昭姿：部長早。部長，我今天的質詢會高度仰賴29年多來來自健保署的聘書，我認真的出席每一場會議所累積的專業知識跟經驗，在這裡跟您做詢答，如果你認為我那29年是錯的，你公然在這地方講，甚至我擔任召集人，你當然也大可以把我所有的發言廢除，你也可以校正回歸，把我所做的決議全部廢除。","部長，我第一個問題，前幾天我有質詢衛福部桃園醫院的院長缺，這麼重要、唯一有機會成為醫學中心的醫院，可以懸缺了22個月的院長一職？是否為王必勝而留？這是醫界傳說的，您說沒有。"],["薛部長瑞元：沒有。"],["陳委員昭姿：這件事我們繼續等著看。"],["薛部長瑞元：好。"],["陳委員昭姿：接下來，不好意思，還是醫界傳說，因為我的消息是非常廣泛的。上次醫院評鑑，報載原本萬芳醫院是降為準醫學中心，台北慈濟是要升為醫學中心，但是因為這個傳說很久以後，整個公布時間延宕到大選過後，而且修改遊戲規則，最後萬芳醫院勉強沒有掉到準醫學中心，安全上樁，台北慈濟如所言就成為醫學中心，雙和醫院又在爭議中從準醫學中心變成了醫學中心，最後臺大新竹醫院也加入進來，總共一口氣在數目上增加了3家醫學中心。醫務管理協會理事長說，這是不是為某個門系、某個派系，究竟是誰受益，一下子增加3家醫學中心，您說這是臆測之詞。可是部長，您即將在光榮卸任以後要回到爭議中成為醫學中心的雙和醫院，你要在那邊服務，你等於是帶著一份非常厚重光榮的禮物回到母院服務，我覺得太巧妙了，這跟王必勝的部分其實是五十步和百步之間，請院長參考，請部長參考，部長，我差點幫你升官，也是有機會的。","每200萬人口應該設立一家醫學中心，這是醫療網的規劃，我覺得臺大新竹升格是合情合理，因為那個地方人口增加了，人數增加了，但是臺北區才750萬人，根據醫療網規劃，200萬人一家醫學中心，應該4家就夠了，但是部長知道現在有幾家嗎？10家。所以部長，你要捫心自問，新增醫學中心到底是要提升醫療品質，還是為了幫助你光榮歸建某派系的醫院？大家可以想想看。部長，我第一次質詢的時候問你醫學中心還不夠多嗎？我們在健保實施之前是很正常的醫療構造，地區醫院大概600家，醫學中心十幾家等等，二十幾年後變轉成這個怪模型，我還問你地區醫院家數將近腰斬變成300出頭，這樣的家數你覺得OK嗎？您當時回答我還有門診，堂堂部長怎麼會認為門診和地區醫院是服務同一群病人？醫院等同診所嗎？我覺得部長的回答很奇怪，而且如果你要談診所，我就要談社區藥局。","衛福部不顧醫療網計畫，帶頭違規、濫設醫學中心，我想請問部長，如果未來中區、南區出現一樣的理由，什麼辨識度有問題，你是不是也要一併都增額錄取呢？你如果不做就是雙標，做了就是惡化分級醫療！所以這個決定根本就沒有經過全盤考慮，導致的潛在後遺症很大！部長！"],["薛部長瑞元：我可以回答嗎？"],["陳委員昭姿：你還能回答什麼？可以，如果你覺得我是對的，你就可以繼續回答我，如果你認為我是錯的，你可以說我講的都是錯的。"],["薛部長瑞元：因為我本人就是從雙和醫院借調過來，當然我如果卸下職務之後，一定必須要回去歸建，但是回去歸建也不見得就是在……"],["陳委員昭姿：我祝福你回到醫院，但是在衝突當中、爭議當中……"],["薛部長瑞元：關於醫學中心的家數，其實從委員在講醫療網規劃的時候……"],["陳委員昭姿：部長，你不要跟我說別人沒有遵守，所以你就不遵守，我覺得這不是部長級的話。"],["薛部長瑞元：不是，一開始的時候，200萬人一家醫學中心就是一個參考標準，因為在當時臺北區就已經8家了，早就超過了。"],["陳委員昭姿：但是你繼續加碼！部長，不好意思！我們繼續往後講，我大概知道你要談什麼，我瞭解。","指示藥違法給付30年，部長有話講嗎？健保法第五十一條第四款規定，指示藥不屬於健保給付範圍，部長，你不要再跟我說前人不守法，我也跟著不守法，這個是小混混講的話，不要用部長級的高度跟我這樣回答。"],["薛部長瑞元：沒有，這部分必須要漸進的，不管任何制度在調整的時候……"],["陳委員昭姿：漸進非常好！部長，搞不好你還沒有我熟，我們來看看怎麼漸進法，來看這個圖，2005年4月侯署長宣布將不再給付指示藥，當時制酸劑所謂的胃藥和維他命成功退場。指示藥中所謂的感冒藥，因為感冒藥很多是非處方藥，所以就卡住了，卡住了之後2014年健保署當時也做了一些配套措施，我今天沒有辦法在這個地方分享，我都有參與。2014年3月健保署宣布依法不再給付指示藥，年底會完成，也是空頭支票，2014年12月二代健保總檢討以及2015年全國藥品政策會議說非處方藥退出，保大不保小，2017年健保會提出要回歸法條，但是這些都是一場空。有人說指示藥只不過一、二十億，影響不大，部長，我不知道你瞭不瞭解，這種見解叫見樹不見林，指示藥不給付事實上是所謂的小病症，小病改變就醫行為，不要動輒就上醫院。因為根據健保署統計，如果每個人每年少看1次病的話，就可以省掉370多億點，所以是不是要回到所謂的自我照顧？光簡單的小病症，俗稱感冒，一年就將近300億點，包括新藥、血友病、愛滋病、罕病加起來也沒那麼多，所以現在我們的重病出問題。我要告訴部長，今天我可以用兩句話來形容臺灣的醫療現況跟困境，小病保得好、大病大缺口，這是我們要的健保嗎？這符合社會保險的精神嗎？小病保得好、小病保得滿、大病大缺口，請部長思考。"],["薛部長瑞元：這個部分我不贊成，現在大病難道都沒有保嗎？"],["陳委員昭姿：癌藥只有保障30%。"],["薛部長瑞元：癌藥是另外一個問題，它是新進的藥進來的太慢。"],["陳委員昭姿：部長，我們再來看看醫療指標，我們現在輸人家輸得很慘。"],["薛部長瑞元：我們最近CEOWORLD才第一名。"],["陳委員昭姿：來看以藥養醫，以藥養醫是很不得已的，因為給付不夠，所以今天大家才會提出點值，然後不得不用其他方式來彌補醫院一些不足的地方，部長，我可以再請問你一次嗎？你的數字還一樣嗎？藥價差有多少？您大腦中的數字，藥價差有多少？"],["薛部長瑞元：差不多在500億，但是總藥價的話是2,300億。"],["陳委員昭姿：500億還是低估了。"],["薛部長瑞元：不能隨便講低估就低估喔！"],["陳委員昭姿：是你要告訴我，我已經查過了。"],["薛部長瑞元：我就跟你講500億。"],["陳委員昭姿：不是我要告訴你，你要負責告訴我，其實石署長知道，但是……"],["薛部長瑞元：對，我就說500億，你如果不同意這個數字，你要提出來。"],["陳委員昭姿：我不同意這個數字，你在反質詢！"],["薛部長瑞元：不能隨便講這樣就是低估。"],["陳委員昭姿：關於健保醫療點值，大家都支持醫療點值要提高，但是我們要有一些配套作法，所以也建請部長思考一下，趁著這次點值調整是不是好好跟醫界溝通，提出一些比較進步的支付制度，譬如DRGs、論質計酬，還有所謂以結果論來當基礎的包裹治療。部長，我要告訴你，臺灣真的還進步嗎？"],["薛部長瑞元：這個現在都已經在做了。"],["陳委員昭姿：臺灣什麼都輸，不只OECD，連韓國都輸得很慘，癌症死亡率輸了10%，5年存活率，人家是70，我們是60，新生兒死亡率也是最高的，糖尿病合併症死亡率也是最高的，不要再讓國人以為我們醫界首列前茅的假象。"],["薛部長瑞元：當然這都有改進的空間。"],["陳委員昭姿：我不會說醫生不好，而是醫療投資不足，保障醫療點值、合理藥價差要同步進行，我同意你把長照加入整個計算裡面，但是我上次也提到了，新的科技、新的醫療進來對長照有幫助的部分、費用減省的部分，也是要一併考慮。有關藥價差部分，我覺得日本的方式可能是比較理想的，先有一個合理的藥價差，它先猛猛地降了一波再慢慢降，再停一下，然後再慢慢降，最後配合現在的點值提高，就回到大家不再仰賴藥價差來作為醫院營利最容易仰賴的因素之一，部長，這樣可以嗎？最重要的是整個藥價的部分透明化、可預測。"],["薛部長瑞元：所有這些改革都是我們必須要逐步來進行，其實也都有。"],["陳委員昭姿：部長，已經30年了，逐步再一個30年。"],["薛部長瑞元：30年是每一個階段、每一個階段逐步的改，你不能說30年，然後要跳到現在，要一次斷崖式的……"],["陳委員昭姿：跟代孕法案一樣再等30年嗎？30年都不做，每個部長都不做就會這樣跳躍啊，如果每個都做一點，就不會是這樣子。"],["薛部長瑞元：當然，本來就是，所以我們現在也在做。"],["陳委員昭姿：我沒有看到效果。"],["主席：接下來請陳菁徽委員質詢。"]],"agenda":{"page_end":242,"meet_id":"委員會-11-1-26-14","speakers":["王育敏","蘇清泉","陳昭姿","陳菁徽","林月琴","黃秀芳","邱鎮軍","涂權吉","廖偉翔","劉建國","王正旭","林淑芬","林德福","賴士葆","李彥秀","盧縣一","楊瓊瓔","黃國昌","賴惠員","陳瑩","楊曜"],"page_start":167,"meetingDate":["2024-05-02"],"gazette_id":"1133901","agenda_lcidc_ids":["1133901_00004"],"meet_name":"立法院第11屆第1會期社會福利及衛生環境委員會第14次全體委員會議紀錄","content":"審查一、委員王育敏等18人擬具「全民健康保險法第六十二條條文修正草案」案；二、委員蘇清\n泉等27人擬具「全民健康保險法第六十二條條文修正草案」案；三、國民黨黨團擬具「全民健康\n保險法第六十二條條文修正草案」案","agenda_id":"1133901_00003"}},"transcript":{"pyannote":[{"speaker":"SPEAKER_01","speaker_name":"陳委員昭姿","start":0.09846875000000001,"end":1.22909375,"speaker_score":0.947},{"speaker":"SPEAKER_01","speaker_name":"陳委員昭姿","start":7.523468750000001,"end":8.957843750000002,"speaker_score":0.947},{"speaker":"SPEAKER_01","speaker_name":"陳委員昭姿","start":9.227843750000002,"end":10.15596875,"speaker_score":0.947},{"speaker":"SPEAKER_00","start":17.64846875,"end":18.22221875},{"speaker":"SPEAKER_01","speaker_name":"陳委員昭姿","start":18.27284375,"end":29.106593750000002,"speaker_score":0.947},{"speaker":"SPEAKER_01","speaker_name":"陳委員昭姿","start":29.34284375,"end":45.03659375,"speaker_score":0.947},{"s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bicyn 您當時回答我說還有門診啊,但是"},{"start":220.349,"end":247.03,"text":"况々部長怎麼會認為門診跟地區醫院跟醫院是服務同一群病人嗎?醫院等同診所嗎?部長您的回答我就覺得很奇怪而且如果你要談診所我就要談社區藥局了。好那衛福部不顧醫療網計劃帶頭違規爭亂社醫學中心那我想請問部長如果未來中區南區出現跟一樣的理由什麼辨識度啊什麼有問題那你是不是也要一併都爭額入局呢?"},{"start":247.751,"end":248.212,"text":"我可以回答?"},{"start":265.03,"end":285.879,"text":"你還能回答什麼嗎?可以啊。如果你覺得我是對的,你就可以繼續回答我。如果你認為我是錯的,你就說我講的都是錯的啊。因為我本人就是從雙核醫院這邊戒掉過來。當然我如果卸下職務之後,一定必須要回去歸建。但是回去歸建也不見得就是在...我祝福你回到...也但是這個在這個衝突當中嘛,爭議當中嘛。"},{"start":290.384,"end":295.667,"text":"adequ一開始的時候兩百萬人一家醫學中心就是一個參考的標準因為在當時的時候臺北區就已經八家了"},{"start":313.547,"end":314.508,"text":"只是要不屬於健保給付範圍。"},{"start":329.005,"end":346.018,"text":"那你也部長你不要再跟我說齁前人不守法我也跟著不守法這個是小混混講的話不要用部長級的高度跟我這樣回答沒有這部分就是要必須要漸進的不管任何的制度在調整的時候部長搞不好你沒有我熟喔我們來看看怎麼漸進法喔好來"},{"start":347.059,"end":348.64,"text":"二、國民黨黨團擬具:「全民健康保險法第六十二條條文修正草案案。」案。"},{"start":367.426,"end":373.81,"text":"二、委員王育敏等19人擬具〈全民健康保險法第六十二條條文修正草案．事由〈全民健康保險法第六十二條條文修正草案．事由〈全民健康保險法第六十二條條文修正草案．事由〈全民健康保險法第六十二條條文修正草案．"},{"start":397.125,"end":415.282,"text":"​​​​​​​​​​"},{"start":415.402,"end":442.388,"text":" bicylson 回到這個所謂的自我照顧。那這個我現在講一下。包括簡單的小病症感冒俗稱感冒一年就將近300億點。那加起來就包括心藥、血友病、艾滋病、寒病加起來也沒那麼多。所以現在我們重病出問題。所以我要告訴部長今天我可以用兩句話來形容我們臺灣的醫療現況跟困境。小病保得好,大病大缺口。"},{"start":443.408,"end":457.724,"text":"這是我們要的健保嗎?這是符合這個社會保險的精神嗎?小病保得好,小病保得滿,大病大缺口。好,請部長思考。這個部分的話我不贊成。我們現在大病難道都沒有保嗎?"},{"start":458.609,"end":486.749,"text":""},{"start":487.628,"end":513.522,"text":"您大腦中的數字,要價差有多少?差不多在500億啦。但是總要價的話是2300億。欸,那個500億還是低估了啦齁?不能隨便講低估就低估喔。是你要告訴我,我已經查過了。我就跟你講說500億啊。你要負責告訴我,其實池組長…我就說500億啊。你如果不同意這個數字,你要提出來啊。"},{"start":514.923,"end":532.398,"text":""},{"start":532.458,"end":533.418,"text":"當然這個都有感情的空間啦。"},{"start":560.589,"end":588.166,"text":"�"},{"start":588.166,"end":605.998,"text":""},{"start":606.397,"end":622.165,"text":"部長,這樣可以嗎?我想最重要的是整個要價的部分透明化、可預測。部長,已經30年了。好,逐步。再一個30年嗎?再整個30年嗎?那30年都不做。每個部長30年都不做就會叫跳躍啊。如果每個都做一點就不會是這樣子吧?當然啊,本來就是這樣。所以我們現在也在做啊。我沒有看到效果。好,謝謝部長。"},{"start":637.301,"end":637.529,"text":"三、國民黨黨團擬具"}],"gazette":[{"speaker":"陳委員昭姿","start":"2024-05-02T09:13:36+08:00","guessed":true,"end":"2024-05-02T09:13:37+08:00","text":"謝謝主席。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:13:37+08:00","guessed":true,"end":"2024-05-02T09:13:38+08:00","text":"有請部長。","quality":0},{"speaker":"主席","start":"2024-05-02T09:13:38+08:00","guessed":true,"end":"2024-05-02T09:13:39+08:00","text":"好，請薛部長。","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:13:36.369000+08:00","guessed":false,"end":"2024-05-02T09:13:36.529000+08:00","text":"委員好。","quality":0.667},{"speaker":"陳委員昭姿","start":"2024-05-02T09:13:36.529000+08:00","guessed":true,"end":"2024-05-02T09:13:55.741000+08:00","text":"部長早。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:13:55.741000+08:00","guessed":false,"end":"2024-05-02T09:14:19.979000+08:00","text":"部長，我今天的質詢會高度仰賴29年多來來自健保署的聘書，我認真的出席每一場會議所累積的專業知識跟經驗，在這裡跟您做詢答，如果你認為我那29年是錯的，你公然在這地方講，甚至我擔任召集人，你當然也大可以把我所有的發言廢除，你也可以校正回歸，把我所做的決議全部廢除。","quality":0.871},{"speaker":"陳委員昭姿","start":"2024-05-02T09:14:19.979000+08:00","guessed":true,"end":"2024-05-02T09:14:29.952000+08:00","text":"部長，我第一個問題，前幾天我有質詢衛福部桃園醫院的院長缺，這麼重要、唯一有機會成為醫學中心的醫院，可以懸缺了22個月的院長一職？","quality":0.143},{"speaker":"陳委員昭姿","start":"2024-05-02T09:14:29.952000+08:00","guessed":true,"end":"2024-05-02T09:14:39.925000+08:00","text":"是否為王必勝而留？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:14:39.925000+08:00","guessed":true,"end":"2024-05-02T09:14:49.898000+08:00","text":"這是醫界傳說的，您說沒有。沒有。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:14:49.898000+08:00","guessed":true,"end":"2024-05-02T09:14:59.871000+08:00","text":"這件事我們繼續等著看。好。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:14:59.871000+08:00","guessed":true,"end":"2024-05-02T09:15:09.844000+08:00","text":"接下來，不好意思，還是醫界傳說，因為我的消息是非常廣泛的。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:15:09.844000+08:00","guessed":false,"end":"2024-05-02T09:15:26.571000+08:00","text":"上次醫院評鑑，報載原本萬芳醫院是降為準醫學中心，台北慈濟是要升為醫學中心，但是因為這個傳說很久以後，整個公布時間延宕到大選過後，而且修改遊戲規則，最後萬芳醫院勉強沒有掉到準醫學中心，安全上樁，台北慈濟如所言就成為醫學中心，雙和醫院又在爭議中從準醫學中心變成了醫學中心，最後臺大新竹醫院也加入進來，總共一口氣在數目上增加了3家醫學中心。","quality":0.409},{"speaker":"陳委員昭姿","start":"2024-05-02T09:15:30.193000+08:00","guessed":false,"end":"2024-05-02T09:15:34.595000+08:00","text":"醫務管理協會理事長說，這是不是為某個門系、某個派系，究竟是誰受益，一下子增加3家醫學中心，您說這是臆測之詞。","quality":0.468},{"speaker":"陳委員昭姿","start":"2024-05-02T09:15:34.595000+08:00","guessed":true,"end":"2024-05-02T09:16:06.589000+08:00","text":"可是部長，您即將在光榮卸任以後要回到爭議中成為醫學中心的雙和醫院，你要在那邊服務，你等於是帶著一份非常厚重光榮的禮物回到母院服務，我覺得太巧妙了，這跟王必勝的部分其實是五十步和百步之間，請院長參考，請部長參考，部長，我差點幫你升官，也是有機會的。","quality":0.179},{"speaker":"陳委員昭姿","start":"2024-05-02T09:16:06.589000+08:00","guessed":false,"end":"2024-05-02T09:16:21.258000+08:00","text":"每200萬人口應該設立一家醫學中心，這是醫療網的規劃，我覺得臺大新竹升格是合情合理，因為那個地方人口增加了，人數增加了，但是臺北區才750萬人，根據醫療網規劃，200萬人一家醫學中心，應該4家就夠了，但是部長知道現在有幾家嗎？10家。","quality":0.564},{"speaker":"陳委員昭姿","start":"2024-05-02T09:16:21.258000+08:00","guessed":true,"end":"2024-05-02T09:16:28.204250+08:00","text":"所以部長，你要捫心自問，新增醫學中心到底是要提升醫療品質，還是為了幫助你光榮歸建某派系的醫院？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:16:28.204250+08:00","guessed":true,"end":"2024-05-02T09:16:35.150500+08:00","text":"大家可以想想看。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:16:35.150500+08:00","guessed":true,"end":"2024-05-02T09:16:42.096750+08:00","text":"部長，我第一次質詢的時候問你醫學中心還不夠多嗎？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:16:42.096750+08:00","guessed":true,"end":"2024-05-02T09:16:49.043000+08:00","text":"我們在健保實施之前是很正常的醫療構造，地區醫院大概600家，醫學中心十幾家等等，二十幾年後變轉成這個怪模型，我還問你地區醫院家數將近腰斬變成300出頭，這樣的家數你覺得OK嗎？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:16:49.043000+08:00","guessed":false,"end":"2024-05-02T09:17:20.413000+08:00","text":"您當時回答我還有門診，堂堂部長怎麼會認為門診和地區醫院是服務同一群病人？","quality":0.912},{"speaker":"陳委員昭姿","start":"2024-05-02T09:17:21.133000+08:00","guessed":false,"end":"2024-05-02T09:17:22.935000+08:00","text":"醫院等同診所嗎？","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:17:22.935000+08:00","guessed":false,"end":"2024-05-02T09:17:27.878000+08:00","text":"我覺得部長的回答很奇怪，而且如果你要談診所，我就要談社區藥局。","quality":0.893},{"speaker":"陳委員昭姿","start":"2024-05-02T09:17:29.360000+08:00","guessed":false,"end":"2024-05-02T09:17:43.010000+08:00","text":"衛福部不顧醫療網計畫，帶頭違規、濫設醫學中心，我想請問部長，如果未來中區、南區出現一樣的理由，什麼辨識度有問題，你是不是也要一併都增額錄取呢？","quality":0.905},{"speaker":"陳委員昭姿","start":"2024-05-02T09:17:43.010000+08:00","guessed":true,"end":"2024-05-02T09:17:44.010000+08:00","text":"你如果不做就是雙標，做了就是惡化分級醫療！","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:17:44.010000+08:00","guessed":true,"end":"2024-05-02T09:17:45.010000+08:00","text":"所以這個決定根本就沒有經過全盤考慮，導致的潛在後遺症很大！部長！","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:17:43.751000+08:00","guessed":false,"end":"2024-05-02T09:17:44.192000+08:00","text":"我可以回答嗎？","quality":0.833},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:01.030000+08:00","guessed":false,"end":"2024-05-02T09:18:02.171000+08:00","text":"你還能回答什麼？","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:02.171000+08:00","guessed":false,"end":"2024-05-02T09:18:07.413000+08:00","text":"可以，如果你覺得我是對的，你就可以繼續回答我，如果你認為我是錯的，你可以說我講的都是錯的。","quality":0.95},{"speaker":"薛部長瑞元","start":"2024-05-02T09:18:07.933000+08:00","guessed":false,"end":"2024-05-02T09:18:19.438000+08:00","text":"因為我本人就是從雙和醫院借調過來，當然我如果卸下職務之後，一定必須要回去歸建，但是回去歸建也不見得就是在……","quality":0.939},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:19.578000+08:00","guessed":false,"end":"2024-05-02T09:18:21.799000+08:00","text":"我祝福你回到醫院，但是在衝突當中、爭議當中……","quality":0.895},{"speaker":"薛部長瑞元","start":"2024-05-02T09:18:21.799000+08:00","guessed":true,"end":"2024-05-02T09:18:24.331500+08:00","text":"關於醫學中心的家數，其實從委員在講醫療網規劃的時候……","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:24.331500+08:00","guessed":true,"end":"2024-05-02T09:18:26.864000+08:00","text":"部長，你不要跟我說別人沒有遵守，所以你就不遵守，我覺得這不是部長級的話。","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:18:26.864000+08:00","guessed":false,"end":"2024-05-02T09:18:31.647000+08:00","text":"不是，一開始的時候，200萬人一家醫學中心就是一個參考標準，因為在當時臺北區就已經8家了，早就超過了。","quality":0.833},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:31.647000+08:00","guessed":true,"end":"2024-05-02T09:18:36.192000+08:00","text":"但是你繼續加碼！","quality":0.143},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:36.192000+08:00","guessed":true,"end":"2024-05-02T09:18:40.737000+08:00","text":"部長，不好意思！","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:40.737000+08:00","guessed":true,"end":"2024-05-02T09:18:45.282000+08:00","text":"我們繼續往後講，我大概知道你要談什麼，我瞭解。","quality":0.05},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:45.282000+08:00","guessed":true,"end":"2024-05-02T09:18:49.827000+08:00","text":"指示藥違法給付30年，部長有話講嗎？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:18:49.827000+08:00","guessed":false,"end":"2024-05-02T09:19:13.291000+08:00","text":"健保法第五十一條第四款規定，指示藥不屬於健保給付範圍，部長，你不要再跟我說前人不守法，我也跟著不守法，這個是小混混講的話，不要用部長級的高度跟我這樣回答。","quality":0.771},{"speaker":"薛部長瑞元","start":"2024-05-02T09:19:13.312000+08:00","guessed":false,"end":"2024-05-02T09:19:19.776000+08:00","text":"沒有，這部分必須要漸進的，不管任何制度在調整的時候……","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:19:19.776000+08:00","guessed":true,"end":"2024-05-02T09:19:20.776000+08:00","text":"漸進非常好！","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:19:19.897000+08:00","guessed":false,"end":"2024-05-02T09:19:22.018000+08:00","text":"部長，搞不好你還沒有我熟，我們來看看怎麼漸進法，來看這個圖，2005年4月侯署長宣布將不再給付指示藥，當時制酸劑所謂的胃藥和維他命成功退場。","quality":0.356},{"speaker":"陳委員昭姿","start":"2024-05-02T09:19:22.018000+08:00","guessed":true,"end":"2024-05-02T09:19:41.024250+08:00","text":"指示藥中所謂的感冒藥，因為感冒藥很多是非處方藥，所以就卡住了，卡住了之後2014年健保署當時也做了一些配套措施，我今天沒有辦法在這個地方分享，我都有參與。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:19:41.024250+08:00","guessed":true,"end":"2024-05-02T09:20:00.030500+08:00","text":"2014年3月健保署宣布依法不再給付指示藥，年底會完成，也是空頭支票，2014年12月二代健保總檢討以及2015年全國藥品政策會議說非處方藥退出，保大不保小，2017年健保會提出要回歸法條，但是這些都是一場空。","quality":0.063},{"speaker":"陳委員昭姿","start":"2024-05-02T09:20:00.030500+08:00","guessed":true,"end":"2024-05-02T09:20:19.036750+08:00","text":"有人說指示藥只不過一、二十億，影響不大，部長，我不知道你瞭不瞭解，這種見解叫見樹不見林，指示藥不給付事實上是所謂的小病症，小病改變就醫行為，不要動輒就上醫院。","quality":0.014},{"speaker":"陳委員昭姿","start":"2024-05-02T09:20:19.036750+08:00","guessed":true,"end":"2024-05-02T09:20:38.043000+08:00","text":"因為根據健保署統計，如果每個人每年少看1次病的話，就可以省掉370多億點，所以是不是要回到所謂的自我照顧？","quality":0.222},{"speaker":"陳委員昭姿","start":"2024-05-02T09:20:38.043000+08:00","guessed":false,"end":"2024-05-02T09:20:49.726000+08:00","text":"光簡單的小病症，俗稱感冒，一年就將近300億點，包括新藥、血友病、愛滋病、罕病加起來也沒那麼多，所以現在我們的重病出問題。","quality":0.9},{"speaker":"陳委員昭姿","start":"2024-05-02T09:20:49.866000+08:00","guessed":false,"end":"2024-05-02T09:21:01.130000+08:00","text":"我要告訴部長，今天我可以用兩句話來形容臺灣的醫療現況跟困境，小病保得好、大病大缺口，這是我們要的健保嗎？","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:01.130000+08:00","guessed":false,"end":"2024-05-02T09:21:03.553000+08:00","text":"這符合社會保險的精神嗎？","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:03.553000+08:00","guessed":false,"end":"2024-05-02T09:21:08.058000+08:00","text":"小病保得好、小病保得滿、大病大缺口，請部長思考。","quality":1},{"speaker":"薛部長瑞元","start":"2024-05-02T09:21:09.119000+08:00","guessed":false,"end":"2024-05-02T09:21:13.724000+08:00","text":"這個部分我不贊成，現在大病難道都沒有保嗎？","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:13.724000+08:00","guessed":true,"end":"2024-05-02T09:21:17.996000+08:00","text":"癌藥只有保障30%。","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:21:17.996000+08:00","guessed":true,"end":"2024-05-02T09:21:22.268000+08:00","text":"癌藥是另外一個問題，它是新進的藥進來的太慢。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:22.268000+08:00","guessed":true,"end":"2024-05-02T09:21:26.540000+08:00","text":"部長，我們再來看看醫療指標，我們現在輸人家輸得很慘。","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:21:26.540000+08:00","guessed":true,"end":"2024-05-02T09:21:30.812000+08:00","text":"我們最近CEOWORLD才第一名。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:30.812000+08:00","guessed":true,"end":"2024-05-02T09:21:35.084000+08:00","text":"來看以藥養醫，以藥養醫是很不得已的，因為給付不夠，所以今天大家才會提出點值，然後不得不用其他方式來彌補醫院一些不足的地方，部長，我可以再請問你一次嗎？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:35.084000+08:00","guessed":true,"end":"2024-05-02T09:21:39.356000+08:00","text":"你的數字還一樣嗎？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:39.356000+08:00","guessed":true,"end":"2024-05-02T09:21:43.628000+08:00","text":"藥價差有多少？","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:43.628000+08:00","guessed":false,"end":"2024-05-02T09:21:45.609000+08:00","text":"您大腦中的數字，藥價差有多少？","quality":0.923},{"speaker":"薛部長瑞元","start":"2024-05-02T09:21:46.910000+08:00","guessed":false,"end":"2024-05-02T09:21:55.094000+08:00","text":"差不多在500億，但是總藥價的話是2,300億。","quality":0.867},{"speaker":"陳委員昭姿","start":"2024-05-02T09:21:56.155000+08:00","guessed":false,"end":"2024-05-02T09:21:56.595000+08:00","text":"500億還是低估了。","quality":1},{"speaker":"薛部長瑞元","start":"2024-05-02T09:21:58.196000+08:00","guessed":false,"end":"2024-05-02T09:21:59.977000+08:00","text":"不能隨便講低估就低估喔！","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:00.357000+08:00","guessed":false,"end":"2024-05-02T09:22:01.498000+08:00","text":"是你要告訴我，我已經查過了。","quality":1},{"speaker":"薛部長瑞元","start":"2024-05-02T09:22:02.258000+08:00","guessed":false,"end":"2024-05-02T09:22:03.159000+08:00","text":"我就跟你講500億。","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:03.939000+08:00","guessed":false,"end":"2024-05-02T09:22:05.420000+08:00","text":"不是我要告訴你，你要負責告訴我，其實石署長知道，但是……","quality":0.435},{"speaker":"薛部長瑞元","start":"2024-05-02T09:22:05.420000+08:00","guessed":false,"end":"2024-05-02T09:22:09.502000+08:00","text":"對，我就說500億，你如果不同意這個數字，你要提出來。","quality":0.95},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:09.502000+08:00","guessed":true,"end":"2024-05-02T09:22:12.661333+08:00","text":"我不同意這個數字，你在反質詢！","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:22:12.661333+08:00","guessed":true,"end":"2024-05-02T09:22:15.820667+08:00","text":"不能隨便講這樣就是低估。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:15.820667+08:00","guessed":true,"end":"2024-05-02T09:22:18.980000+08:00","text":"關於健保醫療點值，大家都支持醫療點值要提高，但是我們要有一些配套作法，所以也建請部長思考一下，趁著這次點值調整是不是好好跟醫界溝通，提出一些比較進步的支付制度，譬如DRGs、論質計酬，還有所謂以結果論來當基礎的包裹治療。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:18.980000+08:00","guessed":true,"end":"2024-05-02T09:22:22.139333+08:00","text":"部長，我要告訴你，臺灣真的還進步嗎？","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:22:22.139333+08:00","guessed":true,"end":"2024-05-02T09:22:25.298667+08:00","text":"這個現在都已經在做了。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:25.298667+08:00","guessed":true,"end":"2024-05-02T09:22:28.458000+08:00","text":"臺灣什麼都輸，不只OECD，連韓國都輸得很慘，癌症死亡率輸了10%，5年存活率，人家是70，我們是60，新生兒死亡率也是最高的，糖尿病合併症死亡率也是最高的，不要再讓國人以為我們醫界首列前茅的假象。","quality":0},{"speaker":"薛部長瑞元","start":"2024-05-02T09:22:28.458000+08:00","guessed":false,"end":"2024-05-02T09:22:29.398000+08:00","text":"當然這都有改進的空間。","quality":0.8},{"speaker":"陳委員昭姿","start":"2024-05-02T09:22:29.398000+08:00","guessed":true,"end":"2024-05-02T09:23:06.928000+08:00","text":"我不會說醫生不好，而是醫療投資不足，保障醫療點值、合理藥價差要同步進行，我同意你把長照加入整個計算裡面，但是我上次也提到了，新的科技、新的醫療進來對長照有幫助的部分、費用減省的部分，也是要一併考慮。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:23:06.928000+08:00","guessed":true,"end":"2024-05-02T09:23:44.458000+08:00","text":"有關藥價差部分，我覺得日本的方式可能是比較理想的，先有一個合理的藥價差，它先猛猛地降了一波再慢慢降，再停一下，然後再慢慢降，最後配合現在的點值提高，就回到大家不再仰賴藥價差來作為醫院營利最容易仰賴的因素之一，部長，這樣可以嗎？","quality":0.068},{"speaker":"陳委員昭姿","start":"2024-05-02T09:23:44.458000+08:00","guessed":false,"end":"2024-05-02T09:23:49.361000+08:00","text":"最重要的是整個藥價的部分透明化、可預測。","quality":0.944},{"speaker":"薛部長瑞元","start":"2024-05-02T09:23:49.361000+08:00","guessed":true,"end":"2024-05-02T09:23:50.361000+08:00","text":"所有這些改革都是我們必須要逐步來進行，其實也都有。","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:23:49.361000+08:00","guessed":false,"end":"2024-05-02T09:23:50.761000+08:00","text":"部長，已經30年了，逐步再一個30年。","quality":1},{"speaker":"薛部長瑞元","start":"2024-05-02T09:23:50.761000+08:00","guessed":true,"end":"2024-05-02T09:23:51.761000+08:00","text":"30年是每一個階段、每一個階段逐步的改，你不能說30年，然後要跳到現在，要一次斷崖式的……","quality":0},{"speaker":"陳委員昭姿","start":"2024-05-02T09:23:51.761000+08:00","guessed":true,"end":"2024-05-02T09:23:52.761000+08:00","text":"跟代孕法案一樣再等30年嗎？","quality":0.273},{"speaker":"陳委員昭姿","start":"2024-05-02T09:23:51.722000+08:00","guessed":false,"end":"2024-05-02T09:23:55.324000+08:00","text":"30年都不做，每個部長都不做就會這樣跳躍啊，如果每個都做一點，就不會是這樣子。","quality":0.939},{"speaker":"薛部長瑞元","start":"2024-05-02T09:23:55.484000+08:00","guessed":false,"end":"2024-05-02T09:23:56.564000+08:00","text":"當然，本來就是，所以我們現在也在做。","quality":1},{"speaker":"陳委員昭姿","start":"2024-05-02T09:23:56.884000+08:00","guessed":false,"end":"2024-05-02T09:23:57.765000+08:00","text":"我沒有看到效果。","quality":1},{"speaker":"主席","start":"2024-05-02T09:23:58.265000+08:00","guessed":true,"end":"2024-05-02T09:24:01.407857+08:00","text":"接下來請陳菁徽委員質詢。","quality":0}]}},"supported_relations":[],"relations":[]}