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慶祝520,上書衛生署長
分類:菸害政策
泡泡龍(fjguo) | 2008/5/20 下午 10:43:51


敬致署長:先救救台灣四百五十萬吸菸人口吧

署長林教授鈞鑒

首先恭喜您榮昇署長,身為臺大醫院的醫師,莫不期望署長能以領導臺大醫院之經驗,創造國民健康之新頁。

在您交接繁忙之際,寫信叨擾,實屬醫療環境惡劣,有些事不得不向您報告。

國民健康局自民國91年開始補助戒菸門診,至今6千位醫師投入戒菸工作,受惠民眾30萬人,本來是衛生署重要政績之一。

兩年前菸稅從一包5元提升至10元之後,每年稅收從100億增加至180億,衛生署卻將大部分經費補貼健保虧損,導致菸害防治經費從每年10億縮減至6億,戒菸門診經費從1.5億減至8千萬。簡言之,吸菸民眾付出增加了,權利卻被剝奪了,為非常不合理之現象。

影響所及,健保局(中區、南區、高高屏)於今年發文給戒菸合約醫院,要求一季不得使用超過2萬5千元之戒菸經費,也就是1個月只能看2個戒菸病人,令醫界譁然。經媒體披露後,健康局卻向媒體宣稱,政府的戒菸管道多元,無法看戒菸門診的病人可以尋求戒菸專線協助或參加戒菸班。所有研究證據皆顯示門診戒菸比其他方法成果好,健康局公然剝奪吸菸者到戒菸門診就診的自由,開倒車之行為令人難以理解。

尤有甚者,健康局某些官員宣稱台灣戒菸門診成效不彰,醫師疑似浪費戒菸經費,所以要求醫師應慎選戒菸病人,健康局為此連發兩份公文給戒菸合約醫院,超額看診的醫師將不予給付。

署長身為醫師應知勸告病人戒菸非常不容易,病人有意願就應該鼓勵戒菸。美國衛生部給醫師的建議是應該盡力提供戒菸服務,豈有刪選病人的道理?那是不是醫師也不要為『可能不按時服藥』的高血壓、糖尿病病人開藥,以免浪費健保資源?

台灣門診戒菸一年成功率為15.3%,與英國衛生部戒菸服務的17.7%不相上下。健康局官員以立委質詢戒菸成效不佳為藉口,附和沒有醫學知識的立委(其實有些立委是因為接受菸商捐贈而找門診戒菸計畫麻煩,此乃公開的秘密,健康局也心知肚明)。為了應付立委,沒有為自己政策辯護的勇氣,令人非常失望。


學生斗膽建議署長以下事項:

1.短期之內鬆綁門診戒菸經費:
將目前6億元菸害防治經費中與健康局無直接相關的部分刪除(例如學校菸害宣導回歸教育部,軍隊菸害回歸軍醫局)。明年實施新的菸害防治法以後,無菸餐廳和無菸職場也不需投入經費推動,因為在餐廳和職場抽菸都是違法的行為。門診戒菸至少應恢復之前每年1.5億的規模,而不是要求戒菸醫師一個月只看兩個病人,成為國際笑話。

2.調查健康局挪用菸害經費的情形:
據董氏基金會調查,6億菸害經費有1.5億被挪它用,健康局也在媒體宣稱戒菸經費只有5億元,究竟短少的1.5億作為什麼用途,健康局應該向署長說明。這也是醫界議論紛紛的焦點。

3.長期而言,增加菸害防治經費:
菸稅有180億收入,90%給了健保局。吸菸病人想戒菸還要再掏腰包買戒菸藥,看戒菸門診,這是令人難以接受的事情。菸稅只拿3%從事菸害防治,是前任立委定下的門檻,建議衛生署應思考如何重新翻案。另外我國菸稅相較於其他國家,包括香港、新加坡、泰國,都還太低,應可以再提高至50元以上。台灣醫界菸害防制聯盟的建議是每包菸150元菸稅,才和英國相當。

台灣目前有四百五十萬吸菸者,每年因為菸害死亡人數約兩萬人,估計馬總統任內四年將有8萬人死於菸害,和中國震災不相上下,是921死亡人數的十幾倍。政府願意花20億為中國賑災,卻刪減門診戒菸經費至8千萬,如此輕重不分的政策令人費解。

學生長期從事戒菸工作,深知基層醫師對最近門診戒菸政策走向非常不滿,敬請署長撥冗了解。對健康局之批評對事不對人,健康局在菸商立委壓迫下不得不低頭,此乃公務機關之無奈,敬請署長思考因應之道。

(本文同步張貼署長信箱)

回應 (3) | 人氣 (15726) | 推薦 (6484) | 轉寄 (4)
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(路人甲) 於 2008/6/5 上午 08:45:20 回應 |
寫得很棒耶~

但是小的略有拙見:
菸害防制經費之分配應該著重於:「菸害之防制」!菸害教育亦不宜回歸教育部。
我國菸害之蔓延情形,成人吸菸率已逐漸降低,但青少年人吸菸率卻大幅提升,抵銷我國吸 菸率下降之力道。而根據研究,青少年吸菸成癮較成人容易,且青少年時期的吸菸行為參雜多樣因素,使得大部分吸菸成癮者的成癮時期大部分皆為青少年時期所種下。在目前菸捐只能分配到3%的事實下,未來除應使菸品健康捐回歸專款專用,更應該大幅度使用於菸害形成前之防制工作。諸如,宣導、媒體曝光度、訓練講習、戒菸教育等。使青少年接觸菸品的機率降低,避免青少年接觸受害。

菸害防制,治標為戒菸,治本為菸品接觸前之防制工作,尤其青少年這一塊,需要很多人力物力投入。如果衛生署能多分配一些經費從事青少年菸害防制工作,將較為有效降低我國吸菸人口之提升。

教育部雖為教育單位,但是對於衛生專業較為不足,菸害防制工作即已成為政府衛生施政之重要標的,那應該回歸專業~~~讓衛生署,專業的來.....
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泡泡龍(fjguo) 於 2008/6/5 下午 11:39:31 回覆
感謝回應。

我希望菸害防制回歸教育部,主要是責任劃分及教師認知的問題。目前校園菸害宣導由於是健康局外力介入的關係,變成是額外的工作,老師往往辦一些演講活動,把經費報銷了事。個人也曾經到學校演講,不覺得這樣的活動有什麼成效,做業績呈報上級的成份比較大。

拒菸、反毒、檳榔、酒精,應該是學校正式教育及生活輔導的一部分,從知識的傳達到人格的養成,應該內建於學校教育之中,為教師之基本責任。衛生單位可以協助教師專業知識及推廣技巧,但是不是代替教師的角色,直接介入校園的反菸活動。這是小弟的看法。
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(地震戶) 於 2008/5/21 下午 10:04:33 回應 |
對不起ㄛ~~借用一下~~
小弟我家昨天受到芮氏8級強震(與老婆小孩吵架)
家裡現在面目全非~~滿目瘡痍

請各位慷慨解囊~~
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泡泡龍(fjguo) 於 2008/5/21 上午 09:58:01 回覆
最近看到要下台的陳阿扁捐20億給中國
我就抓狂了

不過想想還好是陳阿扁已經捐了
否則馬上辦會不會捐50億啊.........

這些錢根本是肉包子打狗
被貪官污吏吃乾抹淨
中國人民完全享受不到
而且在新聞封鎖下
恐怕沒有幾個中國人知道台灣捐大錢了

所以WHO照擋
飛彈照射
也是很自然的事了........
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