近來我發現,在那些針對「熱衷探索自然」的戶外活動愛好者和發布秘境貼文者所日益增長批評裡,最常見的莫過於:
「遊客會製造垃圾!」
「這些地方很多人去的話,接下來就等著看到滿地垃圾吧!」
「這些『熱愛大自然』的人們就是最大的問題!」
「我們不能開放戶外景點給一般大眾,因為他們都不負責任,而且會破壞環境!」
但,真的是這樣嗎?這些遊客是將大量塑膠垃圾傾倒在山林河川當中的主力嗎?讓我們來深入檢視一下這個議題:「為什麼有些廢棄物的最後下場,不是在掩埋場、焚化爐、回收廠、或是相對應的公共衛生處理單位呢?」
不幸的是,一些不成熟的遊客走進了大自然,把垃圾丟在那裡。如果您拜訪任何受歡迎的瀑布或溫泉,可能還會在那裡看到一些垃圾。
遊客傾向於做出兩個錯誤的假設:
<露營垃圾全是可燃的>
這是錯誤的。就像您在家一樣,應將垃圾分類為廢物和可回收物,並隨身攜帶離開。您的垃圾都不應進入營火中。
<食物會迅速分解在自然裡>
雖然沒錯,但蔬菜和加工食品分解可能需要幾個月的時間,橘子皮,蛋殼,骨頭可能需要數年。如果您將麵條或白菜扔進河裡,它們就不會被魚吃掉。它會在那兒呆數周和數月,聞起來酸味並腐爛。即使魚類和動物確實吞噬了您的垃圾,但餵養野生生物也不是您的工作。有生命力的食物種子最終會成為入侵物種,奇怪的食物會使動物生病或死亡。所有多餘的食物都應隨身帶離開。沒有例外。
更糟糕的是隨處可見的煙蒂頭。為什麼吸煙者不認為這些有毒的塑料和化學物質是垃圾?這是無法接受的。
儘管這真令人氣憤,但它並不是山上垃圾的最大來源。嚴重的系統問題是與垃圾收集和處理需求有關
這支影片當中,展示了位於高雄六龜葫蘆谷瀑布的一些垃圾堆。這裡的地勢陡峭,任何被丟進森林裡的垃圾都會沿著斜坡滾下。每當雨水來臨之際之際,重量較輕的塑膠製品就會被沖刷到河流,一路漂流至下游,也就是大家會去玩耍的瀑布那兒;最終,它們進入海洋,並被海浪打上遙遠的某處沙灘。
不過,這隻影片清楚地展示了何謂「誤解」:第一眼看過去,覺得只是幾個保麗龍手搖杯和一些大家會為了踏青而帶出門的東西。但當我們再次細看,裡面居然出現水桶、巨型農用塑膠布(通常寬幅至少為一公尺,幅寬則可長達數十公尺)、農藥空罐、傢俱、和一般家庭垃圾:那些「沒有」任何一個去健行的人會帶著走的物品。這些廢棄物源自山裡,最有可能的來源也就是那些住在山裡的人們。那些垃圾,並非外來者所帶去的。
這並不罕見,也非單一事件。只要在任何山路旁停下,低頭向山壁下望去,就能看見成堆的垃圾袋。那些都是在家裡打包綁好的家庭垃圾,然後在行進中的車上往車窗外扔。家庭垃圾,是來自家庭,並非來自露營者;只要能檢視這些垃圾裡所含有的文件或郵件,便能揭曉它的來源。
即使這些會任意丟棄垃圾的人們只佔了山間居民的極小部分,他們還是有著極大的影響力。而在山區違法傾倒垃圾有過之而無不及的破壞力。無論是什麼原因,有部分居住在山上的住戶,偏好將家庭垃圾棄置於河川勝於妥當的處理。這裡所討論的並非這裡一個、那裡一個的零星垃圾。一個住在台灣的四口家庭,年平均垃圾製造量大約1600公斤。這樣的垃圾量,實屬相當巨大。
而正是因為一個家庭所能產生的垃圾量如此龐大,我們實在很難切確了解這樣的(隨意扔丟家庭垃圾)行為究竟擴及到什麼樣的程度。我在路旁的樹叢裡看過不下數百件垃圾⋯⋯或許數千件了也不一定。但這是因為數十或數百個家庭這麼做,我並無法斷言。唯一能確定的是,塑膠垃圾將「傳承」好幾世代。
如果今天去到偏鄉,將垃圾丟進垃圾桶裡,那些垃圾下場的可能性之一是,人們請來收垃圾的那些車隊將垃圾從民宿或餐廳接走,沒有依照環保署的規定處理,不但沒有把垃圾載到目的地,他們會找個在附近不為人知的地點就隨便把垃圾給倒了。山林裡滿滿都是這樣的情況。我們在河裏所見的一部分垃圾,就是從這些非法掩埋場所洗刷出來的結果。
除了上述提到的部分之外,卻還有其他來源也正在為這樣的情況有所「貢獻」:在許多地方,整卡車的垃圾就是直接傾倒於山路邊,直落山腳的河中。這裡所指的,並非單純的家庭垃圾或傢俱,而是包含來自建築、農業、和工業等的大型廢棄物。諸如此類的物件並非一般民眾所能接觸的到;那麼,之所以會在這裡看到這類型的垃圾只有一個原因:無論是本身製造這些垃圾的單位,或著是他們委託的民間清潔業者,最終選擇不按常規處理廢棄物,選擇違法私了,隨意傾倒。政府的相關單位真的應該要發展一套策略,來確認這些垃圾最終有好好抵達該去的地方。
每年颱風來臨,就會把這些成千上噸的垃圾帶到海洋。但那些垃圾堆卻不會因此減少:因為卡車會帶著新一批的垃圾來再度傾倒。
在對這一切麻痺之前,我那時還會拍攝影片來講述這樣的情況;但現在,我只會假裝眼不見為淨。
話說回來,我倒是能夠理解為何有些偏鄉的家庭垃圾並無法抵達該去的目的地。我本身就是來自於美國的偏鄉地區。在我的成長過程當中,並沒有「公共收垃圾」的這項服務。我們將廚餘做成堆肥,埋在遠離主建築的庭院一角,用落葉堆在上方,放置兩年後再挖來替花園施肥。垃圾和回收物會分在不同的袋子裡。每週一次,我父親會將這些袋子用車子載去離家約二十分鐘車程的郡屬廢棄物集散地和回收中心。的確,整個過程費力費時,但做好回收和妥當處理廢棄物對我爸爸來說非常重要,而我們當時也有這過程裡所需的一切資源來達成這項任務。
但並非我們的街坊鄰居都這麼做。有些家庭沒有時間好好處理垃圾,所以就把成堆的垃圾、生活用具、壞掉的車子和玩具等等,隨意散落在他們的住家四周。這也是相當常見的街景一隅。
在很多方面來說,偏鄉跟都市的生活條件比較起來,的確是不方便許多。以現實層面而言,實際的生活、家庭、經濟狀況,樣樣都會佔去不少時間。並不是所有家庭都能每每在需要之際,花上一個小時來丟好垃圾。但也有人是「能做,但我就是不想做」。沒有垃圾車的時候,他們便會選擇最為便捷的方式。政府真的應該針對山間社區提供更多的收垃圾選項。
我在這裡所訴說一切其實大家都了然於心,卻鮮少被提起。大部分在山林間那些路旁和河邊的垃圾並非來自登山客或是瀑布遊客。那些垃圾來自於那些從未抵達掩埋場的一般人類消耗結果。住在山間那些人們也不願見到如此景象。但這就是現實狀況。
這也是為什麼當我看到像是「殺風景!苦花潭遍地遊客垃圾 部落擬封閉」這樣的標題時,總會不由自主地翻個大白眼。沒錯,遊客不應該留下任何垃圾,但在不到百米之外,就有個在森林深處的家庭垃圾集散地。幾乎到哪兒都有垃圾。
如果大家有興趣前往探勘現場狀況的話,以下提供三個例子:
(大型): 24.035258, 121.170819
(大型): 24.6080971,121.2830025
(小型): 22.705481, 120.669413
面對這樣的狀況,針對個人的罰鍰並沒有太大幫助。大家平時在生活裏已經有夠多的煩惱了,否則也不會這樣處理事情。就是把收垃圾這件事情弄得再簡單一些就能幫上很大的忙了。山區的垃圾廢棄必須得簡單又方便,如同城市裡所提供的一樣。
最後還是要呼籲大家,因為疫情影響,人民改為國內旅遊,這是一件好事,多了親山近水的機會,也增加露營野餐烤肉樂趣,讓朋友家人感情更融洽!但是大家在拜訪大自然的同時,更需要以身作則,帶來多少食物垃圾,也請一件不留帶走。野生動物不需要被人類餵食,牠們喜歡自己自食其力,所以不用擔心動物會餓,而故意留下吃剩食物殘渣。揮揮衣袖,請帶走全部垃圾,包含烤肉架,野生動物不需要自己烤肉啦~
還有,大家不要再報復性集中旅遊啦~明明台灣美景青山綠水多到數不清,要記得分散人流,防疫新生活還是要落實,真的不知道去哪裡玩嗎?歡迎大家逛逛我的部落格,我製作了全台300多個景點地圖,可以選偏僻冷門的景點去唷~
One of the most common criticisms I see raised against nature goers and people who post 秘境 online is that visitors bring a lot of trash with them. If these areas have a lot of visitors, the result will be that there is a lot of trash. Nature-lovers are the problem. We can’t open up the wilderness to the general public, because they are irresponsible, and will trash the place. But is that really true? Are tourists the main driver of plastic waste in rivers and mountains? Let’s examine this issue a bit further and try to determine why some waste ends up in the rivers instead of landfills and public waste processing centers.
Unfortunately, some of immature tourists go into nature and leave their trash there. If you visit any popular waterfall or hot spring, chances are you will see some trash there too.
Tourists tend to make two false assumptions. One is that camping trash is burnable. It’s not. Your trash should be separated into waste and recyclables, just like you do at home, and taken out with you. None of your trash should go in the campfire.
The other is that food degrades quickly. It doesn’t. Vegetables and processed foods can months, orange peels, egg shells, bones can take years. If you toss noodles or cabbage into the river, it won’t be eaten by fish. It will stay there for weeks and months and rot and smell. Even if fish and animals did eat your garbage, it’s not your job to feed the wildlife. Viable food seeds end up as invasive species and strange foods make animals sick or die. All excess food should be taken out with you. No exceptions.
Even worse are cigarette butts. Why do smokers not think these toxic bits of plastic and chemicals are trash? This is unacceptable.
As infuriating as this is though, it’s not the biggest source of mountain garbage. There are serious systemic problems relating to garbage collection and disposal that need to be addressed.
This video shows a large trash pile at Hulugu Waterfall in Kaohsiung City, Liugui District. The terrain here is very steep. Any trash thrown into the forest will roll down the hill. When it rains, the lighter plastic products will be washed into the river and flow downstream, into the waterfalls you play at, and eventually to the ocean, and eventually onto a remote beach somewhere.
However, a closer look at the piles shows that this can be misleading: at first glance, it looks like a few styrofoam tea cups and items that people might bring on an outing with them. But as we look closer at the waste, we can see there are buckets, plastic farm sheeting, pesticide bottles, furniture, and general household waste. Items that no hiker would ever bring with them. This waste originated in the mountains, by people who live in the mountains. It was not brought by outsiders.
Neither is this a rare or isolated incident. If you stop at literally any section of mountain road and look over the edge you will see entire trash bags down below you. These are household trash bags that were packed and tied shut at home, then thrown out of the window of moving vehicles. It’s household trash, from houses, not campers, and critical examination of this waste would reveal the source through mail and other documents inside.
Even if it’s only a small percentage of the mountain population, they still have a big impact. Illegal trash dumps in the mountains have an even bigger impact. For whatever reason it is, some mountain dwellers prefer to throw their household waste into the river than dispose of it properly. This is not a stray bag here and there. The average 4 person household generates 1600KG of trash per year in Taiwan. That’s a lot of trash.
Because a single family can generate so much garbage, it’s difficult to tell how widespread this practice is. I’ve seen hundreds of trash bags in the forest by the side of the road. Possibly thousands. But if this is by dozens of families or hundreds of families I can’t say. Plastic lasts for generations.
If you visit rural communities and dispose of your trash in their trash can, there is a possibility that the private trucks they hired to pick up those waste from the restaurant or minsu aren’t taking it to an EPA landfill. Instead of delivering the trash to the final destination, they find an isolated spot nearby and just dump the garbage there. It may end up in one of these dumping sites instead. The mountains are full of them. Some of what you will see in a river is washed down from these illegal landfills.
In many places, entire truckloads of trash are dumped over the side of the roads and into the river below. This isn’t just household waste and furniture, but also construction, farming, and industrial waste too. This type of waste is not something that tourists bring into the mountains. Whoever was in charge of disposing of this waste properly decided to dump it into the forest instead. The government needs to develop a method of confirming that mountain waste reaches its intended destination.
Every year typhoons carry tons of this trash away to the ocean, but the trash piles never go away, because new trucks arrive to refill them.
I used to make videos about them before I became desensitized, but now I just pretend I didn’t see them.
I do understand why some rural household waste doesn’t make it to the correct locations though. I’m from a rural area myself. I didn’t have a trash service where I grew up. We composted food waste. It was dumped into piles far away from the house. We covered them with leaves and let them sit for two years before using it for soil in the garden. Trash and recyclables were separated into different bags. Once a week my dad drove these bags 20 minutes into town to the county dump and recycling center. It was a lot of effort, but recycling and proper waste disposal were very important to my dad, and we also had the resources to do it.
Not everyone on my street did though. Some families did not have the time and resources for proper waste disposal, and so they had piles of trash, appliances, broken down cars, broken toys, etc around their property. It was a very common sight.
In many ways, country living isn’t as easy and convenient as living in the city. Sometimes real life, family, and financial problems take up all your time. Not all families can spend an hour each time they want to take out the trash. Some people can, but just don’t want to. When trash trucks are not available, they will take the most convenient option. The government needs to increase trash pickup options for mountain communities.
What I’ve written here is well known, but not often talked about. Most of the roadside and riverside trash in the mountains isn’t from hikers and waterfall goers. It’s from normal human consumption that never makes it to a landfill. People who live in the mountains don’t like it either. But that’s what it’s like.
That’s why when I see headlines like (殺風景!苦花潭遍地遊客垃圾 部落擬封閉), I can’t help but roll my eyes. Tourists shouldn’t be leaving trash there, but there is also a household forest trash dump less than 100 meters away. There’s trash almost everywhere.
Here are a few examples if you wanna go check em out yourself:
(big): 24.035258, 121.170819
(big): 24.6080971,121.2830025
(small): 22.705481, 120.669413
Fines to individuals won’t help. People have enough problems, otherwise they wouldn’t act this way. Just make it easier to take the trash away. Trash disposal needs to be easy and convenient for mountain communities, just like it is for urban communities.
Finally, I still want to appeal to everyone. Because of the impact of the epidemic, the people have changed to domestic tourism. This is a good thing. There are more opportunities to get close to the mountains and rivers. It also increases the fun of camping and picnic barbecues, so that friends and family can feel more harmonious! But everyone is visiting nature At the same time, it is more necessary to set an example, and please don’t leave any food waste with you. Wild animals do not need to be fed by humans. They like to support themselves, so there is no need to worry that the animals will be hungry and intentionally leave leftover food residue. Flick your sleeves, please take away all the garbage, including the barbecue grill, wild animals don’t need to barbecue by themselves~
It’s clear that Taiwan’s beautiful scenery, green mountains and green waters are countless, remember to disperse the flow of people, and the new life of epidemic prevention still needs to be implemented. Do you really know where to go? Welcome everyone to visit me In my blog, I have made maps of more than 300 scenic spots in Taiwan. You can choose remote and unpopular scenic spots to go to
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#由實證研究看癌症治療一口價可行性
-基於本土資料的觀光醫療效益分析
文:陳信諭 醫師
壹、前言
中國國民黨高雄市長候選人韓國瑜先生提出政見中,特別強調「觀光醫療」一環,在受訪時,他特別指出:要推動「全亞洲最便宜的治療癌症還有醫療美容」,「我國際掛牌,價格直接訂出來」,「鼻癌、鼻咽癌120塊美金、乳癌200塊美金、眼睛割雙眼皮50塊美金」。
眾所皆知,市長候選人於正式場合發表政策看法,背後均應有幕僚團隊的詳盡研究與分析,數據亦應經過查證。韓國瑜候選人事隔兩個月,經過認真研究後,雖再次指出:「如果大家不滿意價格,眼睛割雙眼皮可以提高到1萬元美金。」
然而,醫療相關政策與果菜市場批發叫賣顯有差異,不該隨意喊價,而其價格亦不是由輿論或選民滿不滿意來決定。迄今為止,韓國瑜候選人尚未收回「癌症觀光醫療」的政策,亦尚未提出最新治癌全球掛牌價碼。
因此,本文將根據嚴謹的本土和國外數據分析,來探討「癌症觀光醫療一口價」的合理成本與可行性。
貳、癌症醫療成本分析
我國實施全民健保已有23年,累積大量的數據,從健保資料庫分析中,便可了解台灣治療各類癌症,在各階段健保成本支出的不同。
以2014年高醫等團隊發表的健保資料庫論文為例 [1],從1996-2007年收集141,772例乳癌、大腸直腸癌、肝癌、肺癌、胃癌分析。在2007年,從診斷到初始治療(12個月內)乳癌的健保花費為8347美金,大腸直腸癌為8113美金,肺癌為10681美金,而胃癌為10780美金。以乳癌而言,單單是「初始治療」,不論是化學治療(3650美元)、放射治療(6310美元)、手術治療(478美元),每一項的花費都遠超過200元美金的國際掛牌價。而我們知道,健保價格已經是經過政策性壓縮,200美元基本上無法進行任何有意義的癌症治療,甚至連診斷成本都不足。
而2016年成大團隊進一步分析健保資料庫[2],以終身治療成本(lifetime cost)而言,乳癌需要28,180 美金,鼻咽癌男性需要29,809美金;女性需要30,225 美金。而以乳癌來說,光是每一生活品質調整人年(Quality Adjusted Life Years; 簡稱QALY),乳癌就需要2054美金成本。男性鼻咽癌病患每個QALY更需要3578元美金成本,均遠遠高於200元。
若我們進一步利用1996-2007年間治癌健保費用上漲趨勢推算,11年內治癌成本便上升了40-70%[1]。若以美國NIH推估之治癌費用上升模型預估,預估10年後成本可能再提升27%[3],回推治療每名病患花費的健保總支出將超過百萬台幣。
根據調查,近12年,可注射癌症藥物花費經通膨調整後,仍上升18%[4]。而隨著標靶藥物不斷推出,新藥成本也持續上揚,舉例而言,2015年FDA核准的幾個新藥,一個月藥價便要1萬美金~6萬5美金。若我們要提供國際品質的治療(包含個人化基因診斷與治療等),但又要堅持「癌症一口價」的方式,可說是全世界絕無僅有,財務上完全不可行的方式。
有趣的是,中國因人力成本較低,且患者不一定都能接受到完整治療,因而癌症治療費用也較低。舉例而言,根據《刺絡針》發表的回顧論文,中國治療每個新增乳癌案例的花費是1216美元[5],而該國沿海省份為2835美元[6]。雖該國醫療品質參差不齊,但仍比韓候選人的價格高了6-14倍之多。且這是在該國醫師平均年薪僅有13,764美元(換算台幣月薪約34K)[7]的情況下達到的。
韓國瑜候選人刻意把治療費用壓低到乳癌200美元,是否是要刻意吸引中國客群,賤賣台灣優質醫療?或是想壓低台灣醫師薪水至與中國同等或更低?其背後動機雖然不明,但仍明顯脫離常理。
參、觀光醫療的分類與我國推動現狀
韓候選人團隊指出,觀光醫療是一個有「創意」的政見。然而,不論就國內外案例來說,均非如此。甚至觀光醫療已是台灣和高雄推行已久的政策。根據衛福部「國際醫療管理工作小組」指出,於2007年起,行政院以「醫療服務國際化旗艦計畫」進行推動臺灣國際醫療服務,由衛生福利部委託臺灣私立醫療院所協會執行「醫療服務國際化推動計畫」,包含「特殊醫療」與「觀光醫療」兩部份。特殊醫療以台灣強項的高技術性手術或療程為主,觀光醫療則是串聯旅遊、醫療院所輔助旅遊業者開發養生、健檢、醫美行程,使國際旅客接受醫療服務同時間享受臺灣優質觀光環境。至2016年,已累積近163萬服務人次,產值達823億台幣[8]。以高雄而言,在地不少醫療院所,如義大醫院也已成立國際醫療工作中心,結合集團飯店、觀光、專業醫療資源。在遊客到院前就提供完整諮詢、治療計劃、辦好政見和安排旅宿。亦可安排在地觀光,後續空中醫療轉送聯繫等服務[9]。
另外,11年前中央推動國際醫療標語為「 醫療走出去,病人走進來」,跟目前韓候選人口號就極為相似。若說創意不過是停留在11年前而已。
如果我們進一步分析觀光或旅遊醫療(Medical tourism)概念,可大致分為旅客從醫療較落後處,到醫療先進處尋求較佳治療的模式;以及從經濟較發達,醫療成本較高處,到成本較低廉處尋求便宜治療的模式。後者是目前較多國家,如泰國、馬來西亞、韓國強調的「觀光醫療」。而根據前述,衛福部也將兩者明確以「特殊醫療」與「觀光醫療」分隔。
根據一篇綜合研究指出,觀光醫療最多的是不孕症、美容手術、減肥手術、牙醫治療等範疇。而就醫意願會受醫療品質、等待時間與花費成本等影響[10]。而部分國家則也已發展出專門的強項,例如匈牙利的減肥手術,波蘭的牙醫,就頗受西歐富裕國家歡迎。而泰國的變性手術或南韓的整形手術也是知名案例。
整體而言,如癌症此類重症醫療,並不屬於觀光醫療範疇,甚至因考量併發症及各類特殊條件,在特殊醫療模式中,也不可能使用「國際掛牌一口價」營運。而不論是哪個觀光醫療成功國家,發展觀光醫療的先決條件都在於營運成本的平衡。根據本研究利用pubmed等資料庫搜尋,並無在重症醫療上大量虧損,而透過觀光業補貼的案例。
韓國瑜候選人團隊指出,醫療觀光客可以透過「到夜市消費」等方式,達成促進經濟效果。姑且不論重症癌症病人與家屬到夜市消費的意願,根據本研究實地考察,高雄六合國際觀光夜市,相似產品的確能達成「國際掛牌,一口價」的標準。本團隊實際考察,在2018年10月30日晚間11點30分時,六合夜市東西各有一家雞排店營業,雞排均是一塊70元。若以平均虧損100萬元台幣計算。約要購買14285片雞排,營業額才能到100萬。而根據不同來源指出,賣雞排毛利率在20-50%左右,因此更需要賣28570~71425片雞排才能打平單獨一位患者的損失。以一家攤位日賣200片雞排就算生意尚不錯下[11],約需不眠不休工作將近一年才能弭補治療一位患者損失,經濟效益極低。
肆、結論
韓國瑜候選人的觀光醫療政策存在嚴重問題,主要包含:
1. 成本效益分析的不可行。
2. 特殊醫療與觀光醫療的概念混淆。
3. 抄襲11年前我國已執行之政策,但缺乏額外的政見內容。
此政見缺乏創意,亦欠缺專業,包含許多隨口而出的臆測數據,若韓國瑜候選人即其團隊的行政能力如此,可能會造成高雄醫療業百億以上的經濟損失,同時也難以創造任何新的經濟機會。
伍、參考文獻
1.Li, T. Y., Hsieh, J. S., Lee, K. T., Hou, M. F., Wu, C. L., Kao, H. Y., & Shi, H. Y. (2014). Cost trend analysis of initial cancer treatment in Taiwan. PloS one, 9(10), e108432.
2.Hung, M. C., Lai, W. W., Chen, H. H., Lee, J. C., Lin, Y. J., Hsiao, J. R., ... & Wang, J. D. (2016). Cost effectiveness of cancer treatment in Taiwan. Journal of the Formosan Medical Association, 115(8), 609-618.
3.Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML (2011) Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 103: 117–128.
4.Burki, T. K. (2017). Rising cancer drug costs in the USA.The Lancet Oncology, 18(11), e652. doi:10.1016/s1470-2045(17)30805-7
5.Fan, L., Strasser-Weippl, K., Li, J. J., St Louis, J., Finkelstein, D. M., Yu, K. D., ... & Goss, P. E. (2014). Breast cancer in China. The lancet oncology, 15(7), e279-e289.
6.Zhao XY, Zhang X, Tang Y, Tang JH. (2009). Analysis on the hospitalization expense of breast cancer operation patients and its influencing factors. Chinese Health Economics, 28, 41–43.
7.Zhang, C., & Liu, Y. (2018). The salary of physicians in Chinese public tertiary hospitals: a national cross-sectional and follow-up study. BMC health services research, 18(1), 661.
8.衛生福利部國際醫療管理工作小組(https://www.medicaltravel.org.tw/Article.aspx?a=18&l=1)
9.義大醫療財團法人國際醫療工作中心
(http://www.edahealthcare.com/AboutUs-CIPS.aspx)
10.Hanefeld, J., Smith, R., Horsfall, D., & Lunt, N. (2014). What do we know about medical tourism? A review of the literature with discussion of its implications for the UK National Health Service as an example of a public health care system. Journal of travel medicine, 21(6), 410-417.
11. 阿甘創業加盟網,開店創業加盟賣炸雞排店擺攤實務經驗談
(http://ican168blog.pixnet.net/blog/post/18860922-賣香雞排成本與獲利實務經驗談)
blog post example 在 Xiaxue Facebook 八卦
I've been going to Carragheen (and only Carragheen) for my eyelash extensions for many years now! I always trust them because they are very skilled and I always feel so pampered and relaxed going there. My lashes always last very long and are customized to the way I want them to look. Dramatic and long or natural and fluttery... They can do it all!
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blog post example 在 Venus Angelic Official Youtube 的評價
Hi my wiggly jiggly jungle papaya monkey beans!
So this is my 100th video, and since many people have requested a video without any make-up and without circle lenses, I decided to do it in this one! ♥
★UPDATE★ In this blog post I described how the massage works and what small face in japan means! http://www.venusangelic.com/2012/08/small-face.html
In this video I'm showing you guys how to get a smaller face by doing massages and exercises! ♥ I think, this is one of my tutorials that need the fewest "ingredients" or "tools". So why not give it a try? ;) Tell me on Twitter @VenusAngelic when you tried it and how your face feels after the exercises and massages!
Every morning, right after getting out of the bed, I splash my face with cold water 5 times, followed by this exercise routine! Not only that it helps aesthetically, but also helps to fresh up my mind! Some of the exercises are from japanese magazines for teenage girls, some from japanese TV shows, but most of them are my own creations. haha♥
I know that many of you wiggly jiggly jungle papaya monkey beans don't like my voice and my accent. I'm very sorry! But I want you to know, that I will never be able to talk like a British or American person! Because I'm not British/American nor was I raised in english speaking environment. I had to teach myself english in primary school 4th grade, because the teacher didn't do english classes and I didn't want to be a dumbo! D :
My Nationality:
No I'm not swedish, russian, japanese, german etc.
I'm half Swiss and half Hungarian. I was born and raised in Switzerland, so my mother tongue is Swiss-German (also called low-german). I don't know how to speak Hungarian.
Languages I speak: Swiss-German (Kanton Aargau), German, English, Spanish (I lived in teneriffe 3 years) and Japanese. I live in London since about 9 months. I have strong accent because I still speak swiss german with my mom everyday. Swiss German is very different from high german. Let me show you an example.
English: I want a cookie.
German: Ich will einen Keks.
Swiss German: Ech wott äs Guetzli.
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Credits
━─━─━─━─━─━─━─━─━─━─━─━─━─━─━
Royalty free music used in this video:
Song Titles: "Aces High", and "Fork And Spoon"
Artist Name of all 2 songs: Kevin MacLeod
Download Links:
http://music.incompetech.com/royaltyfree2/Fork%20and%20Spoon.mp3
http://music.incompetech.com/royaltyfree2/Aces%20High.mp3
![post-title](https://i.ytimg.com/vi/OkPkPM5QpmQ/hqdefault.jpg)
blog post example 在 Ilko Allexandroff Youtube 的評價
今日は夜景でポートレート撮るときのコツを紹介する動画アップします!気に入っていただけると、ぜひコメントください!これから皆さんが見たいテーマあればコメントで教えてくれたら、動画作りまーす!
I will make English version of the video soon too!
Night Portraits Blog Post
【http://www.ilkoallexandroff.com/night-portraits/】
▼ Gear Used / 使ってる機材 ▼
Canon 1Dx ► http://amzn.to/2bsH7pr
Canon 135mm F/2 ► http://amzn.to/2aXScLJ
Blog: http://www.ilkoallexandroff.com/canon-135mm-f2/
Cactus V6 Trigger ► http://amzn.to/2b5TM19
Cactus 60x60 Softbox ► http://amzn.to/2bsHdNH
ROGUE Filters: http://amzn.to/2aWv4wM
Night Portraits Tips
Here is an article I’ve wanted to post for long time! It is for portraiture at night, but I will not put setups for all of the photos in the gallery! Well, it is actually more a kind of gallery with photos taken at night! Generally shooting in the night is also very different depending on the results I am going for and the location, but here are some general things I’m keeping in mind when I shoot at dark outside! If I want to keep the portraits more natural I will go with ISO between 800-1600, so in that way I can balance the ambient light with the strobe light! My shutter speed usually varies between around 1/20 and 1/100, but of course there are many cases to go out of that range! Almost all the time I am at wide open aperture! When I want more dramatic look I would probably go for lower ISO like around 100-200, and from there decide the other parameters! Also I need to say that in most of the times I’m shooting outside at night I’m using strobes! The strobes are quite often at low power, like 1/64 for example! In this article I’m having more photos taken in city environment! I will be having different articles for long exposures and stars portraits, so stay tuned! Also feel free to share this article with your friends, and post any comments below, I would appreciate it!
夜景 ポートレート
ずっと前から書きたい記事です!夜景ポートレートは特にストロボが必要な撮影です!この記事にはそれぞれの写真の設定は書きません!どちらかというと、夜景で撮影したポートレートギャラリーみたいな感じですね!基本的に夜景でポートレートを撮影してるときに普段昼間で撮影してると同じで、場合によって光の使い方がいろいろ変わりますが、よく考えてるポイントをいくつか書きます!たとえば、もっと自然な夜景ポートレートを撮りたいときは、感度をISO-800~ISO-1600の間ぐらいにしています!それに応じてほかの設定を変えています!絞りはほとんど開放で撮影しています!シャッタースピードは1/20~1/100の間が多いですが、もちろんもっと遅いときも早いときもあります!もうちょっとドラマチックな感じで撮りたいときは感度をもっと低くします、ISO-100、ISO-200ぐらいで、そのあとほかの設定を変えています!夜景でポートレート撮影してるときに、ストロボはすごく大事な道具になります!ほとんどの場合は弱い設定で使います、1/64パワーとかですね!もしストロボがなかったら、自販機、お店の看板など、町にある光を使います!この記事にはスローシャッターと星空ポートレートの写真が入ってないです、また別の記事を作りますよ!ぜひシェアしてください!そして、コメントも大歓迎です!
【イルコ・スタイル】シリーズ
【#001】雨ポートレート撮影方法 https://www.youtube.com/watch?v=u7tgqLqOPGI
【#002】夜景ポートレート撮影方法 https://www.youtube.com/watch?v=bOvbVOHp2kg
【#003】自然光の選び方 https://www.youtube.com/watch?v=CB30Pn_g_6M
【#004】星空ポートレート撮影方法 https://www.youtube.com/watch?v=xGForzAyvS0&t
【#005】ポートレート撮影の15ポイント https://www.youtube.com/watch?v=-fwTjKbfWQg
【#006】イルコ・写真集決定! https://www.youtube.com/watch?v=EQlrXLgWMcE
【#007】私が使ってるストロボ https://www.youtube.com/watch?v=EI5QCaFLbzI
【New Ilko's Tips Video Series:】
Episode 1 - Night Portraits: https://www.youtube.com/watch?v=1bDAIM2K5Mc
Episode 2 - Portraits Under the Stars: https://www.youtube.com/watch?v=Hu9HFfyL6HM
Thanks for watching!
▼ Main Playlist / メインプレイリスト ▼
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blog post example 在 Ilko Allexandroff Youtube 的評價
今日は夜景でポートレート撮るときのコツを紹介する動画アップします!気に入っていただけると、ぜひコメントください!これから皆さんが見たいテーマあればコメントで教えてくれたら、動画作りまーす!
English Version: https://www.youtube.com/watch?v=1bDAIM2K5Mc
夜景ポートレートブログ Night Portraits Blog Post
【http://www.ilkoallexandroff.com/night-portraits/】
【カメラの設定シリーズ】
❶シャッタースピード https://www.youtube.com/watch?v=2AWLtEHFsM0
❷絞り & F/値 https://www.youtube.com/watch?v=wFZtyyLs50s
❸ISO-感度 https://www.youtube.com/watch?v=mETO26ftJMk
❹ホワイトバランス https://www.youtube.com/watch?v=jDUAvW9R8Lg
❺焦点距離 https://www.youtube.com/watch?v=5KhbI_ItGlo
❻カスタムホワイトバランス https://www.youtube.com/watch?v=yXqFK2KkEQc
オレンジフィルターの動画: https://www.youtube.com/watch?v=jag-p3ovwOk
大きなサイズのフィルターは近いうちに動画作るので、少しお待ちくださいね!
▼ Gear Used / 使ってる機材 ▼
Canon 1Dx ► http://amzn.to/2bsH7pr
Canon 135mm F/2 ► http://amzn.to/2aXScLJ
Blog: http://www.ilkoallexandroff.com/canon-135mm-f2/
Cactus V6 Trigger ► http://amzn.to/2b5TM19
Cactus 60x60 Softbox ► http://amzn.to/2bsHdNH
ROGUE Filters: http://amzn.to/2aWv4wM
Night Portraits Tips
Here is an article I’ve wanted to post for long time! It is for portraiture at night, but I will not put setups for all of the photos in the gallery! Well, it is actually more a kind of gallery with photos taken at night! Generally shooting in the night is also very different depending on the results I am going for and the location, but here are some general things I’m keeping in mind when I shoot at dark outside! If I want to keep the portraits more natural I will go with ISO between 800-1600, so in that way I can balance the ambient light with the strobe light! My shutter speed usually varies between around 1/20 and 1/100, but of course there are many cases to go out of that range! Almost all the time I am at wide open aperture! When I want more dramatic look I would probably go for lower ISO like around 100-200, and from there decide the other parameters! Also I need to say that in most of the times I’m shooting outside at night I’m using strobes! The strobes are quite often at low power, like 1/64 for example! In this article I’m having more photos taken in city environment! I will be having different articles for long exposures and stars portraits, so stay tuned! Also feel free to share this article with your friends, and post any comments below, I would appreciate it!
夜景 ポートレート
ずっと前から書きたい記事です!夜景ポートレートは特にストロボが必要な撮影です!この記事にはそれぞれの写真の設定は書きません!どちらかというと、夜景で撮影したポートレートギャラリーみたいな感じですね!基本的に夜景でポートレートを撮影してるときに普段昼間で撮影してると同じで、場合によって光の使い方がいろいろ変わりますが、よく考えてるポイントをいくつか書きます!たとえば、もっと自然な夜景ポートレートを撮りたいときは、感度をISO-800~ISO-1600の間ぐらいにしています!それに応じてほかの設定を変えています!絞りはほとんど開放で撮影しています!シャッタースピードは1/20~1/100の間が多いですが、もちろんもっと遅いときも早いときもあります!もうちょっとドラマチックな感じで撮りたいときは感度をもっと低くします、ISO-100、ISO-200ぐらいで、そのあとほかの設定を変えています!夜景でポートレート撮影してるときに、ストロボはすごく大事な道具になります!ほとんどの場合は弱い設定で使います、1/64パワーとかですね!もしストロボがなかったら、自販機、お店の看板など、町にある光を使います!この記事にはスローシャッターと星空ポートレートの写真が入ってないです、また別の記事を作りますよ!ぜひシェアしてください!そして、コメントも大歓迎です!
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