2025/12/29 []

職業傷病的通報與監測：丹麥經驗對我國制度改革的啟發

• 預定刊載卷期：台灣衛誌 2025；44(6)
• 公衛論壇 Public Health Forum
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• 陳宗延、林明瑋、鄭雅文
  Chung-Yen Chen, Ming-Wei Lin, Yawen Cheng
• 職業傷病通報與監測、丹麥經驗、法定義務、低報
  Reporting and Surveillance of Occupational Injuries and Diseases, Danish Experience, Mandatory Reporting, Underreporting
• 良好的通報制度是職業健康政策的基礎，但各國普遍存在低報問題，尤其是非致死職災及慢性職業病。本文探討我國職業傷病通報制度的現況、挑戰，並借鏡丹麥經驗提出改革建議。
  我國現行職業傷病通報機制包含五大類。然而，這些制度長期存在紛亂、低報等問題，且通報後往往未能有效連結至個案管理或職場環境改善。相較之下，丹麥制度以法律強制力為核心，要求雇主與醫師只要合理懷疑傷病與工作相關即可通報，無須負擔實質因果判定責任。此機制成功區隔醫師的照護角色與保險人的調查責任，並將通報數據整合至「工作環境管理局」（DWEA），引導以風險為導向的勞動檢查。
  依據現況回顧與國際制度比較，本文提出七個建議，包含：強化雇主職災通報責任並提高罰鍰；賦予醫事人員法定義務，通報疑似個案至勞工主管機關；建立疑似個案偵測及通報流程；降低醫事人員角色衝突，由勞動主管機關承擔後續調查與認定責任；提供醫療機構通報之合理經濟誘因；檢視績效指標的目的與效果；整合職災個案通報平台等。
• A robust reporting system is the foundation of occupational health policy, yet underreporting remains a universal challenge, particularly for non-fatal injuries and chronic occupational diseases. This article examines the current status and challenges of Taiwan's occupational injury and disease reporting system and proposes reform recommendations based on the Danish experience.
  Taiwan’s current reporting mechanism comprises five main categories. However, these systems have long been plagued by fragmentation and underreporting; furthermore, reporting often fails to effectively link to case management or workplace improvements. In contrast, the Danish system is centered on legal mandates, requiring employers and physicians to report whenever there is a reasonable suspicion of work-relatedness, without the burden of conducting substantive causal determinations. This mechanism successfully distinguishes the physician’s care-giving role from the insurer’s investigative responsibility, integrating reporting data into the Danish Working Environment Authority (DWEA) to guide risk-based labor inspections.
  Based on a review of the current situation and international comparisons, this paper offers seven recommendations: (1) Strengthen employer reporting responsibilities and increase fines to create a deterrent effect; (2) Assign legal obligations to medical personnel to report suspected cases to labor authorities; (3) Establish detection and reporting workflows for suspected cases to simplify the process; (4) Reduce role conflicts for medical staff by ensuring labor authorities handle subsequent investigation and determination; (5) Provide reasonable economic incentives for medical institutions to encourage reporting; (6) Review the objectives and effects of performance indicators to ensure the meaningfulness of reporting; (7) Integrate occupational injury reporting platforms to consolidate data for evidence-based policy making.
• 534-542
• http://bit.ly/3r4HS9R