37卷1期

• Link 政策論壇 Policy Forum
• 誤用彈性安全下的健康衝擊：以勞動基準法再修為例誤用彈性安全下的健康衝擊：以勞動基準法再修為例
• 劉曦宸 、 陳宗延 、 李宸、 林子涵 、 陳秉暉 、陳保中
  劉曦宸 、 陳宗延 、 李宸、 林子涵 、 陳秉暉 、陳保中
• 無
  none
• 無
  none
• 1-7
• 10.6288/TJPH.201802_37(1).106139

• Link 政策論壇 Policy Forum
• 建置公私協力的傳染病防治戰備物資體系－從全球CEPI聯盟與美國的BARDA談起建置公私協力的傳染病防治戰備物資體系－從全球CEPI聯盟與美國的BARDA談起
• 蔡奉真 、郭旭崧
  蔡奉真 、郭旭崧
• 無
  none
• 無
  none
• 8-11
• 10.6288/TJPH.201802_37(1).106112

• Link 原著 Original Article
• 利用文字探勘建立醫學主題詞與基因名稱之關聯性Associations between medical subject headings and gene names based on text-mining in PubMed
• 林宜歆、林嶔、葉釋仁、 蘇遂龍
  Yi-Hsin Lin, Chin Lin, Shih-Jen Yeh, Sui-Lung Su
• 文字探勘 ； 醫學主題詞 ； 基因名稱 ； 常一起出現在摘要中的相關性
  text-mining ; medical subject headings (MeSH) ; gene names ; often appearing in abstracts
• 目標：近年來生物醫學文獻發表量日益增加，有必要借助電腦自動化整理大量文獻並提供有用的資訊。目前自動化整理生物資訊之著名相關網站如Coremine、STRING、DisGeNet等，但都看不到字詞間的間接相關性。本研究欲探討PubMed收錄之非結構化摘要中，醫學主題詞（MeSH）與基因名稱間不同年代使用次數的高低情形與各詞彙間的相關強度。方法：本篇研究所採取的研究設計為text-mining design，研究樣本為2016年7月8日檢索PubMed並下載共26,295,751篇文獻。分別利用美國國立醫學圖書館與國際人類基因組組織命名委員會，編製的醫學主題詞與基因的正式名稱，檢索同義字後建立27,883個醫學主題詞的字庫與39,903個人類基因的字庫；文字比對擷取各摘要中包含的醫學主題詞與基因名稱，以年為單位計算各詞彙於摘要中出現次數，並使用word2vec分析詞彙間的相關強度。結果：本研究建立互動式網站，提供查詢醫學主題詞與基因名稱在各年代摘要中出現次數與頻率，以及最常一起出現在摘要中的相關字詞（https://yihsin.shinyapps.io/meshgeneterm_relation/）。本研究發現在2012年開始有很多文章在摘要中提到China，次數排名於2016年擠進前8名，象徵中國在學術界的崛起；Health從排行第7到第3名，也許表示越來越重視健康的議題。舉退化性關節炎為例，與退化性關節炎最常一起出現在摘要中有截肢手術、髕骨、膝關節與癱瘓等，同時也看的到這些字間的間接相關。結論：利用本研究建立的網站，瞭解各醫學主題詞與基因名稱在摘要中不同年代使用次數與頻率，以及最常與哪些字一起出現的相關強度，讓研究者在探索新領域時能快速有概括性的了解，取得建議研究的方向，以利往後跨領域之科學研究。
  Objectives: In recent years, the biomedical literature has expanded by leaps and bounds. Based on studies available in the databases, it is difficult for users to sort through the massive literature and organize sets of qualitative data. At present, there are well-known websites such as Coremine, STRING, and DisGeNet; however, one can inquire only about words directly related to the search words without any indirectly relevant suggestions. Thus, there is a real need to address the issue. In this study, we investigated the number of uses in each year and the relationship between medical subject headings (MeSH) and gene names in the non-structured abstracts in PubMed. Methods: The study used a text-mining design. The study samples were the 26,295,751 articles in PubMed on July 8, 2016. Using the MeSH from the American National Library of Medicine in the MeSHBrowser, we identified 27,883 words to establish the MeSH dictionary. Genes were officially named by the Human Genome Organization Nomenclature Committee. A search of NCBI Gene yielded a dictionary of 39,903 human genes. The medical subject headings and gene names included in the abstracts were then extracted and calculated by year. We used word2vec to analyze the associations between the MeSH and gene names. Results: We built an interactive website which provides information about the number of uses in different years and the relevant words that most often appeared together with MeSH and gene names in the abstract (https://yihsin.shinyapps.io/meshgeneterm_relation/. For example, words which appeared most often together with Osteoarthritis were Osteotomy, Nails, Patella, Knee joint, Physical examination and Paralysis. There are also indirectly relevant suggestions. Conclusions: The website developed in this study provides the number of uses in different years of MeSH and gene names, and what words were most associated with them; this indicates that these words were often mentioned and discussed together in medical publications. We can also see the indirect correlations between them so that researchers exploring new areas can quickly have a general understanding of the field.
• 12-23
• 10.6288/TJPH.201802_37(1).106086

• Link 原著 Original Article
• 石綿暴露工作者的職業健檢：職業醫學專科醫師的觀點Occupational health examination of asbestos-exposed workers: viewpoints of occupational health physicians
• 蕭汎如、 陳宗延、李俊賢、 鄭雅文
  Fan-Ju Hsiao, Chung-Yen Chen, Lukas Jyuhn-Hsiarn Lee, Yawen Cheng
• 石綿 ； 職業病 ； 職業醫學專科醫師 ； 職業健檢
  asbestos ; occupational diseases ; occupational health physicians ; occupational health examination
• 目標：職業健檢機制的制度缺失之一，為特殊健檢的對象僅限在職者，因而難以早期偵測潛伏期漫長的職業病。有鑑於職業醫學專科醫師（職醫）在職業健檢制度中扮演重要角色，本研究以石綿相關疾病為例，探討職醫對於石綿作業工作者離職後健檢機制必要性、可行性與影響的觀點。方法：研究者在2017年1月至8月間個別訪談15位職醫，訪談主題為：(1)對於目前石綿作業特殊健檢機制的看法，(2)對於建立職業石綿暴露工作者離職後追蹤檢查機制的看法。結果：受訪者都同意現有的職業健檢制度無法對職業石綿相關疾病發揮提早偵測的功能，因此有必要改善。然而，受訪者對於建立石綿職後健檢機制持有疑義，可歸納為以下五個面向：(1)界定石綿暴露工作者的困難，(2)確認石綿暴露的困難，(3)缺乏合適的篩檢工具與專業判讀人員，(4)缺乏明確的財源機制與配套措施，(5)可能引發道德危害疑慮。結論：受訪的職醫皆同意政府應針對石綿暴露工作者建立職後健檢機制，並同意其他可能導致職業病罹病風險的職業危害也應比照，然而在執行層面上之制度設計與配套措施，仍需就上述問題作進一步研商。
  Objectives: One of the many shortcomings of the current occupational health examination (OHE) system in Taiwan is that only on-the-job workers are eligible to participate, making it difficult for the early detection of workers who develop occupational diseases with long disease latencies. We used occupational asbestos-related diseases (OARDs) as an example to explore the opinions of occupational health physicians (OHPs), who play important roles in the OHE system, regarding the necessity, feasibility, and potential impact of post-exposure OHEs involving asbestos-exposed workers. Methods: Fifteen OHPs were interviewed individually during the period from January to August 2017, with questions on the following two themes: (1) opinions about the current OHE system for asbestos-exposed workers; and (2) opinions on the establishment of post-exposure OHEs for asbestos-exposed workers. Results: All of the interviewees agreed that the current OHE system fails to detect OARDs, thus reforms are needed; however, the interviewees had concerns regarding the establishment of a post-exposure OHE system, which were summarized in the following 5 dimensions: (1) problems of identifying asbestos-exposed workers; (2) difficulties in verifying asbestos exposure; (3) uncertainty in choosing a suitable screening tool and in ensuring qualified personnel; (4) lack of financial resources and administrative support; and (5) problems of moral hazards. Conclusions: All of the interviewed OHPs agreed that the establishment of a post-exposure OHE system is needed, not just for asbestos-exposed workers, but for workers exposed to other types of hazardous substances with long disease latencies. To design the system and its implementation procedures, more discussions are needed, especially with respect to the aforementioned issues.
• 24 - 33
• 10.6288/TJPH.201802_37(1).106100

• Link 原著 Original Article
• 發展台灣工作者職場內外心理壓力強度評估表之質性訪談初步驗證Verification of a pilot qualitative interview about the development of an intensity scale of psychological stress induced by life events inside and outside of the workplace for Taiwanese workers
• 葉婉榆、 胡佩怡
  Wan-Yu Yeh, Pei-Yi Hu
• 工作壓力 ； 精神疾病 ； 職業疾病 ； 認定基準 ； 壓力生活事件
  work stress ; mental illness ; occupational disease ; reference guide on identification ; stressful life events
• 目標：我國勞動部（時為勞委會）曾參考日本職業精神疾病認定制度，於2009年發布「工作相關心理壓力事件引起精神疾病認定參考指引」，其中羅列多項職場內外生活壓力事件，本研究將這些事件項目發展為心理壓力強度評估量表，並運用質性訪談蒐集量表內容對於台灣職場脈絡的適用性評估，以及工作者填答壓力強度分數的影響因素。方法：2010~11年間徵得36位來自製造業、服務業、營造業與公共行政業的正職、約聘、派遣工作者參與量表試填與訪談，透過半結構式大綱深入瞭解受訪者填答問卷的難易程度，以及生活壓力事件發生情境和壓力強度評分的考量因素。結果：個人對於生活事件的壓力強度評估經常需要對照對於他人類似經驗的觀察，並隨著發生時間遠近、事件嚴重度的認知、所扮演的社會角色、有無支援體系、個人價值觀等原因而對生活事件的壓力強度判斷產生個別差異，另組織人手不足以及高難度的業績目標對於台灣職場而言可能是值得納入評估表的壓力來源，而收入減少事件雖然在參考指引中被歸類為職場外事件，但工作者的收入減少和職場內的薪資條件亦有相關。結論：在政策面，本研究針對壓力評估表的後續修訂提供實證依據，另對於企業在員工壓力管理與協助方案的規劃，也提供議題設定優先順序的參考。
  Objectives: Taiwan’s Ministry of Labor (formerly the Council of Labor Affairs) has referred to the Japanese occupational mental illness system issued a 2009 document, entitled ”Evaluation guidelines for psychiatric diseases induced by work-related mental stress”, which lists a number of stressful life events inside and outside of the workplace. In this study, these events were established as a psychological stress intensity assessment scale, and qualitative interviews were used to evaluate the applicability of the content of the measurement scale for the Taiwanese workplace, as well as to determine the factors influencing worker stress intensity. Methods: In this study, we recruited 36 regular, contract-based and dispatched workers from the manufacturing, service, construction and public administration industries to participate in the scale test and in-depth interview in 2010~11. A semi-structured outline was employed to determine the difficulty the respondents had in filling out the questionnaire, and to examine the context in which the participants’ stressful life events occurred as well as to consider factors in the rating mechanism as part of the process of completing the stress intensity evaluation scale. Results: Individual assessment of the intensity of stressful life events was often affected by the observation of other people's experiences, and, over time, the perceived severity of the events, the social role, social support system, and personal values about stressful life events produced individual differences. Understaffing and unrealistic performance goals were potential sources of stress for Taiwanese workers and are worth including in evaluation guidelines. Additionally, while income reduction was classified as a non-work event, the workers' income reduction were often highly correlated with salary conditions in the workplace. Conclusions: In terms of policy implications, this study provides an empirical basis for revision of the stress assessment table in the evaluation guidelines, and also provides a reference for priorities in the planning of Employee Assistance Programs (EAPs) as well as in the improvement of training techniques to cope with stress.
• 34 - 49
• 10.6288/TJPH.201802_37(1).106077

• Link 原著 Original Article
• 乳癌及大腸癌篩檢不平等評估－反轉公平假說之檢視Assessing inequalities in breast and colorectal cancer screening-testing the inverse equity hypothesis
• 李佳綺、 李妙純
  Chiach i Bonnie Lee, Miaw-Chwen Lee
• 癌症篩檢 ； Erreygers校正集中指數 ； 相對不平等指數 ； 反轉公平假說
  cancer screening ; Erreygers corrected concentration index ; relative inequality index ; inverse equity hypothesis
• 目標：本研究探討乳癌及大腸癌篩檢利用之收入不平等，以及不平等與篩檢率之關係。方法：本研究資料取自2001、2005、2009、2013年國民健康訪問調查，估計45或50歲至69歲乳癌及大腸癌篩檢之與均等家戶收入關連之Erreygers集中指數（ECI）、相對不平等指數（RII）及影響不平等因素解析。結果：乳房攝影及糞便潛血篩檢率自2001年之9.2%及10.1%分別上升至2013年之46.1%及41.3%；並呈現收入愈高篩檢率愈高的現象。2001年最高收入群體之乳房攝影使用率比最低收入群體多達近一倍（RII=0.984），但到2013年下降為多5.7%（RII=0.057）。最高收入群體之糞便潛血檢查率比最低收入群體多40-60%（RII=0.377~0.634）。除了2013年乳房攝影外，兩項篩檢之使用亦都集中於高收入群體（乳房攝影ECI=0.060~0.150；糞便潛血檢查ECI=0.036~0.104）。免費政策實施前（2001、2005及2009年）收入都是影響篩檢不平等的重要因素，但免費政策實施後（2013年）教育程度為最重要因素。結論：與「反轉公平假說」一致，當篩檢率上升時，不同收入群體篩檢率差異愈小。提升篩檢率可縮減篩檢之社會不平等，有助於緩和健康不平等。
  Objectives: This study analyzed income-related inequalities in breast and colorectal cancer screening in Taiwan and the relationship between inequality and screening rate. Methods: We used data from the 2001, 2005, 2009, and 2013 National Health Interview Surveys. The Erreygers concentration indices (ECI) and relative inequality indices (RII) were calculated and ECIs were decomposed. Results: In 2001, 9.2% of participants reported undergoing mammography and 10.1% reported having a fecal occult blood test (FOBT) within the previous year. Those screening rates within the previous two years increased by 46.1% and 41.3% respectively in 2013 and showed income gradients. In 2001, mammography use by the highest-income group was nearly double that of the lowest-income group (RII=0.984), while that difference in 2013 fell by 5.7% (RII=0.057). Compared with the lowest-income group, the highest income group received 40- 60% more screening for FOBT (RII=0.377 to 0.634). Except for mammography in 2013, both mammography and FOBT were concentrated in the higher income group (ECI=0.06-0.15 for mammography; ECI=0.036-0.104 for FOBT). Before the national cancer screening programs in 2001, 2005 and 2009, income was the most important contributor to inequalities in the screening rate, while education accounted for the greatest contribution in 2013. Conclusions: Consistent with the ”inverse equity hypothesis,” income-related inequalities in cancer screening decreased with higher screening rates. Therefore, an increased screening rate facilitates the reduction in inequality in cancer screening and addresses health inequalities.
• 50 - 62
• 10.6288/TJPH.201802_37(1).106059

• Link 原著 Original Article
• 罹患肺結核的移工在台灣醫療照顧制度中的治療經驗與賦權The treatment experience and empowerment of migrant workers with tuberculosis in Taiwan’s medical care system
• 黃郁惠、 齊偉先
  Yu-Hui Huang, Wei-Hsian Chi
• 肺結核病 ； 移工 ； 檢疫 ； 健康不平等 ； 醫療照護中的賦權
  tuberculosis ; migrant workers ; quarantine ; health inequality ; empowerment in medical care
• 目標：本研究分析台灣罹患肺結核病之移工的醫療照護過程，探究移工這個弱勢社群，是否在獲得醫療照護資源的機會上面臨許多阻礙。研究中說明台灣還存在著這類問題，並試圖提出改善的建議。方法：本研究採質性研究法，採立意取樣的方式，針對九名罹患肺結核的個案及一名資深結核病個管師進行深度訪談，結合訪談及參與觀察的田野資料，進行質性研究方法的分析。結果：分析發現關鍵影響結核病移工獲得照護資源的重要因子，主要有四，分別是現行相關政策所產生的限制、文化及溝通的障礙、仲介及雇主缺乏正確的健康觀念、醫療人員的權宜措施。結論：本研究具體建議(1)政府相關單位應強化醫療人員的多元文化照護能力；(2)醫院應擴大參與面，善用醫療體系之外的資源改善移工的健康問題；(3)政府應加強跨部門的溝通，創造外籍移工獲得較佳治療的機會。
  Objectives: This study investigated the medical treatment of migrant workers with tuberculosis. The aim was to determine if this vulnerable group still had barriers in accessing medical care resources. Methods: Adopting a qualitative research design, this study used purposive sampling to conduct in-depth interviews with nine migrant workers infected with tuberculosis and one tuberculosis case manager. Data collected from these interviews and participant observation were analyzed qualitatively. Results: Four factors were found to influence the migrant workers’ access to medical resources: constraints of current related policies, cultural and communicative barriers, job mediators’ and employers’ lack of medical knowledge, and the tactics of medical personnel. Conclusions: This study recommended that (1) related government departments propose projects to empower medical personnel and improve their cultural competence; (2) hospitals cooperate with civil organizations to provide different resources to solve the health problem of migrant workers; (3) the government reinforce cross-departmental communication to create a better medical treatment environment for migrant workers.
• 63 - 76
• 10.6288/TJPH.201802_37(1).106065

• Link 原著 Original Article
• 合併精神疾病對癌症延遲診斷與治療之相關性Associations of psychiatric disorders with delay in diagnosis and treatment of cancer
• 陳一凡、吳肖琪
  Yi-Fan Chen, Shiao-Chi Wu
• 精神疾病 ； 癌症 ； 延遲診斷 ； 延遲治療
  psychiatric disorders ; cancer ; delayed cancer diagnosis ; delayed cancer treatment
• 目標：國外研究顯示癌症患者合併精神疾病較容易經歷延遲診斷或治療，台灣是否也存在這樣的情形？本研究欲探討癌症病患是否會因合併精神疾病，致癌症延遲診斷或治療。方法：採回溯性世代研究，以2011年確診為肺、肝、結直腸、乳癌、口腔及子宮頸癌新發個案有治療者為對象，利用全民健保門、住診及癌症登記檔進行分析；以傾向分數配對精神疾病與非精神疾病組；另將精神疾病細分為焦慮、老年期診斷、物質濫用、嚴重精神疾患與其他精神疾患。以癌症期別第三期以上定義為延遲診斷，診斷到開始治療?4週為延遲治療；控制變項包括病患、疾病與醫院特質，採條件式邏輯斯迴歸進行分析。結果：癌症治療患者延遲診斷率，合併精神疾病者為48.2%、非精神疾病者為44.3%，兩者無統計上顯著差異（AOR=0.97, 95%CI=0.84-1.11）；合併精神疾病者延遲治療率為58.7%、非精神疾病者為59.7%，亦無統計上顯著差異（AOR=0.94, 95%CI=0.83-1.06）；不同類型精神病分層分析，亦未達統計上顯著差異。結論：整體而言，癌症治療患者合併精神疾病無較高延遲診斷與治療風險；然如何減少延遲診斷與治療國內仍有努力的空間。
  Objectives: Evidence suggests that cancer patients with psychiatric disorders may be more likely to experience a delay in cancer diagnosis and treatment. The association between psychiatric disorders and delayed diagnosis and treatment in patients with cancer has not been studied well in Taiwan. The aim of this study was to determine if pre-existing psychiatric disorders led to delayed diagnosis and treatment among patients with cancer. Methods: A population-based retrospective cohort study was conducted with the use of the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The study subjects were patients who were newly diagnosed and received treatment for lung, liver, colorectal, breast, oral or cervical cancer before 2011. Propensity scores were used to divide the study subjects into two groups with and without psychiatric disorders. Psychiatric disorders were further subdivided into five categories: anxiety disorders, dementia and other organic psychoses, substance abuse and dependence disorders, severe mental disorders, and other mental health disorders. Stage III or IV cancer was identified as a delayed diagnosis, and a period from definite diagnosis to the start of treatment greater than four weeks was identified as delayed treatment. Conditional logistic regression was used for analysis after controlling for demographic, hospital and disease characteristics. Results: Among patients treated for cancer, the rate of delayed diagnosis for people with psychiatric disorders was 48.2%, and for people without psychiatric disorders, it was 44.3%. The risk of delayed diagnosis was not significantly significant between groups (AOR=0.97, 95%CI=0.84-1.11). Moreover, the rate of delayed treatment for people with psychiatric disorders was 58.7%; for people without psychiatric disorders, it was 59.7%. The risk of delayed treatment was not significantly different between the groups (AOR=0.94, 95%CI=0.83-1.06). Conclusions: We still need to make an effort to reduce the delay in diagnosis and treatment of cancer in psychiatric patients.
• 77 - 90
• 10.6288/TJPH.201802_37(1).106083

• Link 原著 Original Article
• 早期太極拳運動對慢性阻塞性肺疾住院病患之運動耐力、焦慮憂鬱及生活品質的長期成效Long-term effects of early Tai Chi on exercise tolerance, anxiety, depression, and quality of life in hospitalized patients with chronic obstructive pulmonary disease
• 沈雪珍、郭素娥、張家豪、楊聰明、 蔡昆道
  Hsueh-Chen Shen, Su-Er Guo, Chia-Hao Chang, Tsung-Ming Yang, Kuen-Daw Tsa
• 早期運動 ； 慢性阻塞性肺疾病 ； 太極拳 ； 運動耐力 ； 生物標誌物
  none
• 目標：早期運動有助於慢性阻塞性肺疾病急性發作（Acute Exacerbation of Chronic Obstructive Pulmonary Disease, AECOPD）的住院病患快速回復，但未有研究探討早期太極拳運動的長期成效，故本研究旨在檢測AECOPD住院病患接受早期太極拳運動訓練在運動耐力、焦慮憂鬱、生活品質與生物標誌物的長期成效。方法：本研究採類實驗設計，立意取樣自雲嘉三間醫院，共31人參與此研究（實驗組，n=17及常規照護的對照組，n=14）。收集6次資料，分別是介入前、出院日、出院後1週、1、3及6個月。運用廣義估計方程式分析太極拳運動成效。結果：實驗組比對照組在出院後1週（p=0.008）及第6個月（p=0.012）有較佳的運動耐力表現；實驗組比對照組在出院後第3個月生活品質明顯改善（p=0.040）；實驗組與對照組相比，實驗組在出院後第3個月第六型介白質（Interleukin-6, IL-6）和C-反應蛋白（C-reactive protein, CRP）的改善幅度，分別減少15.67（pg/ml）（p=0.017）與17.46（ug/ml）（p=0.013），獲得顯著成效。然而在焦慮憂鬱、YKL-40和LCN2的分析上，兩組未達顯著差異。結論：住院期間介入早期太極拳運動可增進病患之運動耐力、生活品質及降低發炎反應且安全可行。此研究結果可供臨床醫護人員做為日後推動住院COPD病患早期運動的實證基礎。
  Objectives: Early sustained exercise can help patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) to quickly return to a steady state; however, to the best of our knowledge, no previous studies have examined the long-term effects of early Tai- Chi or Tai Chi as a bridge between early exercise during hospitalization and exercise at home. The aim of this study was to examine the effects of early Tai Chi on exercise tolerance, anxiety, depression, health-related quality of life and biomarkers in hospitalized patients with AECOPD. Methods: A quasi-experimental study was conducted. A purposive sampling of 31 patients with AECOPD (experimental group n=17 and control group n=14) was selected from hospitals in the Yunlin-Chiayi area. Data were collected during pre-intervention, at discharge, and one week, one month, three months or six months after discharge. Generalized estimating equations were used to examine the effects of the Tai Chi training intervention. Results: The experimental group had better exercise tolerance than did the control group one week after discharge (p=0.008) and six months after discharge (p=0.012). The experimental group had a better quality of life than the control group three months after discharge (p=0.040). The experimental group had decreased biomarker levels (Interleukin-6, p=0.017 and C-reactive protein, p=0.013) more than the control group three months after hospitalization. Anxiety, depression, and other biomarkers (YKL-40 and LCN2) failed to find statistical significance. Conclusions: Early Tai Chi helped promote early exercise in patients with AECOPD.
• 91 - 108
• 10.6288/TJPH.201802_37(1).106122

• Link 評論 Commentary
• 評論：早期太極拳運動對慢性阻塞性肺疾住院病患之運動耐力、焦慮憂鬱及生活品質的長期成效評論：早期太極拳運動對慢性阻塞性肺疾住院病患之運動耐力、焦慮憂鬱及生活品質的長期成效
• 蔡美文
  蔡美文
• 無
  none
• 無
  none
• 109 - 109
• 10.6288/TJPH.201802_37(1).10612201

• Link 實務 Public Health Practice
• 日本的勞災保險制度：對台灣職災保險改革的啟示Industrial accident compensation insurance in Japan: implications for workers’ compensation reform in Taiwan
• 陳宗延、蕭汎如、黃怡翎、鄭雅文
  Chung-Yen Chen, Fan-Ju Hsiao, Yi-Ling Huang, Yawen Cheng
• 勞動者災害補償保險法 ； 職災補償制度 ； 職業傷病
  Industrial Accident Compensation Insurance Act ; workers' compensation ; occupational injuries and diseases
• 目標：台灣職災補償法規範散亂繁複，造成職災勞工的補償權益無法確保、雇主責任無法落實。鑑於台灣與日本國情文化接近，本研究旨在深入探討日本勞災保險制度，作為台灣制度改革借鏡。方法：本研究蒐集並回顧日本勞災保險相關文獻，包含中文或日文的論文、專書、政府官方資料等，並依據下列架構分析、比對資料：(1)制度沿革、(2)法源與行政組織、(3)納保人口、(4)財源與保費、(5)給付內容、(6)認定機制。結果：日本勞災保險依據《勞動者災害補償保險法》，由中央勞動基準局及地方勞動基準監督署主管，涵蓋全體受僱勞工，由雇主全額支付保費，給付內容包含職災勞工及家屬所需各層面。職業傷病認定過程由勞動檢查官主導。結論：參考日本勞災保險經驗，台灣職災補償制度應整合並制定專法、擴大保險涵蓋範圍、精算合理費率、提昇給付內容，同時亦應簡化職業傷病申請與認定流程，由勞檢單位積極介入協助，以確保職災勞工的補償權益。
  Objectives: Workers' compensation in Taiwan is complicated, and it is regulated by various laws; this results in inadequately guaranteed workers' rights to compensation and easy escape from employers' responsibilities. Considering the cultural and socioeconomic similarities between Taiwan and Japan, we examined the institutional arrangements and recognition procedures of the Industrial Accident Compensation Insurance (IACI) of Japan to suggest directions for institutional reform in Taiwan. Methods: The literature about IACI in both Japanese and Chinese including journal articles, books, and official publications was reviewed. Data were analyzed and compared in terms of: (1) institutional evolution, (2) legal basis and administrative organizations, (3) insured population, (4) premiums and financing, (5) benefits, and (6) mechanisms for recognition. Results: IACI in Japan was established on the basis of the IACI Act, and is supervised by the Labor Standards Bureau and prefectural Labor Standards Inspection Offices. All employed workers are covered, and premiums are fully paid by employers. Various types of benefits are provided to the injured workers and their families. The recognition process of occupational injuries and diseases is handled by labor inspection officers. Conclusions: Learning from the experience of IACI in Japan, we believe that a new law is needed to integrate the workers' compensation systems in Taiwan. Coverage should be expanded, the insurance rates should be adjusted reasonably, and benefits should be increased. In addition, the compensation procedures and recognition mechanisms should be simplified and actively assisted by labor inspectors in order to guarantee workers' compensation rights.
• 110 - 123
• 10.6288/TJPH.201802_37(1).106121