45卷4期

• Link 政策論壇 Policy Forum
• 青少年檳榔防制—從口腔黏膜篩檢出發Teenager betel-abuse prevention: starting from oral mucosa screening
• 廖予昊、婁培人
  Yu-Hao Liao, Pei-Jen Lou
• 無none
  無none
• 無none
  無none
• 273-277
• 10.6288/TJPH.202608_45(4).PF04

• Link 公衛論壇 Public Health Forum
• 台灣有多少家戶面臨災難性醫療支出?預算占比法與WHO-Europe capacity-to-pay法之比較 How many households in Taiwan face catastrophic health expenditure? A comparison of the Budget Share Method and the WHO-Europe Capacity-to-Pay Method
• 蒲正筠
  Christy Pu
• 無none
  無none
• 無none
  無none
• 278-283
• 10.6288/TJPH.202608_45(4).115041

• Link 公衛今與昔 Public Health Now and Then
• 公共心理衛生和預防心理學的交會：概念演進、實務發展與未來展望 The intersection of public mental health and preventive psychology: conceptual evolution, practice development, and future directions
• 張珏、周才忠
  Chueh Chang, Tsai-Chung Chou
• 無none
  無none
• 無none
  無none
• 284-297
• 10.6288/TJPH.202608_45(4).115019

• Link 綜論 Review Article
• 臨床工程人員制度化情境下之運作效益與護理任務移轉探討Operational benefts and nursing task shifting under the institutionalization of clinical engineering personnel
• 黃庭漢
  Ting-Han Huang
• 臨床工程人員、醫學工程師、醫療設備、醫院營運、人力管理
  clinical engineering personnel, medical engineers, medical equipment, hospital operations, human resource management
• 近年高階醫療儀器與智慧照護科技快速導入臨床場域，包括導航設備、高階影像系統、機械手臂、智慧監測設備及 AI 輔助照護裝置等，使醫療儀器於診斷、監測、治療與照護流程中的重要性持續提高。此類設備往往需較長學習時間、專業操作能力、定期校正、品質管制及特殊保養，也增加醫療及護理人員在設備使用、異常排除與跨專業溝通上的工作負擔。設備操作安全、效能維持與跨專業協作，已成為醫療品質與病人安全的重要議題。台灣目前尚無正式法定之臨床工程人員為醫事人員職類，但相關制度化討論已進入政策與立法場域；同時，護理人力亦面臨空缺率、離職率上升及高齡照護需求增加等壓力。本文整合護理人力、任務移轉、臨床工程及醫療設備管理相關文獻，並參照美國與日本制度經驗，分析台灣未來可能之任務分工模式、效益、限制與配套條件。 美國模式以設備生命週期管理與技術支援為主，日本模式則於醫師指示下參與特定高風險設備操作。對台灣而言，較可行方向並非全面取代護理人員，而是在明確授權、標準化訓練與責任界面下，逐步承接部分儀器準備、功能確認、操作支援、品質管制及異常通報等技術性任務。整體而言，臨床工程人員制度化具支援任務重整與改善設備治理之潛力，但仍有賴法規、訓練與本土實證研究配合。
  Advanced medical devices and smart care technologies, including navigation systems, highend imaging platforms, robotic systems, intelligent monitoring devices, and AI-assisted care equipment, have been rapidly introduced to clinical settings. Their increasing role in diagnosis, monitoring, treatment, and care processes has increased the importance of safely operating such devices, maintaining them, and encouraging their operators to engage in interdisciplinary collaboration. These technologies often require extended training, specialized operating skills, regular calibration, quality control, and dedicated maintenance, which can increase the workload of medical and nursing staff as they learn to use devices, troubleshoot problems, and communicate with other professionals. In Taiwan, clinical engineering personnel have yet to be formally recognized as a statutory category of health-care professional, although institutional, policy, and legislative discourse has suggested recognizing their contributions to the medical feld. In addition, the nursing workforce faces increasing pressure from staff vacancies, turnover, and demand for older-adult care. This article reviewed the literature on nursing workforce problems, task shifting, clinical engineering, and medical equipment management and explored institutional experiences from the United States and Japan to examine models of task division, benefts, limitations, and conditions supporting task shifting and the use of clinical engineering in Taiwan. Institutional models in the United States typically prioritize equipment lifecycle management and technical support, whereas models in Japan typically prioritize nurse and clinical engineer participation in selected high-risk equipment operation under physician instruction. In Taiwan, replacing nursing staff is not currently feasible; instead, Taiwanese hospitals should gradually assign technical tasks such as equipment preparation, functional verifcation, operational support, quality control, and anomaly reporting to clinical engineering personnel under clear authorization, standardized training, and defined boundaries of responsibility.
• 298-306
• 10.6288/TJPH.202608_45(4).115024

• Link 原著 Original Article
• 在關係中工作：台東縣原住民族文化健康站照顧服務員的情緒勞動經驗研究Working in relationships: emotional labor experiences of care workers in Indigenous Cultural Health Stations in Taitung County, Taiwan
• 劉麗娟、廖淑萍
  Li-Chuan Liu, Shu-Ping Liao
• 文化健康站、照顧服務員、情緒勞動、原住民族、質性研究
  Cultural Health Station, care worker, emotional labor, Indigenous peoples, qualitative research
• 目標：隨著高齡化與長期照顧政策的推動，原住民族文化健康站已成為原住民族地區重要的社區照顧據點。原住民族文化健康站照顧服務員除了承擔照顧與活動執行，亦需在日常互動中進行情緒管理與情感付出，形成高度的情緒勞動。然而，現有公共衛生與長期照顧文獻中，對於原住民族文化健康站照顧服務員情緒勞動的實證研究仍相當有限。本研究旨在探討台東縣原住民族文化健康站照顧服務員於工作情境中所經驗之情緒勞動型態、情緒調節策略及其影響因素，並分析其對照顧實務與工作感受的意涵。方法：本研究採質性研究設計，以半結構式深度訪談方式，於2022年5∼6月訪談台東縣多處原住民族文化健康站16位照顧服務員。研究資料以主題分析法進行分析，歸納照顧服務員在照顧過程中所展現的情緒勞動經驗與調適方式。結果：研究結果顯示，原住民族文化健康站照顧服務員的情緒勞動主要呈現三項特徵：(1)以關係維繫為核心的情緒展演；(2)角色期待與情緒壓力交織的日常實作；(3)透過文化認同與同儕支持進行情緒調節，情緒勞動同時帶來工作成就感與情緒耗竭的雙重影響。結論：原住民族文化健康站照顧服務員的情緒勞動深受部落文化脈絡與制度條件影響。建議未來在原住民族文化健康站站政策與人力培力設計中，以文化安全與照顧為基礎，並納入對情緒勞動的正式支持機制，以促進照顧服務員身心健康與服務品質。
  Objectives: Indigenous Cultural Health Stations have become a key community-based care setting in Indigenous areas in Taiwan. Care workers in these stations not only provide daily care services but also provide extensive emotional labor through consistent interpersonal interactions. However, empirical public health research focusing on the emotional labor experiences of care workers in Indigenous Cultural Health Stations remains limited. Therefore, this study explored the emotional labor experiences, emotional regulation strategies, and infuencing factors of care workers in Indigenous Cultural Health Stations in Taitung County, Taiwan. Methods: This study adopted a qualitative research design. Semistructured in-depth interviews were conducted with 16 care workers from several Indigenous Cultural Health Stations located in Taitung County between May and June 2022. Data were subjected to thematic analysis to identify care workers’ experiences of emotional labor and coping strategies in the care process. Results: The fndings revealed that the respondents’ emotional labor experiences involved three main features: (a) emotional performance centered on relationship maintenance, (b) everyday practices shaped by the combination of role expectations and emotional pressure, and (c) emotional regulation through cultural identity and peer support. These experiences fostered both a sense of work achievement and emotional exhaustion. Conclusions: Emotional labor among care workers in Indigenous Cultural Health Stations is deeply embedded in Indigenous cultural contexts and institutional arrangements. Future policy and workforce training designs for Indigenous Cultural Health Stations should focus on cultural safety and care. Additionally, formal support mechanisms for emotional labor should be incorporated into Indigenous Cultural Health Stations to improve the physical and mental well-being of care workers and enhance service quality.
• 307-319
• 10.6288/TJPH.202608_45(4).115020

• Link 原著 Original Article
• 全民健保開辦初期台灣中老年人自陳多重慢性病的時期與世代訊號：1993-2003年之年齡-時期-世代分析與2011年延伸 Period and birth-cohort patterns in self-reported multimorbidity in middle-aged and older Taiwanese adults during early National Health Insurance consolidation: an age-period-cohort analysis, 1993–2003, with an extension to 2011
• 黃芳誼
  Fang-Yi Huang
• 多重慢性病、年齡-時期-世代分析、全民健康保險、中老年身心社會生活狀況長期追蹤調查、老化政策
  multimorbidity, age-period-cohort analysis, National Health Insurance, Taiwan Longitudinal Study on Aging, aging policy
• 目標：以年齡-時期-世代（age-period-cohort, APC）模型描述全民健保開辦初期台灣中老年人自陳多重慢性病的時期與出生世代訊號，區分「制度可見度」與「世代健康資本」，並界定哪些結論可辨識。方法：分析中老年身心社會生活狀況長期追蹤調查1993至2003年四波合併樣本（18,049人次／7,397人）。多重慢性病為八項自陳醫師診斷慢性病中至少二項，另以各病之日常生活不便題組建立嚴重度分級結果。以條件式APC邏輯迴歸搭配500次受訪者層次拔靴信賴區間（CI）估計，以正解線（solution line）分析檢驗部分識別、以界限分析處理追蹤流失，並另作2011年延伸分析。結果：65歲以上共同支持區間之年齡標準化盛行率由1993年33.8%升至2003年43.9%、2011年47.9%。時期成分由1996年低點（勝算比OR=0.78, 95% CI [0.73, 0.83]）升至2003年（1.36, [1.16, 1.57]）；世代成分以1920-1929年為高平台，逐世代降至1950-1954年（0.46, [0.25, 0.90]）。非線性成分顯示1996年低點與1925-1929年世代高點不依賴識別限制，線性趨勢幅度則隨假設變動。嚴重度分級結果之時期上升較小（2003年1.17）。結論：上升同時與可見度提升及世代健康資本改善相容；慢性病監測宜將兩種成分分開報告，並區分可辨識與不可辨識之部分。
  Objectives: To describe period and birth-cohort patterns in self-reported multimorbidity in middle-aged and older Taiwanese adults during the early consolidation of Taiwan’s National Health Insurance, distinguish changes in institutional visibility from differences in health across birth cohorts, and clarify which fndings can and cannot be identifed from age-period-cohort analysis. Methods: Four pooled waves of the Taiwan Longitudinal Study of Aging (1993–2003) included 18,049 person-wave observations from 7,397 respondents. Multimorbidity was defned as two or more of eight self-reported physician-diagnosed conditions. Severity-graded outcomes also incorporated activity limitations associated with these conditions. Conditional age-period cohort logistic regression was performed, and confdence intervals (CIs) were estimated using 500 person-level cluster bootstrap replicates. Partial identifcation was performed by fixing the linear age slope at different values along the solution line. Attrition was examined using inverse probability weighting and extreme-value bounds. The 2011 wave (n = 3,727) was analyzed as an extension. Results: Age-standardized prevalence over the common age ≥65-year support increased from 33.8% in 1993 to 43.9% in 2003 and 47.9% in 2011. The period component reached a nadir in 1996 (odds ratio [OR] = 0.78, 95% CI [0.73, 0.83]) and increased to 1.36 [1.16, 1.57] in 2003. The cohort component plateaued for the 1920–1929 birth cohorts (OR, approximately 1.44) and declined to 0.46 [0.25, 0.90] for 1950–1954 birth cohort. Constraint-free nonlinear estimates confrmed a nadir in 1996 (OR = 0.85 [0.82, 0.89]) and a peak for the 1925–1929 birth cohort (OR = 1.37 [1.19, 1.55]). However, the magnitude of the linear trends depended on the assumed age slope. The period-related increase was smaller for the severity-graded outcome (2003, OR = 1.17 vs 1.36). Conclusions: The observed multimorbidity trajectory is compatible with both period-related and birth-cohort interpretations. Chronic disease monitoring should report period and cohort components separately and distinguish quantities that are identifed from those that depend on model assumptions.
• 320-333
• 10.6288/TJPH.202608_45(4).115027

• Link 原著 Original Article
• 自願性健康保險在全民健康覆蓋體系中的角色：跨國比較的觀點The role of voluntary health insurance under universal health coverage: from the comparative health system perspectives
• 謝雨純、盧瑞芬
  Yu-Chun Hsieh, Rachel Jui-Fen Lu
• 跨國健康體系比較、自願性健康保險、全民健康覆蓋
  comparative health systems, voluntary health insurance, universal health coverage
• 目標：本研究以跨國比較的觀點，探討健康體系特性與自願性健康保險在全民健康覆蓋體系中的角色。方法：本研究為一跨國比較研究，採比較個案研究法，選取六個案例國家（德、日、加、澳、星、韓），透過收集彙整既有文獻、報告及政府網站等資料，並輔以專家諮詢，針對現行體制給付內容（包括給付服務項目、民眾自付費用）及政府對自願性健康保險之政策，進行跨國比較分析。結果：自願性健康保險常於健保保障不足或政府強調個人對健康之責任時扮演補位角色。部分國家積極與之協作以強化保障，部分則因考量健康服務利用之公平性、健康體系之財務永續及防止資源分布不均而加以管制。政府的協作程度與健康保障高低無絕對關係，而是取決於健康體系的制度設計、政府的政策立場以及對自願性健康保險的角色期許。結論：參酌他國對自願性健康保險之政策時，應瞭解台灣健康體系與他國之差異，辨別其政策目標及對台灣的適用性，依據未被滿足需要之性質研議政策與配套，以強化民眾醫療保障，並維持健康體系之互助公平與永續發展。
  Objectives: This study examines the role of voluntary health insurance (VHI) within universal health coverage (UHC) systems from an international comparative perspective. Methods: Synthesizing academic literature, policy reports, government publications/website information, and relevant regulatory materials—supplemented by expert consultations—this study analyzes the role of VHI across six countries: Germany, Japan, Canada, Australia, Singapore, and South Korea. The comparison focuses on statutory benefit design (service coverage and out-of-pocket payments) alongside governmental regulatory frameworks. Results: VHI typically plays a complementary or supplementary role where statutory benefits are limited or where public policies emphasize personal responsibility. While certain countries integrate VHI to enhance financial protection, others enforce strict regulations to prevent resource misallocation, preserve equity in access, and maintain fiscal sustainability. The degree of reliance on VHI does not inherently correlate with better financial protection; rather, outcomes depend on overall health system architecture, policy objectives, and the defined role of private insurance. Conclusions: When drawing on international experiences with VHI to strengthen financial protection in Taiwan, policymakers must carefully account for institutional differences and assess the contextual applicability of external policy models. Reform efforts should address specific unmet needs and incorporate targeted safeguards to enhance financial protection while preserving system solidarity, equity, and long-term sustainability.
• 334-351
• 10.6288/TJPH.202608_45(4).115023

• Link 實務 Public Health Practice
• 我國職業病鑑定案之爭點與結論形成因素分析：以2012–2025年職業病彙編為例Analysis of disputed points and concluding factors in occupational disease determination in Taiwan: a study of compiled cases, 2012–2025
• 林意凡
  I-Fan Lin
• 職業病、職業災害、工作暴露、表列職業病
  occupational diseases, occupational injuries, occupational exposure, listed occupational diseases
• 目標：職業病認定涉及長期工作暴露與多重致病因子，為我國勞工職業災害保險制度中最具爭議且高度仰賴專業判斷之環節。本研究旨在分析我國職業病申請案件中進入職業病鑑定會審查之鑑定案之主要爭點，並探討影響鑑定結論形成之關鍵因素，以評估現行職業病鑑定制度之運作特性及潛在改善方向。方法：本研究採回溯性次級資料分析，蒐集職業安全衛生署公布之2012–2025年間共120件職業病鑑定案，依職業病類型、工作型態(受僱／非受僱)、進入鑑定案之爭點、鑑定結果與形成鑑定結論之主要原因進行分類與描述性分析，並以Fisher’s exact test比較受僱與非受僱個案之鑑定通過情形。結果：職業病彙編中的鑑定案以人因性疾病為最多。職業病申請案件進入鑑定程序最常見之爭點為工作暴露量是否足夠，其次為是否存在其他主要致病因子，而形成鑑定結論時，工作暴露評估為最關鍵之判斷因素。受僱與非受僱個案之鑑定通過率尚未呈現顯著差異。結論：工作暴露評估為職業病認定制度中最核心且最具爭議之環節。研究結果顯示，若能於職業病審查初期即制度化工作暴露資料蒐集與評估機制，並建立非表列職業病認定之一致性原則，或可減少需要進入職業病鑑定會的行政資源，並提升職業病認定制度之一致性與可預測性。
  Objectives: Occupational diseases involve long-term work exposure and multiple etiological factors, consequently, occupational disease recognition is the most complex component of Taiwan’s occupational injury insurance system and highly reliant on professional judgment. This study analyzed the principal issues in cases referred to the Occupational Disease Review Committee and examined the key factors infuencing review conclusions, in order to evaluate the current review system and explore potential areas for improvement. Methods: A retrospective secondary data analysis was conducted using 120 occupational disease review cases from Occupational Disease Compendiums published by the Occupational Safety and Health Administration between 2012 and 2025. Cases were categorized by disease type, employment status (self-employed or employed), and review outcomes. Issues leading to committee review and the primary reason underlying review conclusions were extracted and inferred from case descriptions. Descriptive analyses were performed, and Fisher’s exact test was used to compare approval rates between self-employed and employed individuals. Results: Ergonomic-related disorders were the most common type of case. The leading issue prompting referral for committee review was whether occupational exposure was suffcient, followed by the presence of other major etiological factors. In forming review conclusions, assessment of occupational exposure was the most critical determinant. No statistically signifcant difference in approval rates was observed between self-employed and employed individuals. Conclusions: Assessment of occupational exposure is the central and most contentious element of the occupational disease recognition system. Institutionalizing early collection and evaluation of exposure data and establishing consistent principles for non-listed occupational diseases may reduce the administrative burden of formal committee review and improve consistency and predictability.
• 352-362
• 10.6288/TJPH.202608_45(4).115015