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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 張睿詒 | |
dc.contributor.author | Pen-Hsi Lin | en |
dc.contributor.author | 林 本 奚 | zh_TW |
dc.date.accessioned | 2021-06-17T06:36:08Z | - |
dc.date.available | 2021-09-04 | |
dc.date.copyright | 2018-09-04 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-08-16 | |
dc.identifier.citation | 1.全國法規資料庫:勞動基準法,取自:https://law.moj.gov.tw/Index.aspx.引用2018/05/01。
2.勞動部勞動法令查詢系統:勞基法法規沿革,取自:https://laws.mol.gov.tw/flaw/flawdat07.aspx?lsid=FL014930,引用2018/05/14。 3.林毅:醫師納入勞基法的漫漫長路,取自:http://www.thinkingtaiwan.com/content/4757,引用2015/10/28。 4.張濱璿、張耀懋:醫師適用勞動基準法的爭議-以會計師、律師經驗為鏡。台灣公共衛生雜誌201610(35:5期):459-476。 5.West, C. P., Tan, A. D., Habermann, T. M., Sloan, J. A., & Shanafelt, T. D..Association of resident fatigue and distress with perceived medical errors. In:JAMA The Journal of the American Medical Association 302(12),2009:1294-300. 6.Wallack, M. K., & Chao, L.. Resident work hours: The evolution of a revolution. In:Archives of Surgery, 136(12), 2001:1426-1432. 7.Jagsi, R., Weinstein, D. F., Shapiro, J., Kitch, B. T., Dorer, D.,& Weissman, J. S.. The Accreditation Council for Graduate safety. Medical Education's limits on residents' work hours and patient A study of resident experiences and perceptions before and after hours reductions. In: Arch Intern Med, 168(5), 2008:493-500. 8.胡方翔:醫師納入勞基法,缺的是錢不是人。天下讀者投書,2016/07/27,取自:https://opinion.cw.com.tw/blog/profile/52/article/4583,引用 2018/04/28。 9.衛生福利部:2016年11月18日醫師納入勞基法其程規劃報告,引用2018/05/01。 10.中央社:醫師納入勞基法,衛福部建議工時彈性,2017/11/12,取自:http://www.cna.com.tw/news/aipl/201711120088-1.aspx,引用2018/04/28。 11.林玉茹(2000)。教學醫院內外婦兒科醫師工作負荷之研究。國立陽明大學衛生福利研究所碩士論文,未出版,台北市。 12.楊明欽&黎伊帆&魏璽倫:教學醫院主治醫師與住院醫師之工作時數與相關因素之研究。醫學教育,2007;11:222-33。 13.陳秉暉、許睿琪、張漢任、陳宗延:2012年醫師工作環境問卷調查,取自:https://zh.scribd.com/document/138434825/2012,引用2018/05/30。 14.李明濱、胡佩怡、廖士程:勞安所研究報告-我國醫師工作壓力風險因子評估。勞動部勞動及職業安全衛生研究所,2014;1-108。 15.中時電子報:醫師納入勞基法‧薛瑞元:需增加9百名醫師,2018/04/19,取自:http://www.chinatimes.com/realtimenews/20180419001894-260405,引用2018/05/08。 16.熊昭、張毓宏(2014)。個別型- PH-103-SP-15 住院醫師納入勞基法之衝擊影響評估計畫。國家衛生研究。 17.張睿詒、蔡雅芳(2017)。計畫編號:M05A7435 醫師納入勞動基準法對於醫院營運之財務影響評估計畫,衛生福利部。 18.自由時報:醫師納入勞基法‧無配套恐大亂‧楊泮池2016-9-19,取自:http://news.ltn.com.tw/news/focus/paper/1033402,引用2018/05/02。 19.What is the European Working Time Directive. In: BMA-EWTD,取自:https://www.bma.org.uk/advice/employment/working-hours/ewtd,引用2018/04/18。 20.邱駿彥、李政儒:103年度研究計畫ILOSH103-R322 各國工時制度暨相關配套措施之比較研究。勞動部勞動及職業安全衛生研究所,2015;1-219。 21.方文伶(2014):我國工作時間除外規定之研究-以勞基法第八十四條之一為中心。中國文化大學法律學系碩士在職專班碩士論文,未出版,台北市。 22.Judgment of the Court of Justice, Jaeger, Case C-151/02 (9 September 2003),取自:https://www.cvce.eu/en/obj/judgment_of_the_court_of_justice_jaeger_case_c_151_02_9_september_2003-en-03d0bfbf-032c-4cfd-b72e-51b08d3439d8.html,引用2018/05/23。 23.The Impact of Siamp and Jaeger European Court of Justice Judgments Select Committee on European Union Ninth Report,取自:https://publications.parliament.uk/pa/ld200304/ldselect/ldeucom/67/6706.htm.引用2018/05/23。 24.McBide, Anne,EU Directive drives reform of junior doctors’ working hours ,2014/08/20,取自:https://www.eurofound.europa.eu/it/observatories/eurwork/articles/eu-directive-drives-reform-of-junior-doctors-working-hours,引用2018/05/23。 25.The Implementation of the Working Time Directive,and its Impact on The NHS and Health Professionals,2014/03,取自:https://www.ficm.ac.uk/sites/default/files/FICM-EWTD-Report-2014-1.pdf,引用2018/05/18。 26.Royal College of Surgeons:Comment on European Working Time Directive discussions,2017/12/21,取自:https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/comment-on-european-working-time-directive-discussions,引用2018/05/23。 27.Fitzgerald, J. E. F., & Caesar, B. C.. The European Working Time Directive: A practical review for surgical trainees. In: International Journal of Surgery, 10(8),2012: 399-403. 28.Lambert, T. W., Smith, F., & Goldacre, M. J.. The impact of the European Working Time Directive 10 years on: views of the UK medical graduates of 2002 surveyed in 2013–2014. In: JRSM Open, 7(3),2016: 2054270416632703. 29.Opting out of the European Working Time Directive. In: Cornell Univesity ILR School,2015.取自:https://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?referer=https://www.google.com.tw/&httpsredir=1&article=1453&context=intl,引用2018/6/20。 30.Health and Safety Executive:The Working Time Regulations,取自:http://www.hse.gov.uk/contact/faqs/workingtimedirective.htm,引用2018/05/23。 31.BMA:What is the European Working Time Directive,2018/04/18,取自:https://www.bma.org.uk/advice/employment/working-hours/ewtd,引用2018/05/23。 32.GOV.UK: Maximum weekly working hours,取自: https://www.gov.uk/maximum-weekly-working-hours/weekly-maximum-working-hours-and-opting-out,引用2018/06/14。 33.The European Working Time Directive: a practical review for surgical trainees. In:NCBI,2012;10(8):399-403. 34.胡博硯:淺談德國對醫師工時與勞動條件之規範。Angle Health Law Review 2016:1-8。 35.林更盛(2011)。個別型- NSC 99-2410-H-029-042- 論「工作時間」的界定-我國與德國法的比較研究成果報告(精簡版)。行政院國家科學委員會專題研究計畫成果報告。 36.1111人力銀行:1例1休專區-工作時間怎麼看,在家待命算嗎?2016/12/23,取自:https://www.jobforum.tw/discusstopic.asp?cat=medical&id=109232,引用2018/06/05。 37.Employment law in Denmark,2017/04/10,取自:http://www.millerrosenfalck.com/2017/04/employment-law-in-denmark-2,引用2018/06/14。 38.Rules on working hours.Laegeforen ingen,2017,取自:https://www.laeger.dk/information-in-english-yngre-laeger,引用2018/06/14。 39.https://www.facebook.com/notes/yawen-cheng.引用2018/06/14。 40.Employment, Social Affais & Inclusion-Your social security rights in Denmark. European Commission., 2013,取自: http://ec.europa.eu/employment_social/empl_portal/SSRinEU/Your%20social%20security%20rights%20in%20Denmark_en.pdf,引用2018/06/14。 41.Wallack, M. K., & Chao, L.. Resident work hours: The evolution of a revolution. In: Archives of Surgery, 136(12),2001: 1426-1432. 42.陳俊愷(2016)。受僱醫師工作時間之研究。國立政治大學法律學系論文,未出版,台北市。 43.Ciolli, & Ciolli, A.. The Medical Resident Working Hours Debate: A Proposal for Private Decentralized Regulation of Graduate Medical Education. In: Yale journal of health policy, law, and ethics, 7(1),2001: 175-228. 44.ACGME Common Program Requirements,2011. In:ACGME(Accreditation Council for Graduate Medical Education). 45.The ACGME 2011 duty hour standard : Enhancing Quality of Care, Supervisio n and Resident Professional Developmen.In: Accreditation Council for Graduate Medical Education,2011:1-114. 46.Drolet, B. C., Khokhar, M. T., & Fischer, S. A.. The 2011 duty-hour requirements--a survey of residency program directors.In: N Engl J Med, 368(8),2013; 694-697. 47.Reena Pattani, Peter E. Wu and Irfan A. Dhalla. Resident duty hours in Canada: past, present and future. In:CMAJ,2014/05/20. 48.Guide to the Work Health and Safety Act 2011 Queensland,取自:https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0006/82545/guide-to-work-health-and-safety-act-2011.pdf,引用2018/06/14。 49.Industrial Relations Commission/Industrial Relations Act 1999 - s. 156 - Certification of an agreement Medical Officers' Queensland Health Certified Agreement,2009/12/16. 50.The impact of reduced working hours on surgical training in Australia and New Zealand. In:The Surgeon of ELSEVIER 9(1),2011;s8-s9. 51.勞動部:日本勞動環境及勞動法令簡介-日本篇,取自:https://www.mol.gov.tw/media/1381062/%E6%97%A5%E6%9C%AC.pdf,引用2018/06/02。 52.中野 雅之:労働時間の短縮の促進に関する臨時措置法の一部を改正する法律案。厚生労働省労働基準局,2001/02/09,取自:http://www.mhlw.go.jp/topics/0102/tp0209-3.html,引用2018/06/02。 53.労働政策研究:日本の長時間労働・不払い労働時間の実態と実証分析。労働政策研究報告書2005(22期):1-12。 54.侯岳宏:醫師適用勞動基準法-日本法之判準。Angle Health Law Review 2016:1-5。 55.関西医科大学研修医過労死事件,2005,取自:https://ja.wikipedia.org/wiki,引用2018/06/02。 56.労働基準法(ろうどうきじゅんほう、昭和22年4月7日法律第49号),取自:http://www.archives.go.jp/ayumi/kobetsu/s22_1947_02.html,引用2018/06/02。 57.勤務医と労働基準法,取自:http://www.medical-bank.org/medicstv/file/kinmui,引用2018/06/02。 58.侯岳宏:日本工作時間與待命時間之認定的發展與啟示。臺北大學法學論叢201009(75期):175-209。 59.鄭雅文、吳宣蓓、翁裕峰:過勞職災的認定爭議與政策因應:日本經驗對台灣的啟示。台灣公共衛生雜誌2011(30:4期):301-315。 60.日本学術会議:病院勤務医師の長時間過重労働の改善に向けて,2011/09/27,基礎医学委員会・健康・生活科学委員会合同,パブリックヘルス科学分科会。 61.醫療維新:橋本佳子:勤務医の35%、「時間外労働、月60時間以上」-意識調査『「時間外労働」の上限規制、医師に適用すべき?』,2017/03/04,取自https://www.m3.com/open/iryoIshin/article/508419/,引用2018/06/02。 62.自由時報:日本決修勞基法明定單月加班不得超過100小時「過勞死線」,取自:2018-2-2/ http://news.ltn.com.tw/news/world/breakingnews/2331132,引用2018/06/02。 63.衛生福利部:住院醫師勞動權益保障及工作時間指引,取自:https://www.mohw.gov.tw/fp-2736-8859-1.html,引用2018/03/05。 64. 衛福部立法院黨團協商:受僱醫師納入勞基法時程規劃說明,2016/09/20。 65.自由時報:工時喬不攏‧受僱醫師納勞基法恐生變,2017/08/22,取自:http://news.ltn.com.tw/news/life/breakingnews/2170419,引用2018/07/03。 66.民報:住院醫師工時新制違勞基法,勞動部:依試辦結果調整,2017/11/13,取自:https://tw.news.yahoo.com/-065935239.html,引用2018/07/03。 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72336 | - |
dc.description.abstract | 醫師工作過勞已是社會議題,不僅損及自身健康,更可能危害病人醫療安全。衛生福利部2016年9月公布規劃受僱醫師納入勞基法將於2018年9月1日前完成發布命令,2019年9月1日正式實施。從社會公義角度,一般大眾應普遍都認同,然因醫療照護與醫師工作性質的特殊性,醫師工時受規範,將面臨醫師人力不足,醫院整體財務影響與民眾就醫受限等問題,尤其在醫師工時定義未明前題下,更難釐清醫師人力缺口。
本研究藉由衛福部委託台灣大學「受雇醫師納入勞基法財務影響評估計畫」,辦理全國巡迴說明會方式,參考德國工時五分類,定義國內醫師工作時間,經由問卷方式,收集地區醫院各醫療專科醫師工時現況,地區醫院有64家回覆,有效樣本451份,依據「住院醫師工時指引」每週工時80小時為上限,分析地區醫院主治醫師除神經外科約有2位醫師人力缺口,在非都會區又需肩負中度急救責任醫院條件下主治醫師的人力缺口約有65人,其它各類型的條件推估皆無主治醫師人力缺口。如以勞基法每週工時40小時為上限,以整體地區醫院推估主治醫師人力總缺口數約2,562人。如以緊急醫療能力分級為條件,主治醫師人力總缺口數約2,575人。以都會區與非都會區做劃分,主治醫師人力總缺口數約2,541人,如再加上緊急醫療能力分級條件,主治醫師人力總缺口數約2,676人,其中屬非都會區、又需肩負中度急救責任醫院的主治醫師人力缺口最大,約712人。如以急性一般病床數100床為界線,加上緊急醫療能力分級為條件,主治醫師人力總缺口數約2,637人,100床以上又須負擔中度急救責任的醫院,其主治醫師人力缺口約710人。最後如依據衛福部所訂定的23個醫療專科做推估,整體地區醫院主治醫師人力總缺口數約2,284人。 本研究發現,在醫師納入勞基法每週40小時的工時規範,地區醫院主治醫師人力缺口數約2,284人至2,676人,其中在非都會區、需負擔急救責任的醫院,或急性一般病床100床以上又須負擔急救責任的醫院,將面臨更嚴重的主治醫師人力缺口的問題。 | zh_TW |
dc.description.abstract | Excessive workloads for doctors not only encroach upon the health of doctors themselves, they may potentially affect the health of the people under those doctors’ care. Thus the question of excessive hours has become an issue of attention for Taiwanese society. Taiwan’s Ministry of Health and Welfare announced in September 2016 that doctors would be brought under the purview of the Labor Standards Act; the order would be issued by September 1, 2018, and would go into effect one year after that, on September 1, 2019. The public has universally acknowledged the social justice aspect of this issue. However, due to the unique characteristics of medical care practitioners and doctors, a restriction of working hours may lead to a general shortage of doctors, influence the finances of these doctors, and place limits on people seeking medical attention. These problems are especially pertinent when the working hours of doctors are not clearly stipulated. Thus it remains uncertain just how large the shortage of doctors will be.
This study uses National Taiwan University’s Plan to Evaluate the Financial Influence Resulting from Incorporation of Doctors in the Labor Standards Act, which was commissioned by the Ministry of Health and Welfare. Seminars were held at various locations around Taiwan. Working hours for doctors in Taiwan were defined by reference to the five categories of working hours in German labor law. By use of questionnaires, working-hour data were collected from doctors per specialty in district hospitals throughout Taiwan. A total of 64 hospitals responded and supplied a total of 451 valid individual responses. If 80 hours per week is assumed to be the ceiling for working hours for doctors, as is provided in the Guidelines Governing the Working Hours of Resident Doctors, analysis of the data from the district hospitals surveyed revealed that, with the exception of neurology departments, there is a shortage of 2 attending physicians. In non-urban hospitals that are required to undertake intermediate emergency responsibilities, there is a shortage of 65 attending physicians. There are no shortages of attending physicians for any of the other factors considered. Assuming the limit of 40 working hours per week as defined in the Labor Standards Act, it may be estimated that there will be an overall shortage of 2,562 attending physicians in district hospitals throughout Taiwan after the act is applied to doctors. That shortage becomes 2,575 attending physicians if the hospital emergency capacity accreditation by level is taken into consideration. Considering urban and non-urban areas, the shortage will be approximately 2,541 attending physicians. And when the hospital emergency capacity accreditation by level is added into the calculation, that shortage becomes 2,676 attending physicians. The shortage for non-urban hospitals that are required to undertake intermediate emergency responsibilities will be the largest, at 712 attending physicians. If we assume a limit of 100 acute care hospital beds and consider the hospital emergency capacity accreditation by level, the shortage will be 2,637 attending physicians. For hospitals with more than 100 beds that are required to undertake intermediate emergency responsibilities, the shortage will be approximately 710 attending physicians. Lastly, basing the estimate on the 23 medical specialties stipulated by the Ministry of Health and Welfare, the overall shortage for district hospitals will be 2,284 attending physicians. It was discovered in this study that there will be a shortage of approximately 2,284 to 2,676 attending physicians in district hospitals after working hours for doctors are limited to 40 hours per week by the Labor Standards Act. Hospitals with the most serious shortages will be those hospitals in non-urban areas that are required to undertake emergency responsibilities, or those hospitals with more than 100 acute care hospital beds that are required to undertake emergency responsibilities. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T06:36:08Z (GMT). No. of bitstreams: 1 ntu-107-P05848008-1.pdf: 1540523 bytes, checksum: c2d4dc4d39f6a7c02eb328a66e8efd45 (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 摘要 I
目錄 IV 圖目錄 V 表目錄 VI 第一章 緒論 - 1 - 第一節 研究背景與動機 - 1 - 第二節 研究問題與目的 - 6 - 第二章 文獻探討 - 8 - 第一節 各國對醫師工作時數、休假規定及影響 - 8 - 第二節 台灣勞基法、住院醫師工時規範及文獻探討 - 28 - 第三章 研究方法 - 49 - 第一節 研究流程 - 49 - 第二節 研究樣本與資料來源 - 50 - 第三節 研究工具與分析方法 - 51 - 第四章 研究結果 - 55 - 第一節 地區醫院主治醫師工作時間現況調查 - 55 - 第二節 地區醫院主治醫師人力缺口推估 - 67 - 第三節 討論 - 79 - 第四節 研究限制 - 81 - 第五章 結論與建議 - 82 - 第一節 結論 - 82 - 第二節 建議 - 84 - 參考文獻 - 85 - | |
dc.language.iso | zh-TW | |
dc.title | 醫師納入勞基法對地區醫院醫師人力之影響 | zh_TW |
dc.title | The Impact of Applying the Labor Standard Act to Physicians upon the Manpower of District Hospitals in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 石崇良,簡志誠 | |
dc.subject.keyword | 勞基法,工時,醫師人力,地區醫院,緊急醫療能力分級, | zh_TW |
dc.subject.keyword | Labor Standards Act,working hours,medical personnel,physician supply,district hospitals,hospital emergency capacity accreditation by level, | en |
dc.relation.page | 97 | |
dc.identifier.doi | 10.6342/NTU201803412 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-08-16 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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