臺灣大型企業推行職業健康服務之現況及困境

Abstract

研究目的:了解企業規模在 200 人以上之大型企業,推動職業健康服務之現況、推行之困難、事業單位認知需求程度及需要政府協助之程度及內容,以提供未來法規規定適當推動時機之參考。 研究方法:本研究為橫斷描述性研究。以「事業單位勞工健康服務調查問卷(200-299 人)」及「事業單位勞工健康服務調查問卷(300 人以上) 」為研究工具,並經由與中華電信租借之線上問卷平台進行問卷資料之收集。問卷信度採用折半信度檢定問卷的內在一致性,得 Cronbach’s alpha 為 0.91;而問卷效度之量表整體專家內容效度值為 0.98。收案之納入條件為在扣除投保於工會等組織者之後,所有安衛投保人數在 300 人以上之各事業單位共 1,676 家,及所有安衛投保人數在 200 人至 299 人之事業單位共 1,017 家;受試者為於上述條件之公司工作並負責提供或規劃職業健康服務之相關人員,如:職業衛生護理人員、安全衛生人員 (包括正式及委外人員)、人力資源人員、僱主或僱主代表等,排除條件則為非上述條件者、不識字,以及非制定職場健康服務之相關行政人員或編列預算者或執行職場健康服務者,每家事業單位至少需派一位代表填答問卷。 研究結果:共回收 1,427 份問卷,扣除同一人重復填答兩份之問卷(共扣除55份),即得有效問卷共為 1,372 份。其中有 200 份為同一家公司但不同身分別填答兩份的情形,故有 1,272 家事業單位回覆,回覆率為 47.2%;,其中安衛投保人數在 200-299 人者有 474 家事業單位回覆,回覆率為 46.6%;安衛投保人數在 300 人以上者共有 798 家事業單位回覆,回覆率為 47.6%。結果發現安衛投保人數在 200-299 人之事業單位已有部分有提供職業健康服務,其中尚未提供之事業單位,有一半以上之建議政府可「提供經費補助」、「加強法令宣導」、「提供或加強教育訓練」及「提供專業輔導團隊服務」,對於職業健康服務之建議醫師提供臨廠服務之頻率為 A 組為 3.2±1.6 小時(n=61,missing data=39);而 B 組為 2.8±1.4 小時(n=537,missing data=43)。A 組大多數之事業單位建議護理人員之服務是委託醫療機構派員的方式提供;B 組則建議要專職雇用。而在建議推動臨廠健康服務之時機會因事業單位規模有所不同,時機點平均落在民國 103 年~民國 105 年,總觀來看,事業單位並不排斥推行職業健康服務。 結論:經由此次之研究,了解到事業單位並不排斥推行職業健康服務,而是需要在更完善之規劃及充足之時間以準備,且大多的事業單位是需要政府提供相關不論是經費、人力或相關訓練等相關輔導。然而,就長遠來看,倘若事業單位們不能自動自發地辦理職業健康服務,即便提供再多的經費補助最後也只可能讓職業健康服務的推廣付諸東流。有如古人所云:「授人以魚,不如授人以漁;授人以漁,不如授人以欲。」,因此,政府若要提供事業單位相關經費補助或人力輔導,應要設定階段性的目標,讓事業單位能自我要求並有所成長,使達到能自動自發辦理,並致使最終認同職業健康服務的重要。

Objectives: This study aims to understand the occupational health services provision of large-scale enterprises which employ 200 or more workers. Also, the difficulties of the implementation of such services and the assistance needed from the government are also discussed. Methods: A cross-sectional study using an online questionnaire is utilized to collect data. The questionnaire we used is based on the contents of three others: 'Temporary plant health service institution status of implementation of the survey report”, 'Industries provide occupational health services questionnaire (200-299 people)”, and 'Industries provide occupational health services questionnaire (more than 300)'. We used split-half reliability to test the questionnaire’s internal consistency. The calculated Cronbach's alpha was 0.91 while the overall content validity scales is 0.98. The exclusion criteria is the industries’ insurance on trade unions and other similar organizers. The subjects of the industries with more than 300 employees (called group B) are 1,676; the subjects of the industries with 200 to 299 employees (called group A) are 1,017. The subjects that work in those industries and accord with the above conditions are responsible for providing or planning occupational health services such as occupational health doctors, occupational health nurses, health and safety personnel, human resources personnel, employer representatives, or the employer. Result: A total of 1,427 questionnaires were completed, 200 of which were returned by the same companies but different persons. So, a total of 1,272 companies returned the questionnaires (47.2% response rate). The results showed that some of the companies with 200-299 employees have been providing occupational health services. More than half of the companies that do not provide occupational health services suggested that the government could 'provide funds', 'strengthen laws propaganda', 'provide or strengthen education and training”, and 'provide professional counseling service team'. Group A recommended that the occupational doctor should provide 3.2±1.6 hours per occupational health service. Group B recommended that the occupational doctor should provide 2.8±1.4 hours occupational health service. Most Group A companies recommended that the occupational nurses should be commissioned, while most Group B companies recommended hiring full-time. In this study we can find that the timing to implement occupational health services will vary due to business scale, but generally can be fully implemented in 2016. Overall, the institution does not exclude the implementation of occupational health services. Conclusion: Companies do not repel the idea of occupational health services, but they need better planning and plenty of time to prepare. Most of the companies need the government to provide funding, human resources, related training or counseling and so on. However, in the long run, if the companies do not proactively apply occupational health services, even government funding will not help. As the ancients said, “Instead of giving fish, teach the man how to fish; instead of teaching fishing, give the man the desire to fish.” Therefore, if the government provides companies with resources, milestones should be set. This way, companies can desire the best occupational health services, implement occupational health services proactively, and ultimately identify the importance of occupational health services.