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標題: | 職業傷害的社會不平等分布:全民健保職災醫療給付與勞工保險職業傷害現金給付之分析 Social Inequality of Occupational Injury: Analysis of National Health Insurance Medical Benefits and Labor Insurance Compensation Benefits |
作者: | Yi-Jing Chen 陳怡靜 |
指導教授: | 鄭雅文(Yawen Cheng) |
關鍵字: | 全民健康保險,勞工保險,職業傷害,疾病負擔,社會不平等,健康不平等, national health insurance,workers’ compensation insurance,occupational injury,burden of disease,social inequality,health inequality, |
出版年 : | 2020 |
學位: | 碩士 |
摘要: | 背景:工作者的社經地位是重要的社會決定因素,且可能影響職業傷害的發生風險。在臺灣,針對職業傷害風險已有不少研究,對工作者人口學進行廣泛分析,發現藍領階級者有較高的職業傷害風險。然而少有研究分析工作者的社經地位與職業傷害風險及疾病負擔程度之相關。 目的:本研究旨在檢視職業傷害社會不平等的現象及歷年趨勢。 方法:本研究利用2016年至2018年的勞工保險職業災害現金給付資料以及2000年至2016年的全民健康保險職災醫療給付資料,比較不同性別、年齡、投保薪資、投保單位類別、產業以及各行政區域之職業傷害發生狀況及疾病負擔程度。勞保資料方面,分析2016年至2018年三年間致死性與非致死性職業傷害發生率及趨勢;全民健保方面,分析2016年不同社經地位工作者之職業傷害醫療給付發生率、死亡率、就醫後30天內致死率、住院率、住院後30天內致死率、平均每人醫療花費、失能調整人年,和2000年至2016年各變項之趨勢,並利用邏輯斯迴歸分析不同社經地位工作者的職業傷害風險。 結果:(1)於勞保資料中,2016年至2018年間之總投保人年為30,809,863人年,三年間共發生1,617件致死性及150,026件非致死性職業傷害案件。三年之致死性及非致死性職業傷害發生率分別為5.25/105人年及486.94/105人年。趨勢方面,非致死性職業傷害發生率呈現下降趨勢,致死性職業傷害發生率則無顯著趨勢。(2)於健保資料中,2016年之投保人年為12,109,590人年,發生共154,561件職業傷害醫療給付案件、114件職業傷害就醫後30天內死亡案件、11,813件住院案件、49件住院後30天內死亡案件。職業傷害發生率為1,276.35/105人年、職業傷害死亡率為0.94/105人年、職業傷害就醫後30天內致死率為0.70/103、住院率為97.55/105人年、職業傷害住院後30天內致死率為4.15/103、平均每人醫療花費點數為126.74點、DALYs為34.04/105。趨勢方面,職業傷害醫療給付發生率呈現上升趨勢,職業傷害就醫後30天內致死率、住院率則呈現下降趨勢,職業傷害死亡率、住院後30天內致死率及平均每人醫療花費則無顯著趨勢。整體而言,男性的職業傷害疾病負擔及發生風險皆較女性高;年輕工作者職業傷害發生風險較高、年長工作者職業傷害死亡風險較高;投保薪資高者職業傷害疾病負擔及發生風險皆較低,但投保薪資與職業傷害風險之相關未呈現階層化分布;投保身分則以受僱者及職業工會投保者的職業傷害疾病負擔及發生風險較高;營造業的職業傷害風險顯著高於其他行業。 結論:本研究透過勞保資料及健保資料檢視職業傷害的社會不平等分布,但並未發現一致性的社會階層化現象,可能與社會階層指標的選取與測量方式較為粗略有關。有關投保薪資與社會經濟地位之關聯則需進一步探究。然而本研究仍指出,職業傷害仍對勞動人口造成相當高的疾病負擔。勞動主管機關應檢視現有的職業安全保護措施,並針對高風險族群加以改善。 Background: Worker’s socioeconomic position is an important social determinant of health and may influence the risks of occupational injury. In Taiwan, the associations between workers’ demographic factors and the risk of occupational injury have been studied, showing that blue-collar workers had higher risk of occupational injury. However, few researches have been conducted to examine the association of workers’ socioeconomic position with the risk of occupational injury and disease burden. Objectives: This study was designed to examine if there were social inequalities in the risks of occupational injury and to examine the recent trends. Methods: Data from the workers’ compensation insurance for the period from 2016 to 2018 and the national health insurance for the period from 2000 to 2016 was obtained. Incidence rates and the burdens of occupational injury were compared across genders, age groups, levels of insured salary, employment types, industries and selected countries. With data from workers’ compensation insurance, fatal and non-fatal rates of occupational injury were calculated and the trends over the three-year period were examined. With data from national health insurance, incidence rate, mortality rate, case fatality within 30-day after admission, hospitalization rate, case fatality within 30-day after hospitalization, medical expenses and disability-adjusted life years were calculated and their trends over the period from 2000 to 2016 were examined. Logistic regression models were performed to examine the associations between workers’ socioeconomic status and these measures. Results: (1) During the period from 2016 to 2018, a total of 1,617 fatal and 150,026 non-fatal occupational injury benefit claims was granted upon 30,809,863 insured person-years. Incidence rates of fatal and non-fatal occupational injury were 5.25 and 486.94 per 100,000 person-years, respectively. There was a decreasing trend in the rate of non-fatal occupational injury but no apparent trend was observed for fatal occupational injury. (2) Data from the national health insurance in 2016 showed that there were a total of 154,561 occupational injury medical benefit claims, 114 fatal cases within 30 days after admission, 11,813 hospitalization cases, and 49 fatal cases within 30 days after hospitalization, upon a total of 12,109,590 insured person-years. Incidence rate, mortality rate and hospitalization rate were 1,276.35, 0.94 and 97.55 per 100,000 person-years, respectively. Case fatality within 30-day of admission and hospitalization were 0.70 and 4.15 per 1,000, respectively. Medical expenses per person were 126.74 points per person and disability-adjusted life years were 34.04 per 100,000 person-years. Incidence rates were increasing, but case fatality within 30-day of medical treatment and hospitalization rate were decreasing. For both incidence rate and burden of occupational injuries, men, those aged older than 60 or lower than 20 years old, construction workers and employees were at significantly higher risks. Although those in the highest salary bracket had a lowest incidence of occupational injury, no apparent pattern was observed between insured salary and occupational injury rate. Conclusions: Utilizing data workers’ compensation insurance and national health insurance in Taiwan, this study estimated the burden of occupational injury by workers’ socioeconomic position. Although those in the highest salary bracket had a lowest incidence of occupational injury, no apparent pattern was observed between insured salary level and the risk of occupational injury. Negative findings might be due to the inappropriateness of the indicators used in this study to reflect workers’ socioeconomic position. The relationship between insured salary and socioeconomic position deserves further research. Nevertheless, this study showed that occupational injury took a significant toll of disease burden in working population in Taiwan. Labor authorities should examine and strengthen measures for the protection of occupational safety especially for high risk groups. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/53828 |
DOI: | 10.6342/NTU202002381 |
全文授權: | 有償授權 |
顯示於系所單位: | 健康政策與管理研究所 |
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