我國旅居越南工作者的工作、健康及醫療照顧需求

Abstract

研究背景與目的：全球化之下導致勞工跨國的流動日益頻繁。因個人動機或企業組織要求而外派至其他國家工作的工作者，也是全球化之下逐漸攀升的族群。國際文獻指出，外派工作者可能因旅居地環境、語言與社會適應不良等問題而產生醫療服務受限及身心健康問題；然而國內鮮少有相關的實證研究。本研究為初探性研究，旨在探討我國旅越工作者的工作、健康與醫療利用，並與勞動部2016年工作者調查資料進行比較，了解兩族群間在工作與健康的差異。

研究方法：於2023年2月17日至5月12日進行網路問卷調查。研究對象為20歲以上、旅居越南工作至少六個月以上的臺灣工作者；問卷內容包含每日平均工時、每月平均收入、外派資歷、語言能力、居住狀況、自評健康、心理健康、個人疲勞與醫療利用；本研究問卷共發放389份，回收有效樣本388份。本研究自勞動部2016年調查資料，選取年齡、性別、教育程度及職業類別配對之國內工作者進行比較，並針對自評健康、心理健康與個人疲勞進行複迴歸分析。

研究結果：我國旅越工作者以製造業為多數（76.0%）、職務類型多為管理人員（52.1%）、聘僱型態以受僱者為多數（89.4%）。旅越工作者每週平均工作六天，每日平均工時為8-10個小時，整體的工作時間高於國內工作者；居住安排以住在廠區宿舍為主（68.8%）。相較於國內一般工作者，旅越工作者的每週工作天數（p＜0.001）與每日平均工時較高（p＜0.001），且心理健康較差（p＜0.001）；有15.7%過去一年因工作受傷或罹患疾病；在自評症狀類型方面，以眼睛不適、消化系統疾病、睡眠問題較為常見。迴歸分析顯示，在旅越工作者中，每日平均工時大於10小時相對於小於10小時者（OR=3.348）、平均月收入小於60,000元相對於80,000元以上者（OR=3.331）、外派資歷5年以上（OR=6.492）相對於小於2年者是心理健康不佳的重要相關因素。旅越工作者在越南以藥局為獲取醫療照顧資源的最主要管道（69.3%），而買藥的主要原因為呼吸系統疾病，其次為消化系統疾病。赴醫院門診就醫的原因則以消化系統疾病為多數，其次為呼吸系統疾病；診所的就醫原因為呼吸系統疾病。調查對象中有55人(14.2%)表示在旅越期間有健康照顧需求但未就醫，其原因包括對當地醫療品質缺乏信心、自行備藥、語言差異、欠缺前往就醫的交通工具。

結論：高工時與長期旅居外地的工作特性可能導致旅越工作者有較差的身心理健康，然而礙於醫療品質與可近性問題，造成部分工作者雖有健康照護需求但未能滿足。在經濟球全球化之際，政府與企業在推動產業國際化之時，亦應重視外派工作者於旅居地的工作、健康與醫療照顧需求。

Background and objectives: Globalization has expedited cross-border labor flow in Taiwan and worldwide. Consequnently, people working in other countries due to personal motives or dispatched by corporate organizations have been increasing . International literature points out that expatriates may have physical and mental health problems due to inadequate living environment, language barriers, and social maladaptation; however, few relevant empirical studies exist in Taiwan. As an exploratory research, this study aimed to explore the work, health, and healthcare utilization among Taiwanese expatriates in Vietnam. This study also compared them with domestic workers in Taiwan to understand the differences in work and health between these two groups.

Methods: An online questionnaire survey was conducted from February 17 to May 12, 2023. The participants in this study were Taiwanese expatriates over 20 years old who had lived and worked in Vietnam for at least six months; A questionnaire was used to obtain information regarding working hours, monthly income, expatriate experience, language proficiency, living arrangement, self-reported health (SRH), mental health, personal burnout, and health care utilization. A total of 389 questionnaires were distributed, and 388 valid samples were available for analysis. Furthermore, a sample of domestic workers matched to the study population on age, gender, education, and occupational type was drawn from a national survey for comparison purposes. Logistic regression models were performed to explore the correlates of self-rated health, mental health, and burnout.

Results: The majority of Taiwanese expatriates working in Vietnam were in manufacturing (76.0%), and most of them were managers (52.1%) and employees (89.4%). Most worked six days a week, with average daily working hours of 8-10 hours. The overall working hours were higher than domestic workers; Most lived in dormitories in the factory provided by enterprises (68.8%). Compared with domestic workers in Taiwan, Taiwanese expatriates had significantly higher rates of working days(p<0.001), working hours(p<0.001), and poor mental health(p<0.001); 15.7% of them have injured or disease. Discomforts of eyes, digestive system, and sleep problems discomforts were the top three most cited health concerns. Regression analyses showed that working hours of more than 10 hours, having a monthly income of less than 60,000, and having more than 5 years of expatriate tenure were significantly associated with poor mental health among Taiwanese expatriates. Taiwanese expatriates obtained healthcare mainly from pharmacies (69.3%). The main reasons for using pharmacies were respiratory and digestive illnesses; digestive illnesses were the most common reasons for hospital outpatient visits, followed by respiratory illnesses; respiratory illnesseswere the main reason for clinic visits. The study found that 55 (14.2%) participants had healthcare needs but did not seek healthcare in Vietnam. The reasons included a lack of confidence in the quality of local medical care, self-preparation of medicines, language barrier, and lack of transportation to get medical care.

Conclusions: High working hours and prolonged duration of expatriation may lead to increased risks of having poor physical and mental health among Taiwanese expatriates working in Vietnam. However,their healthcare needs have not been fully addressed because of quality concerns and insufficient accessibility. With economic globalization, the government and enterprises should pay attention to the work and health conditions as well as healthcare needs of expatriates working abroad.