全民健康保險職業傷病認定的檢討

Current Status in Assessment and Benefit Payments of Occupational Diseases in Taiwan

劉紹興(Saou-Hsing Liou) ； 譚開元(Kai-Yuan Tan) ； 劉鴻文(Hwan-Wun Liu) ； 祝年豐(Nain-Feng Chu) ； 顧天倫(Tyan-Luen Gu) ； 吳聰能(Trong-Neng Wu)

《中華職業醫學雜誌》 3卷1期 (1996/01) Pp. 24-29

摘要

自全民健保實施以後，職業傷病享有免轉診和免部分負擔的優惠，但職業傷病的認定也由過去勞保局時代的醫師認定改為由投保單位認定並填發職業傷病就醫證明單。職業傷病的醫療給付也還是與普通傷病給付沒有差別。雖然健保局與勞委會降低塵肺症的診斷標準，對老舊職業病如塵肺症准予申請重大傷病，並著手修訂職業病種類表，但對勞工職業災害的認定政策仍不儘理想，謹提出下列建議：(一)職業災害就醫證明單應由診療醫師認定後填發；(二)提高職業傷病的醫療給付或以獎勵金方式獎勵職業傷病的診斷與治療：(三)設立職災基金培養職業醫學專科醫；(四)修訂職業病種類表，並區分一般職業病；(五)制定因過去職業而罹患職業病如塵胞症，但已轉業勞工的醫療照顧。

關鍵字

全民健康保險 ； 職業災害保險 ； 職業傷病 ； 職業病種類表 ； 醫療給付

並列摘要

Patients with occupational diseases and injuries had benefits of avoiding transferring processes and partial payments in current National Insurance Program. However, the judgement of occupational diseases and injuries was made by personnels in insured company. The medical payment was not different between occupational and non-occupational diseases and injuries. The policies of benefit payments for occupational diseases had improved in the last several months. For example, the criteria for diagnosis of compensable pneumoconiosis had reduced from grade IV to grade II; occupational diseases was in the lists of major insured diseases of National Insurance Program; and the definition of occupational diseases in labor insurance was revising. However, the following recommendations are suggested to improve the efficacy and completeness of occupational disease insuance. First, to tranferthe right of certifying occupational injuries and diseases certificate from employers to occupational physicians; Second, to increase the medical payments for diagnosis and treatment of occupational diseases and injuries in out-patient clinic; Third, to establish the board certification system to accredit occupational medicine physicians; Fourth, to separate the compensable and noncompensable occupational diseases in the lists of occupation diseases of labor insurance; Fifth, to establish the medical care system of occupational diseases patients who had transferred to other industries. These recommendations would improve accuracy in the estimation of risk of occupational diseases and injuries in various industries and sectors and have better care of patients with occupational diseases.

並列關鍵字

National insurance ； labor insurance ； occupational diseases and injuries ； medical payment