醫師納入勞基法對地區醫院醫師人力之影響

The Impact of Applying the Labor Standard Act to Physicians upon the Manpower of District Hospitals in Taiwan

林 本 奚(Pen-Hsi Lin)

指導教授 ： 張睿詒

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2018年)

https://doi.org/10.6342/NTU201803412

摘要

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。

關鍵字

勞基法 ； 工時 ； 醫師人力 ； 地區醫院 ； 緊急醫療能力分級

並列摘要

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.

並列關鍵字

Labor Standards Act ； working hours ； medical personnel ； physician supply ； district hospitals ； hospital emergency capacity accreditation by level

參考文獻

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