以醫療服務利用檢視移民勞工之健康不平等

Examine Health Inequality of Migrant Workers in Taiwan under Medical Utilization

王嬿晴(Yen-Ching Wang)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學研究所/碩士(2008年)

https://doi.org/10.6833/CJCU.2008.00186

摘要

自1992年開放移民勞工之後，每年在台移工人數已超過三十萬人，其中50%為製造業，40%為監護工及家庭幫傭，4%為營造業。移工因為語言、文化等適應問題，導致其醫療服務利用率遠低於國人，且不同行業醫療服務利用亦有差異。製造業、營造業、監護工及家庭幫傭是否肇因於不同的勞動處境，而造成不同的疾病風險暴露，或因母國文化與在台生活處境影響其醫療可近性。因此，欲從職業屬性探究移工醫療服務利用情形，並控制在台居留時間後，進一步分析其影響因素。研究目的為瞭解不同國籍與職業別移工之醫療服務利用情形，進而檢視其是否有健康不平等之情況。
使用次級資料分析方法，資料來源為2004年「入境移工基本資料檔」及「全民健保研究資料庫」，擷取2004年12月底在台移工為分析對象，共計190,714人。居留未滿一年移工以門診利用比例和第一次就醫時間作為醫療服務利用指標，居留一年以上移工則為年平均就醫率和次數。假設相同國籍、職業、性別會有相同的健康需求，若依「健康平等」的原則，應有相同的醫療服務利用。因此，控制年齡、居留時間與城鄉醫療資源後，以Cox Model、複迴歸、邏輯式迴歸分析不同性別職業別和國籍移工間之醫療利用相對機率與差異性。
研究發現，移工就醫比例隨來台時間的增加而有上升的趨勢，初期（三個月內）就醫比例為9.7%，第四個月至第十二個月則急遽增加至44.1%，一年以後再提高至71.6%。有就醫者平均第一次就醫時間為來台第7.9個月，其中又以男性營造業最短(5.9個月)(p<0.001)。不分來台時間，皆以男性營造業的利用比例最高（一年內39.1%，一年以上79.6%），其次為女性製造業(36.2%；78.0%)、男性製造業(32.4%；70.1%)，女性監護工最低(27.9%；69.4%)。平均每人每年利用門診次數為3.2次(標準差5.0)，有就醫者年平均門診次數為4.5次(標準差5.5)。值得注意的是，女性監護工的利用比例最低，但其有就醫者之平均就醫次數卻最多(5.4次)，男性營造業(3.5次)與男性製造(3.8次)最低。呼吸系統疾病為所有移工最主要之就醫疾病類型，次要疾病則因性別職業類別而有所差異。男性營造業為損傷中毒與骨骼肌肉損傷，男性製造業未滿一年移工亦是損傷中毒與骨骼肌肉損傷，一年以上則為損傷中毒與皮膚疾病。女性製造業移工不分時間皆以皮膚和泌尿生殖系統疾病為最多，監護工為皮膚與消化系統。
從移工門診就醫資料中擷取急診就醫記錄，8.7%移工利用過急診，其中以男性營造業與男性製造業急診比例最高(11%)，女性監護工(5.6%)最低。急診就醫原因近五成為損傷及中毒，其次為消化系統與呼吸系統疾病。在控制居留時間後發現，來台未滿一年之男性營造業移工損傷中毒的急診就醫率高於男性營造業(RR＝2.7)，但一年以上則無差異；呼吸系統急診相對機率亦高於其他職業(RR＝3.2）。女性製造業因為泌尿生殖系統疾病而急診的相對機率高於女性監護工（一年內RR＝1.5，一年以上RR=1.9）。
職災就醫率也發現與性別職業成顯著性相關，居留一年以上移工有1.3%曾因職災就醫，其中以男性製造業職災比例(2.7%)最高，其次是男性營造業(0.9%)、女性製造業(0.6%)。職災中有九成以上為損傷及中毒，其中以開放性傷口最為常見，其次是骨折與壓砸傷。泰籍移工的高職災率(2.4%)實際上是因為泰籍移工多為男製造業和營造業使然。
影響健康不平等因素來自暴露於不健康有壓力的工作和生活環境、健康服務可近性不足、與生活方式選擇受限的健康危害行為。職業間的疾病類型差異，反映其各自暴露於不同的疾病風險中。男性營造業與男性製造業的高損傷中毒率和職災率，顯示男性移工的工作安全風險高；女性製造業的高泌尿生殖道感染，意味著製造業的工作型態可能招致健康危害行為，如工作服穿脫不便或生產線人力不足造成少喝水、憋尿等不健康行為。研究結果證實，移工之職業類型會造成其健康不平等。移工管理單位應根據其職業類型，提供適合的衛生教育資訊及職業安全訓練，製造業與營造業移工需加強工地職業安全訓練；製造業、監護工需加強自我照顧方法及管道的資訊。

關鍵字

移民勞工 ； 健康不平等 ； 醫療服務利用

並列摘要

It is in 1992 that the Taiwan government allowed to introduce migrant workers. It was estimated that more than three hundred thousand migrant workers were imported. The 50% of them work in factory, and the other 40% served as caretakers or servants, and the 4% work in construction industry. The migrant workers must encounter the problem of language barrier and culture shock that decreased their utilization of medical care, which was much lower than that of Taiwanese. Furthermore, the utilization of medical care varied with occupations. is using different part of it, such as manufacture, construction, caretakers or servant would expose to different environments and cause to dissimilar disease and the culture of mother country and their situation of living in Taiwan would affect their medical utilization availability. Therefore, this research is focus on the occupations of using medical utilization. The data is limited in time after the workers stay in Taiwan and analyzes the reason of affection. The purpose is to find out the usage of medical utilization of different nationality’s workers and occupations and examine health inequality of migrant workers in Taiwan have under medical utilization or not.
This essay is using the “secondary data analysis” analyzes, and the data is from 2004 “the migrate workers data” and “the research of national health insurance data”. Taking the data of the migrate workers, 190,714, while 2004 December. After the particular data of ages and over one year workers and the resource of country then test with multiple regression analysis on the related of the times of go to a doctor and the sex and occupation and using multiple logistic regression to test their relations and also using Cox Proportional Hazard Model, Cox model to find out this people’s Relative risks.
From this report, the percent of the migrate workers go to a doctor the proportion to come along the Taiwan time increase to have the rise tendency, the initial period (three months) goes see a doctor the proportion is 9.7%, fourth month to 12th month then increase hurriedly to 44.1%, year later will again enhance to 71.6%. The average of the workers to go to hospital first time is 7.9 month and most of them are male, works in construction industry, which is 5.9 month (p<0.001). No matter the time when the workers coming, the highest rate of medical utilization is the male workers work in construction industry(within one year 39.1%，after stay one year later 79.6%), the following is female (36.2%；78.0%)and male(32.4%；70.1%) workers work in manufacture industry and the lowest is the caretakers(27.9%；69.4%). Average each human of every year uses the outpatient service number of times is 3.2 times (standard deviation 5.0), has the going see a doctor annual mean outpatient service number of times is 4.5 times (standard deviation 5.5). It is noteworthy that, the feminine guardianship labor use proportion is lowest, but it has the going see a doctor average of to go see a doctor the number of times to be actually most (5.4 times), masculine building industry (3.5 times) and masculine manufacture (3.8 times) lowest. The respiratory disorder for all moves the labor most mainly to go see a doctor disease type, then the secondary disease has a difference because of the sex professional category. Masculine building industry for the damage poison and the skeleton muscle damage, the masculine manufacturing industry full year has not moved the labor also is damages toxicant and the skeleton muscle damage, above a year for damage poison and skin disease. The feminine manufacturing industry moves the labor not time sharing between all take the skin and uropoiesis reproductive system disease as most, guardianship labor for skin and digesting system.
From migrate workers outpatient service to go see a doctor in the material to pick up the emergency medical treatment to go see a doctor the record, 8.7% moves the labor to use the emergency medical treatment, in which and the masculine manufacturing industry emergency medical treatment proportion is highest by masculine building industry (11%), feminine guardianship labor (5.6%) lowest. The emergency medical treatment goes see a doctor the reason nearly five to become the damage and the poison, next for digesting system and respiratory disorder. Discovered after the control residence time that, comes Taiwan full year male building industry not to move the labor damage poison emergency medical treatment to go see a doctor rate is higher than masculine building industry (RR=2.7), but above a year does not have the difference; The respiratory system emergency medical treatment relative probability also is higher than other occupations (RR=3.2). But the feminine manufacturing industry the emergency medical treatment relative probability is higher than the feminine guardianship labor because of the uropoiesis reproductive system disease (in a year RR=1.5, above a year RR=1.9).
The duty disaste goes see a doctor rate also discovered because and the sex occupation became the significance to be related, resides above for a year to move the labor to have 1.3% once the duty disaster to go see a doctor, in which by masculine manufacturing industry duty disaster proportion (2.7%) highest, next was masculine building industry (0.9%), the feminine manufacturing industry (0.6%). In the duty disaster has the over ninety percent for the damage and the poison, in which is most common by the open wound, next is the bone fracture and the pressure crushes and injures. The Thai immigrant laborer quality disaster rate (2.4%) in fact is because Thai immigrant laborer many and building industry makes to cause to so for the male manufacturing industry.
The influence health not equal factor comes from exposes does not have the pressure work and the living conditions, the health service accessibility insufficiency, with the life style choice in the ill health the health danger behavior which limits. The occupation disease type difference, reflected it exposes respectively in the different disease risk. Masculine building industry and the masculine manufacturing industry high damage poison rate and the duty disaster rate, demonstrated the male moves the labor job safety risk to be high; The feminine manufacturing industry high uropoiesis genital tract infection, meant the manufacturing industry the work state possibly incurs the health danger behavior, like the work clothes put on escape inconvenient or the production line manpower create insufficient little drink water, suppress the urine and so on the ill health behavior. The findings confirmed that, moves occupation of type the labor to be able to create its health not to be equal. Moves the labor administrative unit to be supposed to act according to its professional type, provides the suitable health education information and the occupational safety training, the manufacturing industry and building industry moves the labor to have to strengthen the work site occupational safety training; The manufacturing industry, the guardianship labor must strengthen the self-attendance method and the pipeline information.

並列關鍵字

migrant workers ； health inequality ； health utilization

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