全民健康保險實施前後勞工意外事故發生率之變化及其涵意

Workers' Unintentional Injuries Associated with the Change of Insurance Policy in Taiwan-The Implications of the Change

李中一(Chung-Yi Li) ； 杜宗禮(Chung-Li Du) ； 陳秋蓉(Chiou-Jong Chen)

《中華公共衛生雜誌》 17卷4期 (1998/08) Pp. 317-325

https://doi.org/10.6288/CJPH1998-17-04-05

摘要

本研究利用「勞工保險現金給付資料」分析1994與1996年勞工保險（以下簡稱勞保）被保險人職業與非職業傷害、疾病、殘廢、與死亡發生率，以及潛在工作生命損失率之變化，以探討全民健康保險（以下簡稱全民健保）實施前後勞保被保險族群特性是否改變，及估計勞工意外事故發生率的變化。分析結果發現：全民健保實施後，勞保總投保人數減少了近一百萬人，降幅約為125%，職業相關事故年齡標準化發生率(‰)由3.97人次上升為4.26人次，而非職業事故年齡標準化發生率(‰)則由31.37人次大幅下峰為21.20人次，其中非職業事故發生率大幅下降主要則是由於非職業疾病之發生率大幅下降所致。作者推測：由於全民健保實施前有許多「寄保」人口，因此使得1994年實際的職業意外事故發生率可能被低估，而在「寄保」人口退出勞保後留在勞保者則是真正具有職業意外事故風險的勞工，因此1996年之職業意外事故發生率估計值相對而言較為正確，因而造成職業意外事故發生率在全民健保實施後上升的現象。此外，非職業相關疾病發生率在全民健保實施後明顯下降，也反應出全民健保實施後的勞保族群似乎是比較健康的一群人。本研究建議：未來研究利用勞保現金給付資料比較1995前後勞工意外事故發生率時，對於結果的闡述必需小心。此外，未來研究亦應探討如何結合全民健保與勞保現金給付資料，期能更精確地估計台灣地區勞工意外事故之發生率及嚴重性。

關鍵字

職業 ； 傷害 ； 殘廢 ； 死亡 ； 潛在工作生命損失數

並列摘要

Using compensation records of the National Labor Insurance, this study estimates workers' incidence rates of injury or illness, disability, and mortality from occupational or non-occupational causes for 1994 and 1996, the year prior to and the year post the effectiveness of the National Health Insurance, respectively. The purpose is to assess changes in these rates and to propose implications related to those changes. The number of workers covered by the Labor Insurance decreased by some one million or 12.5% after the national health insurance program became effective in March 1995. While the rate of overall occupational injury increased slightly from 3.97/10^3 in 1994 to 4.26/10^3 in 1996, rate of overall non-occupational injury, on the other hand, declined dramatically from 31.37/10^3 to 21.20/10^3, respectively, largely due to a substantial reduction of non-occupation-related diseases. The results may lead to two implications. Firstly, the increase of occupational injury might be associated with the substantial dropout of people who were not ”real” workers but covered in the system leading to a reduced population size of workers actually at potential risk of occupational injury. Secondly, a remarkable decrease in risk of non-occupation-related diseases may lead to a speculation that the labor-insured workers were relatively healthier in 1996 than in 1994. Our findings call for a particular caution to use the labor health compensation records documented before and after 1995. Future studies should be devoted to merge data from both compensation records and national health insurance registry for the attainment of accurate estimation of incidence rate and severity of workers' injuries in Taiwan.

並列關鍵字

occupation ； injury ； disability ； mortality ； potential work years of life lost