我國職災死亡監控系統完整性之評估

Evaluation of the Completeness of the Surveillance System for Fatal Occupational Accidents in Taiwan

對於一個現代化的國家而言，職業傷病的監控系統是非常重要的，然而我國目前仍缺乏完整的規劃。以職業災害而言，現今的監控資料來源主要是由工作場所、事業單位發生勞工死亡或三人以上受傷時，雇主依據勞工安全衛生法第二十八條第二項規定報告檢查機構者，有低估職災個案數的可能。由於職業病之診斷較職業傷害之診斷複雜，本研究以職業傷害當中最為嚴重者―也就是職災死亡的個案―為標的，進行監控系統完整性之評估。本研究參考先進國家的作法，採用多重管道監控系統，收集民國 88 年 11 月 1 日至 89 年 5 月 30 日死亡者，以透過專家會議制定的定義經醫師判定職災死亡個案。結果研究期間共計有 976 例個案，來自勞委會勞動檢查報告、公保因公死亡給付、勞保職災死亡給付、媒體報導、警政署交通事故資料庫、法醫鑑定報告資料庫、衛生署死亡登記、問卷調查等資料；其中有 214 例（21.9%）向勞動檢查機構通報。分析未通報原因，主要是因為交通事故、非工作場所、就業場所職災未包括在報告之要求規定範圍中，而不適用勞工安全衛生法之事業單位勞工的職災及自營雇主發生者不在通報範圍。經比對發現，沒有一個單一的管道能夠發現所有的個案。因此，我國建立多重管道的職災死亡監控系統是有必要的，而且應該利用即時的資料蒐集方式才能確保資料的完整性與正確性。

Occupational health and injury surveillance is critical to a modern country, but it has not been well established in Taiwan. For occupational accidents, at present, the sources of surveillance data are mainly from the monthly reports by the employers according to Article 28 of the Labor Safety and Health Law. The number of cases may be underestimated. Because diagnoses of occupational diseases are generally more complicated than those of occupational injuries, the most serious cases of occupational accidentsfatal occupational injuries-were targeted to evaluate the completeness of the current surveillance system. According to the experiences of industrialized countries, the multi-channel approach was applied to collect data from November 1, 1999 to May 30, 2000. The case definition was determined through expert meetings and classifications of cases made by physicians accordingly. A total of 976 cases were identified during the study period, and the sources of data included the instant reporting system of the Council of Labor Affairs, compensations claims paid by the government employee insurance program, compensations claims paid by the Bureau of Labor Insurance, mass media, traffic accident database of the National Police Administration, forensic medicine database, the national death registry of the Department of Health, and questionnaire interviews. Among those, 214 (21.9%) were covered by the instant reporting system of the Council of Labor Affairs. The major reasons of under-reporting were that the reporting of traffic accidents was not mandated and the fact that self-employed workers are not covered by the reporting system. After comparison, no single source was capable of covering all cases, and therefore it is necessary to establish a multi-channel surveillance system and to use instant data collection mechanism to ensure the completeness and accuracy of the data.