臺灣地區中大型工廠及工業區職業衛生服務現況

Occupational Health Services in Medium- and Large-Sized Factories and Industrial Zones of Taiwan

職業衛生服務在工作場所的重要性，已經在國際上被確認。然而台灣地區職業病防治工作的主要問題是雇主與勞工對職業衛生認知嚴重缺乏、勞工健康檢查無法發揮早期篩檢的功能、職業病醫護專業人員不足、以及國內本土性資料缺乏。本研究包括中大型工廠及工業區調查二部分，執行期間為八十七年一至四月，前者依據經濟部八十五年「台閩地區各行業工廠名錄」，針對789 家員工人數在300 人以上的中大型工廠，以電話訪問及問卷訪問之方式進行調查；完成電話訪問的工廠有521 家，其中聘有護理人員的有281 家佔53.9%；郵寄問卷281 份，有效問卷回收111 份。後者依據經濟部工業局八十六年「台灣地區工業區簡介」，針對95 個已開發完成的工業區進行調查，其中48 個設有管理中心，經由電話訪視得知有7 個管理中心設有聯合門診中心，其中實地訪視6 個中心。結果顯示中大型工廠目前的職業衛生服務則由傳統的醫療照顧的層面逐漸轉變到健康保護及健康促進，未來將進而轉變到整體性的健康照護，並強調行政協調及證據性研究的重要性。若與勞工健康保護規則第七條規定比較，可看出目前國內中大型工廠所提供之職業衛生服務內容仍停留在配合政府法令行事的狀態，但目前已從治療的層面逐漸朝向疾病預防及健康促進的層面，但植基於有效的管理及科學的證據之整體性健康照護則仍有待加強。而位於工業區聯合門診中心目前僅提供一般及緊急醫療服務為主，未來應發展為整體性的職業衛生服務中心。

The importance of occupational health services has been recognized internationally. The main problems in the prevention of occupational diseases in Taiwan are the lack of awarewess of employers and employees of the importance of occupational health, inadequate workers’ health examination, a shortage of occupational health professionals and poor risk assessment. The objective of this study was to investigate the functions and status of the current occupational health services in Taiwan. It included two surveys for both mediumand large-sized manufacturing industries and industrial parks during the period between January and April of 1998. The first survey conducted initial teltphone contacts with the occupational health department of 789 factories employing more than 300 workers. There were 521 valid responses. Among these 281, 53.9% factories employed at least one occupational health nurse. Questionnaires were then sent to these 281 factories, with only 111 valid replies. The subjects of the second survey were 95 industrial parks, with administration centers in 48 parks and only seven clinics for multiple practices. Six on-site visits to these clinics were also conducted. The results of this study showed that most current occupational health activities in Taiwan still conformed to the regulations dictated by the Labor Health Protection. However, they had gradually changed from the traditional health care to health protection and promotion related practices. They are expected to progress to comprehensive occupational health care, based on effective management and scientific evidence. Clinics for multiple practices in the industrial parks currently offer general and emergency medical services only. They should be developed to become centers for comprehensive occupational health services.