我國職業病鑑定案之爭點與結論形成因素分析：以2012–2025年職業病彙編為例

Factors influencing the determination of occupational diseases in Taiwan: a study of cases from 2012 to 2025

目標：職業病認定涉及長期工作暴露與多重致病因子，為我國勞工職業災害保險制度中最具爭議且高度仰賴專業判斷之環節。本研究旨在分析我國職業病申請案件中進入職業病鑑定會審查之鑑定案之主要爭點，並探討影響鑑定結論形成之關鍵因素，以評估現行職業病鑑定制度之運作特性及潛在改善方向。方法：本研究採回溯性次級資料分析，蒐集職業安全衛生署公布之2012–2025年間共120件職業病鑑定案，依職業病類型、工作型態（受僱／非受僱）、進入鑑定案之爭點、鑑定結果與形成鑑定結論之主要原因進行分類與描述性分析，並以Fisher’s exact test比較受僱與非受僱個案之鑑定通過情形。結果：職業病彙編中的鑑定案以人因性疾病為最多。職業病申請案件進入鑑定程序最常見之爭點為工作暴露量是否足夠，其次為是否存在其他主要致病因子，而形成鑑定結論時，工作暴露評估為最關鍵之判斷因素。受僱與非受僱個案之鑑定通過率尚未呈現顯著差異。結論：工作暴露評估為職業病認定制度中最核心且最具爭議之環節。研究結果顯示，若能於職業病審查初期即制度化工作暴露資料蒐集與評估機制，並建立非表列職業病認定之一致性原則，或可減少需要進入職業病鑑定會的行政資源，並提升職業病認定制度之一致性與可預測性。

Objectives: Occupational diseases determination involves long-term occupational exposure and multiple etiological factors. It is therefore one of the most contentious components of Taiwan’s occupational accident insurance system and relies heavily on professional judgment. The present study analyzed the principal concerns noted in cases referred to Occupational Disease Appraisal Committees and examined key factors influencing appraisal conclusions. The aim was to characterize the current system and identify areas for improvement. Methods: A retrospective secondary data analysis was conducted using 120 occupational disease appraisals published by the Occupational Safety and Health Administration between 2012 and 2025. These cases were categorized by disease type, employment status (self-employed vs. non-self-employed), issues leading to appraisal, appraisal outcomes, and the primary reason underlying appraisal conclusions. Descriptive analyses were performed, and Fisher’s exact test was used to compare appraisal approval rates between self-employed and non-self-employed claimants. Results: Ergonomic disorders were the most common type of occupational disease among these cases. The most common concern prompting appraisal was whether occupational exposure was sufficient, followed by the presence of other etiological factors. Assessment of occupational exposure was the primary factor underlying appraisal conclusions. Appraisal approval rates did not differ significantly between self-employed and non-self-employed claimants. Conclusions: Assessment of occupational exposure is the central and most contentious element of Taiwan’s occupational disease determination system. Institutionalizing early collection and evaluation of exposure data and establishing consistent principles for the determination of nonlisted occupational diseases may reduce administrative resources required for formal appraisal and enhance consistency and predictability of the system.