| 摘要: | 摘要 我國於民國八十四年三月一日起由中央健康保險局負責統籌將勞保、公保、農保等不同醫療保險加以整合辦理。在此一個整合各保險體系的新制度實施，不論是被保險人或是政府相關機構，對於新制度的規定流程，均得重新適應。以職業病醫療費用支出而言，勞工在職業傷病就醫時，因對新制度的不熟悉、程序的不正確或知識不足，有可能使得原應由職災保險負擔之醫療成本，變成健保局的額外支出。 本研究是利用醫療經濟學研究經常使用的可歸因比率來計算職業暴露所造成的醫療或社會成本，及利用因職業暴露致病的風險差異計算絕對的醫療成本。並以勞工常罹患之慢性職業病選擇其醫療費用較高（肌肉骨骼疾病）、盛行率較高（肌肉骨骼疾病）及職業病病因診斷爭議較小（皮膚病、聽力損失）等疾病類別之發生人數與醫療費用，及參考國外疾病的發生率或盛行率，推算可歸因於職業病之醫療費用，作為健保局在計算職業災害醫療費用作為推估的參考應由勞保局負擔多少比例。 以本研究之推算結果建議，勞保局在職業傷病醫療費用方面，每年可以考慮核退給健保局約30億元，或由健保局與勞保局雙方就醫療核退費用於20億至43億之間，透過行政程序協調核退金額。 關鍵字：職業病、可歸因比率、風險差異、醫療成本; Estimation on the Medical Expenditure Attributable to Occupational Diseases Since March the first 1995, the Bureau of National Health Insurance took the responsibility for delivering health care for people in Taiwan, by integrating varies previous schemes for the labors, civil servants and the peasants. In the past, the Labor Insurance bore the costs of health care that is attributable to both occupational and other common diseases of the labors. In the national health insurance scheme, the Bureau of National Health Insurance bears the costs for common diseases rather than the occupational ones. Some health care expenditures of the national health insurance, therefore, have to be reimbursed by the Labor insurance. This study aims to estimate the health care expenditures of national health insurance that should be reimbursed by the Labor Insurance. Using the concept of attributable proportion and risk difference of occupational exposures, this study estimates the expenditures of the occupational diseases of skin, hearing losses and skeleton and muscle. These three are selected due to their ability to cause high health care expenditures, high prevalence and less debatable nature about the causality of occupational exposures. According to the results, this study suggests that the Bureau of Labor Insurance should reimburse an average of 3.0 billion NT dollars per year for, which occupies for about 1% of, the health care expenditures of the national health insurance in Taiwan. Or, the Bureau of Labor Insurance and the Bureau of National Health Insurance can negotiate the amount of reimbursement from 2.0 to 4.3 billion NT dollars, which represent the estimates of this study for the floor and ceiling, respectively. Key Words: Occupational Diseases, Health Care Expenditures, Risk Difference, Attributable Proportion. |
