職災補償制度之國際比較及台灣制度之改革方向

Abstract

社會安全制度旨在確保人民的基本生存權，其中，職災補償救濟乃是先進國家中最早出現的社會安全制度之一。為瞭解職災補償制度的核心精神，以釐清台灣職災補償制度的問題與改革方向，本文回顧國際間職災補償制度之發展歷史以及國際勞工組織相關公約，並選取特定國家，比較其法源依據、行政組織、涵蓋人口範圍、財源、給付內容與給付方式等。從國際比較分析可發現，台灣職災補償制度的問題包括：相關法規分散、缺乏專責於職災保護制度的主管機構、職災補償制度未涵蓋所有受僱者、保險費率偏低、給付不足、健保代辦職災醫療給付而造成部份的職災門診醫療被全民健保吸收。我們建議，台灣職災社會保險制度應獨立立法且應設置獨立的業務專責機關；此外，職災保險應涵蓋所有受僱者、應強化職災預防之誘因機制、應適當提昇給付額度與範圍，並應與健保醫療照顧制度作適度區隔。 The purpose of social security is to ensure people's basic right to existence. In the developed countries, workers' compensation is one of the oldest types of social security system. To better comprehend the problems of the current workers' compensation system in Taiwan, we reviewed the historical development of workers' compensation systems worldwide, as well as the related conventions adopted by the International Labor Organization. In addition, we compared workers' compensation schemes in selected countries with regard to legislative framework, administrative organization , coverage of workforce, source of funds, and content and means of delivery of benefits. Based on international comparative analyses, we concluded that the problems with the workers' compensation system in Taiwan include: a complicated legislative framework with multiple laws and regulations, lack of an administrative authority specializing in workers' compensation, exclusion of some employees from the coverage, low premium rates, insufficient benefits, and inadequate coordination with the national health services and other social security systems. We suggest that changes in the legislative framework and administrative infrastructure should be the priorities in policy reform. In addition, the workers' compensation system should cover all salaried employees, incentive mechanisms for prevention should be strengthened, benefits provided should be adjusted and the benefit levels raised, and a clear line should be drawn between medical care services offered by the workers' compensation system and the National Health Insurance.