【正文】 Injury ? According to BLI, the percentage of occupational injury with temporary disability is about one fourth of ordinary injuries among workers ? trend of increased occupational injury and disease – esp., after National Health Insurance System enacted in 1995 ? incur more than 6 billion NT$ in direct workers pensation costs ? indirect cost: production delays, damage to equipment, and recruiting and training replacement workers ? estimated to be five times, or about 30 billion NT$ Increased percentage of occupational injuryamong total injury related temporarydisability (1990～ 2022, BLI)0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%1990199119921993199419951996199719981999202220222022Y e a rOccupationalinjuries anddiseasesActualpayment forinjuries anddiseasesOccupational Injury ? Workers’ pensation benefits permanent total disability, temporary total disability, permanent partial disability, temporary partial disability, and survivor’s benefits. ? In Taiwan, only lump sum but no annuity paid to the insured worker. ? During rehabilitation period, only sick leave or designated auxiliary tools for handicapped are offered ? no vocational or psychological counseling or retraining or job placement assistance, pared to United States or most European countries medical expenses of five main occupational injury after NHI Meanwhile, Labor insurance pensation claim also increase dramatically !! 19961999Cost due to hospitalization2 . 4 92 . 1 01 . 7 71 . 4 20 . 8 6 0 . 8 90 . 9 91 . 1 70 . 1 9 0 . 2 1 0 . 3 00 . 6 41 . 2 00 . 8 40 . 9 20 . 9 30 . 3 50 . 2 60 . 2 4 0 . 3 300 . 511 . 522 . 51996 1997 1998 1999H u n d r e dM i l l i o nF r a c t u r eO p e n w o u n d s o fu p p e r e x t r e m i t yR o l l i n g o v e rB u r nH e a d t r a u m a Occupational Medicine specialty ? AD 1700, Bernardino Ramazzini, the father of occupational medicine and an Italian physician: De Morbis Artificum Diatriba ? to work without acquiring a wretched disease that would make one’s work a curse rather than a love ? diseases of metal digger, painters, midwives, glassmakers, potters, sewer worker ? affliction by inhaling noxious gases and dusts, or from disorderly motions and improper postures of the body Occupational Medicine specialty ? the primary care physician have taken the responsibility of health care for the industry ? worker’s pensation issues usually followed after treatment ? occupational pensation system emerged from Germany since mid19 century ? state (or government) run vs. private insurance carriers ? most are pulsory, and even with penalties for not having insurance Occupational Medicine specialty ? The employer’s responsibility which includes providing medical treatment and pensation benefits transferred to the insurance agencies ? preventing injury or disease shared by the employer and the insurers or related authorities ? reporting of occupational injury employer ? reporting of occupational illness physicians Occupational Medicine specialty ? occupational physician system acpanied the progress and change of industry ? new legislation to protect the workers’ health and enhance their benefits ? hightech ages labor force subjected to conditions never before confronted in the small shop or craftsman era ? Production and profit are still the primary concern of pany, not employee safety ? practice of occupational medicine cover even a broader scope Occupational Medicine specialty to meet the demand of society ? modern society occupational hazard stress and related disease, musculoskeletal disorder ? occupational physicians have to realize the regulatory or pensation system, able to design suitable occupational health program ? To integrate occupational medicine with environmental, occupational safety and health ? to serve for both the employer and employee ? to discover new techniques or strategies Occupational health care amp。 Management ? Health care industry cost containment, managed care system ? Change is a requirement of life and an integral part of all plex endeavors of society, including the financing, provision and anization of health care service ? Taiwan National Health Insurance system, cover nearly all hospitals and clinics. Occupational health care amp。 Management ? clinical managed care to change the number or mix of services provided and to reduce the price paid for service ? case management is a process, one ponent in the managed care strategy ? the inclusion of salary replacement is not inherent to the health insurance managed care market ? evaluation of quality of care, and timely return to work by injured employees more important in occupational health care Definition of case management ? ”case management is a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs, using munication and available resources to promote quality, costeffective outes.” ? major areas of activity medical, financial, behavioral/motivational, vocational the Commission for Case Manager Certification (CCMC) Occupational health care amp。 Management ? In workers’ pensation, managed care must address a different objectiveres