五分鐘學英文-醫療人力危機：台灣醫護短缺的挑戰

圖源 報導者攝影 余志偉

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1. 現況分析 Current Status Analysis

據衛福部2024年統計，台灣醫療體系面臨約12,000名護理人員缺口，較2023年增加15%。急診科缺額率高達23%，內科19%，加護病房21%。

According to the Ministry of Health and Welfare’s 2024 statistics, Taiwan’s healthcare system faces a shortage of approximately 12,000 nursing staff, a 15% increase from 2023. Vacancy rates are 23% in emergency departments, 19% in internal medicine, and 21% in intensive care units.

2024年調查顯示，58%的護理人員曾考慮離職。實際離職者中，47%完全轉行，35%轉往診所或私人醫療機構。離職主因為工時過長(76%)和薪資不符合工作負荷(68%)。

A 2024 survey showed that 58% of nursing staff had considered resigning. Among those who actually left, 47% changed careers completely, while 35% moved to clinics or private healthcare institutions. The main reasons for resignation were excessive working hours (76%) and insufficient compensation (68%).

台灣醫護人員工作負荷遠高於國際標準：

• 護理人員照護比：台灣1:12，美國1:5，加拿大1:4
• 醫師每週平均工時：台灣65小時，美國51小時，加拿大49小時
• 每千人口醫師數：台灣2.4名，OECD平均3.5名

Taiwan’s healthcare professionals face workloads significantly higher than international standards:

• Nurse-to-patient ratio: Taiwan 1:12, US 1:5, Canada 1:4
• Average physician weekly working hours: Taiwan 65 hours, US 51 hours, Canada 49 hours
• Physicians per 1,000 population: Taiwan 2.4, OECD average 3.5

2. 主要成因 Main Causes

薪資與待遇不足

Inadequate Salary and Benefits

台灣護理人員起薪約40,000-45,000元新台幣，較同等學歷的其他職業低15-25%。以購買力平價計算，台灣護理師年薪約38,000美元，美國78,000美元，加拿大62,000美元。

Entry-level salaries for nursing staff in Taiwan are approximately NT$40,000-45,000, 15-25% lower than other professions requiring similar education. By purchasing power parity, Taiwanese nurses earn about US$38,000 annually, compared to US$78,000 in the United States and US$62,000 in Canada.

工時過長與勞動環境惡劣

Excessive Working Hours and Poor Working Conditions

護理人員平均每月超時工作20-30小時，67%出現中度以上職業倦怠症狀。醫療暴力事件增加，2024年達1,850件，較2022年增加23%。

Nursing staff work an average of 20-30 overtime hours monthly, with 67% showing moderate or higher burnout symptoms. Healthcare violence incidents increased to 1,850 in 2024, up 23% from 2022.

健保給付制度限制

National Health Insurance Payment System Limitations

健保總額預算制使醫院傾向控制人事成本。多數醫院表示，即使想提高護理人員薪資，也受限於健保給付水平。

The global budget system under National Health Insurance leads hospitals to control personnel costs. Most hospitals indicate that even if they want to increase nursing salaries, they are constrained by insurance payment levels.

3. 影響與後果 Impacts and Consequences

醫療人力短缺導致病患安全風險上升。2024年調查顯示，護病比超過1:12的單位，感染率增加18%，壓瘡發生率增加21%。

Healthcare staffing shortages lead to increased patient safety risks. A 2024 survey showed that in units with nurse-to-patient ratios exceeding 1:12, infection rates increased by 18% and pressure ulcer incidence by 21%.

若問題持續惡化，預計2027年將有25-30家中小型醫院面臨關閉風險，23%的地區醫院已無法提供24小時急診服務。

If the problem continues to worsen, 25-30 small and medium-sized hospitals may face closure by 2027, and 23% of district hospitals are already unable to provide 24-hour emergency services.

醫護人員心理健康受損，42%的護理人員和36%的醫師出現焦慮或憂鬱症狀，顯著高於一般人口。

Healthcare workers’ mental health is deteriorating, with 42% of nursing staff and 36% of physicians showing symptoms of anxiety or depression, significantly higher than the general population.

4. 國際經驗借鏡 International Experiences

美國與加拿大

United States and Canada

• 差異化薪資結構：專科護理師年薪可達10萬美元以上
• 彈性工時：三天工作四天休息等多元排班
• 護理助理制度：擴大輔助人力使用
• 持續教育獎勵：提供進修經費和時間
• Differentiated salary structures: Specialist nurses can earn over US$100,000 annually
• Flexible scheduling: Various options including three days on, four days off
• Nursing assistant system: Expanded use of auxiliary staff
• Continuing education incentives: Providing funds and time for further education

日本與韓國

Japan and South Korea

日本：

• 科技輔助照護：導入照護機器人和遠距醫療
• 外籍照護人員引進：特定技能簽證
• 護理保險制度：專門支應長期照護費用

Japan:

• Technology-assisted care: Implementing care robots and telemedicine
• Foreign care staff introduction: Specific skills visas
• Nursing care insurance system: Specifically funding long-term care costs

韓國：

• 護理師薪資改革：逐步提高公立醫院護理人員薪資
• 工時規範強化：嚴格執行工時上限
• 職場暴力零容忍政策：加重醫療場所暴力行為刑責

South Korea:

• Nursing salary reform: Gradually increasing public hospital nursing salaries
• Strengthening working hour regulations: Strictly enforcing working hour limits
• Zero-tolerance policy for workplace violence: Increased penalties for violence in medical settings

5. 台灣可行的解決方案 Viable Solutions for Taiwan

短期措施

Short-term Measures

• 建立護理人員最低薪資標準，確保起薪不低於55,000元
• 實施工時上限規定，每週不超過44小時
• 設立特殊科別津貼，對高壓力科別提供額外補助
• Establish minimum salary standards for nursing staff, ensuring starting salaries of at least NT$55,000
• Implement working hour limits not exceeding 44 hours weekly
• Establish special department allowances for high-pressure specialties

中長期策略

Mid to Long-term Strategies

• 建立專業外籍護理人員引進機制
• 擴大專科護理師制度，提供明確的專業發展路徑
• 增加非臨床職涯發展選項
• 建立醫療暴力防治專案，加強醫院安全措施
• Establish mechanisms for introducing professional foreign nursing staff
• Expand the specialist nurse system to provide clear professional development paths
• Increase non-clinical career development options
• Establish healthcare violence prevention programs and strengthen hospital security

結語 Conclusion

台灣醫療人力短缺已成為全民健康危機。解決問題需要政府、醫療機構、教育單位和社會大眾共同努力，採取全面行動，才能維持優質醫療體系，確保全民健康。

Taiwan’s healthcare staffing shortage has become a public health crisis. Addressing this issue requires joint efforts from the government, healthcare institutions, educational units, and the general public. Only through comprehensive action can Taiwan maintain a quality healthcare system and ensure public health.