| BACKGROUNDWith the rapid development of economy, China’s occupational health management has gradually established a more perfect system, obtained the certain achievement in the occupational disease prevention and control, effectively protected health and rights of the laborers, and promoted economic and social sustainable development. But occupational health in China is still facing great challenges. Occupational accidents, injuries and diseases are too frequent and the economic losses are huge. The occupational hazards have characteristics like group accidents, high death rate and disability rate, and difficult to cure, so they make damage to the family, bring instability to enterprises and the region, and become the social instability factors which even lead to social conflicts. The mass incidents due to the occupational hazard have a negative impact on our country and even the world, and have become a public health problem and serious social problem that affects the social stability and harmony. So to speak, occupational health management work is related to the workers’ health and safety, the sustainable development of labor resources and economy, and social harmony and stability of the society. With the globalization, industrialization and urbanization, and profound changes to the economic system and employment system, the occupational health management system is doubted and need to be amended.As one of the first countries which established the occupational safety and health law, the U.S. has accumulated rich experience on occupational health management, especially on organization, the system of laws, standards and regulations, occupational disease management, worker compensation and occupational health management on the enterprises. It is necessary for us to learn advanced ideas on occupational health management in the United States, by comparative analysis, to summarize the advantages and successful experiences on occupational health management in the United States, looking out for the approaches on occupational health management; In addition, It is necessary for getting the more understanding based on occupational health management situation of our country, the specific situation of development based on comprehensive survey of occupational health management, providing suggestions to improve the occupational disease prevention policy and management work.OBJECTIVES AND SIGNIFICANCES(1)To investigate the characteristics of health management of China and the United States, by comparing the differences on occupational health management in the two countries and exploring the reasons why make these differences, to learn advanced the US experiences on occupational health management;(2)To explore the establishment of comprehensive evaluation index system and comprehensive evaluation method on the occupational health management, for facilitating to get more comprehensive, scientific and accurate evaluation system of occupational health management;(3)To understand the basic situation on occupational health management in our country, discuss the existing problems and put forward suggestions, promote the development of occupational health management, and effectively protect workers health.The significances of this thesis mainly summarized as the following aspects:(1) Understanding and grasping the differences on the occupational health management from many aspects, finding shortcomings exist in China’s occupational health management, in order to take specific measures, providing reasonable suggestions for reform to China’s occupational health management, facilitating to the reform to China’s occupational health management mode, improving significantly the occupational health management work.(2) Building the evaluation mode on occupational health management, getting more in-depth understanding of the status quo of occupational health management, and making a comprehensive and objective evaluation on present situation of the occupational health management. By using the built evaluation system, making the objective evaluation on occupational health management in enterprises of different industries in Shandong Province.(3)Helping to realize the internationalization on China’s occupational health, by learning the US advanced experience on occupational health, helping to promote the development of the internationalization on China’s occupation health, making relevant management departments and enterprises to understand the needs of reform and development of occupational health management from a global perspective, and following the globalization trend of occupational health.METHODSLiterature review:By retrieving materials and all kinds of information on occupational health management of China and the U.S., the study summarized history and status quo on occupational health management of the two countries from multiple perspectives, and provided the basis for the conclusion of the study. Then according to the information, combining with the existing problems, the study determined the hot issue in occupational health management and designed the questionnaire.Comparative study:This study obtained objective information on occupational health management through the literature analysis, and the subjective qualitative data through theoretical research. Then, by analyzing the above two types of data, formed the description and interpretation to the status, characteristics of China and the US occupational health management, and gradually determined the comparison standard, defined the elements of comparison, build a comparative framework and carried out comparative analysis. Questionnaire survey:According to the study aims, designed the questionnaire by using cross-sectional survey method. Occupational health professionals conducted the site field survey, and kept the detailed records of investigation to ensure the accuracy of the information. Delphi Method:This study asked the experts who had engaged in occupational health management research and work for a long time and had the rich experiences to evaluate related issues on occupation health management. After several rounds of consultation, the specific evaluation index system was determined. AHP:By building the matrix of indicators, the study compared and analyzed importance of the indexes through multiple comparisons, and then ranked the weight of these indexes, and then established the weight of each index. Based on the establishment of comprehensive evaluation indexes, according to expert judgment, the AHP were used to calculate the weight coefficient. TOPSIS:Weighted TOPSIS was used in the research to build the evaluation system of occupational health management. Through the ranking for enterprises of different industries in Shandong province, the study found the problems in occupational health management and put forward the strategy to improve.CONTENTSThe main contents of the study are divided into two parts:First, a comparative study on occupational health management in China and the US. The comparative facets included management agencies, system of laws, regulations and standards, occupational disease management, worker compensation, occupational health management in enterprises. By comparison, the study found out the differences between the two countries and the reasons of the difference. Second, survey on occupational health management:A questionnaire survey conducted in Shandong province. It randomly selected8262enterprises from coal, chemical, papermaking, power, building materials and other industries to conduct survey on the occupational health management status. Third, by using the Delphi expert consultation method and AHP, the study built the evaluation index system and made the evaluation on occupational health management of enterprises from different industries in Shandong.RESULTS The main results include:(1) Management agencies:The United States has a unified occupational health management system which OSHA and MSHA are located in the Department of labor. It is a more effective and reasonable structure. And China, with decentralized occupational health management system, is difficult to form a unified mechanism to promote coordination between departments, adversely affect the overall efficiency of the occupational health supervision.(2)System of laws, regulations and standards:The United States has the legal system which based on Occupational Safety and Health Act. The US federal government adjusts laws to be increasingly detailed and complete with the development of economy, effectively promote the occupational safety and health management and ensure government agencies and enterprises to comply. Legislation attaches great importance to sociality. But in China, occupational health and occupational safety is separated in legislation. Laws are not complete and perfect, dominantly promoted by department. Legislation focuses on economy, rather than sociality.(3)Occupational disease management:In China, traditional occupational disease is still in high incidence, but has been controlled in the United States. The US just put forward classification of occupational disease for prevention. However, in China, occupational disease list is only used for the purpose of compensation, not for prevention. On occupational disease surveillance, China has more problems than the United States. Due to the presence of a large number of undiagnosed cases in migrant workers, the occupational disease statistics and severity are undervalued. In the United States, all certificated doctors can diagnose occupational disease. While, in China, the qualified medical and health institutions and physicians have the right to do the collective diagnosis. The United States have no special agency of occupational disease diagnosis and identification. In China, the two level of identification was implemented and the conclusion of provincial identification was final. The US government agencies do not formulate the standards for occupational disease diagnosis, but provide principles and methods of the related occupational disease for physicians and occupational disease compensation agencies to determine. In China, the standards for occupational disease diagnosis provide the basis for evaluation of the disability grade to workers who suffer from occupational injury and disease.(4)Workers compensation:The United States has Act on workers compensation. The coverage of workers compensation is based on the employment relationship with no specific subjects, and some special enterprise or industry may join or not join. Work injury insurance and employer’s liability insurance coexist. There is a variety of ways to promote industrial injury prevention and occupational rehabilitation. But in China, the relevant law of industrial injury insurance is not few, but more on the low legislation level. Until now, there is no complete Act on industrial injury insurance, so the legislation is scattered and confused. The laws and regulations specified the main body participation in industrial injury insurance within a limited scope. The workers who have no formal individual labor contract or payroll and cannot prove the employment relationship have no right to get compensation. Participation in the social insurance is the legal obligation, while, to participate or not in the commercial insurance is decided by the various units. In practice, compensation is the first and prevention is the second, and occupational rehabilitation level is relatively low.(5)Occupational health management in enterprises:The US government agencies provide variety of programs to support enterprises to protect workers’safety and health, but the Chinese government agencies have more mandatory supervision and have fewer measures to serve the enterprises. In addition, the United States strongly support the small enterprises, and China, on the contrary, large enterprises are the focus of government to fund and help.The survey involved8262enterprises in Shandong Province.The number of the workers who suffered from occupational hazard:the actual number of practitioners of the enterprises involved in this investigation was2,160,185, including1,630,010production workers, accounting for75.46%of the actual practitioners; production workers who were exposed to harm factors was7,16,572, the exposure proportion was33.17%.Of industries, a higher exposure proportion exists in the industry of coal mining, handicrafts and other manufacturing, textile and garment, shoes and hat manufacturing. In different economic types of enterprises, domestic enterprises exposure proportion is32.45%; the exposure proportion of enterprises invested by Hong Kong, Macao, Taiwan is40.26%; the exposure proportion of enterprises with foreign investment is36.93%. In enterprises of different scales, the exposure proportion of small enterprises is42.68%; the exposure proportion of medium-sized enterprises was32.42%; the exposure proportion of large enterprises was29.22%.The evaluation index system of occupational health management:Based on the literature review and expert consult, the study designed its own index system to evaluate occupational health management. After two rounds of expert consultation and the reliability analysis, the positive coefficient of the expert in the first round was96.97%and positive coefficient of the second round was100%, the expert authority degree is0.8902. By calculating the Kendall coefficient to obtain expert opinion coordination and P<0.05, consulting outcome is obtained. Then use AHP to calculate the weights of indexes, through test, CI=0.0598, CR=CI/RI=0.0388<0.10. So that, the calculated weight coefficient is acceptable. Eventually, it formed a complete index system to evaluate occupational health management.Comprehensive evaluation:Based on the survey data, the study made a comprehensive evaluation on occupational health management work of enterprises with different industries in Shandong province, by using TOPSIS method. The study found the power, heat production and supply industry, gas production and supply industry is the best, and the leather, fur, feathers and its products industry, the waste of resources and waste materials recycling industry, papermaking and paper products industry, etc is the worst.CONCLUSIONS AND SUGGESTIONSConclusions:A long-term collaborative work mechanism on occupational safety and health management institutions in China between is not perfect; the system of laws, regulations and standards of occupational safety and health can not achieve the goal to control occupational hazard effectively; Occupational disease management faces more difficulties and challenges. The industrial injury insurance system can’t play its due role. As a large industrial province, there are a large number of workers with exposure to occupational hazards in Shandong. The occupational health management of enterprise in monopoly industry is good, but in some industry which the small and medium enterprises concentrated is not good.Suggestions:(1) To perfect the legislation, to learn from the advanced legislative pattern on occupational safety and health of Western countries, and form a unified law on occupational safety and health;(2) To strengthen the construction of institutions on occupational safety and health, to improve occupational safety and health supervision;(3)To develop the work of occupational disease prevention and control, for better protection to workers;(4)As the main body to be responsible for the occupational safety and health, enterprises must strengthen the management;(5) To improve the industrial injury insurance system, for providing the guarantee for workers occupational safety and health;(6)To strengthen international exchanges and cooperation, to promote the international development of occupational safety and health management. |
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