Investigation into the frequency of compensation for occupational diseases (ODs) caused by hazardous chemicals revealed an important opportunity for the improvement and further development of occupational health and safety systems in Korea. In response to concerns after outbreaks of disease due to chemical exposure, specific criteria for recognition of ODs were established and included in the Enforcement Decree of the Labor Standard Act (LSA) and the Industrial Accident Compensation Insurance Act (IACIA) on June 28, 2013. However, the original versions of the LSA and IACIA contain several limitations. First, the criteria was listed inconsistently according to the symptoms or signs of acute poisoning. Second, all newly recognized hazardous chemicals and chemicals recognized as hazardous by the International Labor Organization (ILO) were not included in the LSA and IACIA. Although recent amendments have addressed these shortcomings, future amendments should strive to include all chemicals listed by the ILO and continuously add newly discovered hazardous chemicals as they are introduced into the workplace.
Adolescent ; Burns, Chemical/economics ; Female ; Humans ; Metals, Heavy/economics/poisoning ; Occupational Diseases/*chemically induced/*economics ; Occupational Exposure/*adverse effects ; Poisoning/economics ; Republic of Korea ; Workers' Compensation/*economics

The context of specific criteria for the recognition of occupational diseases (ODs) due to physical agents in the Enforcement Decree of the Industrial Accident Compensation Insurance Act (ED-IACIA) and the Labor Standard Act (LSA) does not describe definite disease along with the agents but listed symptoms or obscure clinical conditions. Moreover, the needs for an amendment of these Acts have recently attracted renewed interest. To establish agreed criteria for compensable ODs due to physical agents, we reviewed the criteria for recognizing ODs on the basis of International Labor Organization (ILO) documents and European Union (EU) guideline. After providing a brief review of the history of OD outbreaks due to physical exposure in South Korea and the responses to them, we describe the basis for the recent amendments to the IACI Act and LSA and assess their appropriateness. On the basis of these findings, this study could be helpful for determining and compensating process of ODs. However, further work is required to ascertain the scientific relationship between diseases caused by physical agents and the exposure criteria.
Accidents, Occupational ; Humans ; Male ; Noise/*adverse effects ; Occupational Diseases/*economics ; Occupational Exposure/adverse effects ; Radiation Injuries/*economics ; Republic of Korea ; Vibration/*adverse effects ; Workers' Compensation/*economics

Occupational diseases may be defined only medically or scientifically, and even then, their definition is not simple. However, compensable occupational diseases involve the additional layer of legal systems and social welfare policies as well. Their multifaceted nature makes determining the work-relatedness of these diseases more complex. Korea has established standards for the recognition of occupational diseases in Schedule 5 of the Enforcement Decree of the Labor Standards Act, and specific criteria for the recognition of occupational diseases are listed in Schedule 3 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act. The new list of compensable occupational diseases comprises 13 articles as an open-ended system. The newly added articles pertain to lymphohematopoietic (Article 5) and infectious diseases (Article 9), as well as diseases of other target organs. Furthermore, the article on liver diseases (Article 8) has been partially revised. The new act has been changed to clarify the meaning as it has been presented in recent research. It is necessary to achieve agreement among concerned parties, including experts from the legal, medical, and social domains to resolve the issues of work-relatedness, causation, notion of aggravation, and so on for preparing a list and a process that are more reasonable.
Adult ; Benzene/toxicity ; Communicable Diseases/*economics ; Dimethylformamide/toxicity ; Drug-Induced Liver Injury/economics ; Female ; Hematologic Diseases/chemically induced/*economics ; Humans ; Lead/toxicity ; Liver Diseases/*economics ; Male ; Middle Aged ; Occupational Diseases/*economics ; Republic of Korea ; Trichloroethylene/toxicity ; Vinyl Chloride/toxicity ; Workers' Compensation/*economics

Standards for the recognition of occupational diseases (ODs) in Korea were established in 1954 and have been amended several times. In 2013, there was a significant change in these standards. On the basis of scientific evidence and causality, the International Labour Organization list, European Commission schedule, and compensated cases in Korea were reviewed to revise the previous standards for the recognition of ODs in Korea. A disease-based approach using the International Classification of Diseases (10th version) was added on the previous standards, which were agent-specific approaches. The amended compensable occupational neurological disorders and occupational mental disorders (OMDs) in Korea are acute and chronic central nervous system (CNS) disorders, toxic neuropathy, peripheral neuropathy, manganese-related disorders, and post-traumatic stress disorder. Several agents including trichloroethylene (TCE), benzene, vinyl chloride, organotin, methyl bromide, and carbon monoxide (CO) were newly included as acute CNS disorders. TCE, lead, and mercury were newly included as chronic CNS disorders. Mercury, TCE, methyl n-butyl ketone, acrylamide, and arsenic were newly included in peripheral neuropathy. Post-traumatic stress disorders were newly included as the first OMD. This amendment makes the standard more comprehensive and practical. However, this amendment does not perfectly reflect the recent scientific progress and social concerns. Ongoing effort, research, and expert consensus are needed to improve the standard.
Female ; Humans ; Mental Disorders/chemically induced/*economics/pathology ; Nervous System Diseases/chemically induced/*economics/pathology ; Occupational Diseases/*economics ; Occupational Exposure ; Republic of Korea ; Stress Disorders, Post-Traumatic/diagnosis/*economics ; Workers' Compensation/*economics

The Korean list of occupational skin diseases was amended in July 2013. The past list was constructed according to the causative agent and the target organ, and the items of that list had not been reviewed for a long period. The revised list was reconstructed to include diseases classified by the International Classification of Diseases (10th version). Therefore, the items of compensable occupational skin diseases in the amended list in Korea comprise contact dermatitis; chemical burns; Stevens-Johnson syndrome; tar-related skin diseases; infectious skin diseases; skin injury-induced cellulitis; and skin conditions resulting from physical factors such as heat, cold, sun exposure, and ionized radiation. This list will be more practical and convenient for physicians and workers because it follows a disease-based approach. The revised list is in accordance with the International Labor Organization list and is refined according to Korean worker's compensation and the actual occurrence of occupational skin diseases. However, this revised list does not perfectly reflect the actual status of skin diseases because of the few cases of occupational skin diseases, incomplete statistics of skin diseases, and insufficient scientific evidence. Thus, the list of occupational diseases should be modified periodically on the basis of recent evidence and statistics.
Burns, Chemical/pathology ; Dermatitis, Contact/pathology ; Humans ; Occupational Diseases/*economics ; Occupational Exposure ; Republic of Korea ; Skin/*pathology ; Skin Diseases/*economics/*pathology ; Skin Diseases, Infectious/pathology ; Stevens-Johnson Syndrome/pathology ; Vitiligo/pathology ; Workers' Compensation/*economics

The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.
Alveolitis, Extrinsic Allergic/economics/pathology ; Asbestosis/economics/pathology ; Asthma/economics/pathology ; Humans ; Lung Diseases/*economics ; Occupational Diseases/*economics ; Occupational Exposure ; Pneumoconiosis/economics/pathology ; Pulmonary Disease, Chronic Obstructive/economics/pathology ; Republic of Korea ; Workers' Compensation/*economics

The legal scope and criteria for occupational cancer in Korea was out of date. The aim of this study was to review the current criteria for occupational cancer and amend the existent criteria on the basis of recent scientific evidence. The scientific evidence and the legal list of occupational cancer were analyzed to identify the causes of occupational cancer on a global scale. The relationship between compensated occupational cancer cases and carcinogen exposure in Korea was examined. The factors associated with specific causes and target cancers were determined to produce additional criteria. Five-hundred and nineteen cases of 2,468 were awarded compensation for occupational cancer including lung, malignant mesothelioma, lymphohematopoietic, and liver cancers from January 2000 to October 2012. Between 1996 and 2005, benzene accounted for 84.4% of cases, and between 1999 and 2005, asbestos was associated with 62.3% of cases. Fourteen novel causative agents and 12 additional target cancers were identified and the final guidelines were amended to include 23 causative agents and 21 target cancers. This amendment of the criteria for occupational cancer represents the widest change in Korean history and is expected to improve the understanding of occupational cancer by providing an up-to-date and accurate reference guide.
Asbestos/toxicity ; Benzene/toxicity ; Carcinogens/toxicity ; Female ; Humans ; Insurance, Health/*economics ; Middle Aged ; Neoplasms/chemically induced/*economics ; Occupational Diseases/*economics/mortality ; Occupational Exposure/*adverse effects ; Republic of Korea ; Workers' Compensation/*economics/legislation & jurisprudence/standards

The range of diseases covered by workers' compensation is constantly expanding. However, new regulations are required for the recognition of occupational diseases (ODs) because OD types evolve with changes in industrial structures and working conditions. OD criteria are usually based on medical relevance, but they vary depending on the social security system and laws of each country. In addition, the proposed range and extent of work-relatedness vary depending on the socio-economic conditions of each country. The Labor Standards Act (LSA) and the Industrial Accident Compensation Insurance Act (IACIA) of Korea employ lists based on their requirements without listing causes and diseases separately. Despite a considerable reshuffle in 2003, the basic framework has been maintained for 50 yr, and many cases do not fit into the international disease classification system. Since July 1, 2013, Korea has expanded the range of occupational accidents to include occupational cancers and has implemented revised LSA and IACIA enforcement decrees. There have been improvements to OD recognition standards with the inclusion of additional or modified criteria, a revised and improved classification scheme for risk factors and ODs, and so on.
Accidents, Occupational/*classification/*economics ; Humans ; Insurance, Accident/economics ; Insurance, Health/economics ; Neoplasms/chemically induced ; Occupational Diseases/*classification/*economics/mortality ; Occupational Exposure/adverse effects ; Occupational Health ; Republic of Korea ; Risk Factors ; Workers' Compensation/*economics/legislation & jurisprudence/standards

OBJECTIVETo investigate workers' willingness to participate and wiliness to pay for a hypothetical industrial injury insurance scheme, to analyze the influential factors, and to provide information for policy making of the government.

METHODSMultistage cluster sampling was used to select subjects: In the first stage, 9 small, medium, orlarge enterprises were selected fromthree cities (counties) in Zhejiang province, China, according to the level of economic development, transportation convenience, and cooperation of government agencies; in the second stage, several workshops were randomly selected from each of the 9 enterprises. Face-to-face interviews among all workers in the workshops were conducted by trained interviewers using a pre-designed questionnaire.

RESULTSIt was found that 73.87% (2095) of all workers were willing to participate in the hypothetical work injury insurance scheme and to pay 2.21% of monthly wage (51.77 yuan) on average, and more than half of the workers were willing to pay less than 1%of monthly wage (35 yuan). Of the 741 workers who were not willing to participate, 327 thought that the premium should be borne by the state or enterprises, instead of individuals, and others were not willing to participate because of low income, unstable job, or poor understanding of the hypothetical industrial injury insurance scheme. Logistic regression analysis showed that workers with higher education levels, longer length of services, longer weekly working time, or more knowledge of occupational diseases showed higher willingness to participate in the scheme; workers who were exposed to physical hazards, had health records, or had participated in the existing medical insurance or industrial injury insurance were more willing to participate. Multiple linear regression analysis showed that with increasing average monthly wage, weekly working time, and self?health evaluation, the proportion of workers with willingness to pay increased; however, with increasing work intensity and awareness of occupational disease, the proportion of workers with willingness to pay decreased. The workers who were not covered by the industrial injury insurance paid more than those covered by the industrial injury insurance.

CONCLUSIONThe hypothetical industrial injury insurance scheme increased the applicability and advantage of independent third-party running and lifetime insurance, which significantly increased the workers' willingness to participate in or to pay for the insurance scheme. Therefore, the industrial injury insurance can be improved in these aspects to promote workers' willingness to participate in and to pay for the insurance scheme. This conclusion provided a reference for the solution of delayed or shirking corporate responsibility for paying the premium.

Accidents, Occupational ; economics ; Attitude to Health ; China ; Cluster Analysis ; Financing, Personal ; Health Policy ; Humans ; Insurance ; Insurance, Health ; economics ; utilization ; Models, Theoretical ; Occupational Diseases ; economics ; Surveys and Questionnaires

An understanding of the characteristics of occupational lung cancer is important to establish policies that prevent carcinogen exposure and to compensate workers exposed to lung carcinogens. This study analyzed the characteristics of occupational lung cancers in workers who were compensated under the Industrial Accident Compensation Insurance Law between 1994 and 2011. A total of 179 occupational lung cancers were compensated. The main carcinogenic exposure was asbestos, followed by crystalline silica and hexavalent chromium. The mean exposure duration and latency were 19.8 and 23.2 yr. The most common industry was manufacturing, followed by construction and transportation. The most common occupation was maintenance and repair, followed by foundry work, welding, painting, and spinning or weaving. Although asbestos was predominant carcinogen, the proportion of these cases was relatively low compared to other developed countries. Proper surveillance system is needed to monitor occupational lung cancer and improve prevention measures.
Adult ; Aged ; Asbestos/toxicity ; Chromium/toxicity ; Female ; Humans ; Insurance Benefits/legislation & jurisprudence ; Lung Neoplasms/economics/*epidemiology/etiology ; Male ; Middle Aged ; Occupational Diseases/economics/*epidemiology/etiology ; Occupational Exposure ; Republic of Korea/epidemiology ; Silicon Dioxide/toxicity ; Smoking ; Workers' Compensation/statistics & numerical data