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One of the many shortcomings of the current occupational health examination (OHE) system in Taiwan is that only on-the-job workers are eligible to participate, making it difficult for the early detection of workers who develop occupational diseases with long disease latencies. We used occupational asbestos-related diseases (OARDs) as an example to explore the opinions of occupational health physicians (OHPs), who play important roles in the OHE system, regarding the necessity, feasibility, and potential impact of post-exposure OHEs involving asbestos-exposed workers. Methods: Fifteen OHPs were interviewed individually during the period from January to August 2017, with questions on the following two themes: (1) opinions about the current OHE system for asbestos-exposed workers; and (2) opinions on the establishment of post-exposure OHEs for asbestos-exposed workers. Results: All of the interviewees agreed that the current OHE system fails to detect OARDs, thus reforms are needed; however, the interviewees had concerns regarding the establishment of a post-exposure OHE system, which were summarized in the following 5 dimensions: (1) problems of identifying asbestos-exposed workers; (2) difficulties in verifying asbestos exposure; (3) uncertainty in choosing a suitable screening tool and in ensuring qualified personnel; (4) lack of financial resources and administrative support; and (5) problems of moral hazards. Conclusions: All of the interviewed OHPs agreed that the establishment of a post-exposure OHE system is needed, not just for asbestos-exposed workers, but for workers exposed to other types of hazardous substances with long disease latencies. To design the system and its implementation procedures, more discussions are needed, especially with respect to the aforementioned issues. [ABSTRACT FROM AUTHOR]

Objectives: Asbestos-related diseases (ARDs) occur years or decades after the first exposure to asbestos. Secondary to its widespread use, the prevalence of ARDs continues to increase, making its recognition and compensation a major occupational health issue. Many countries have expanded occupational health examination programs to include workers currently and/ or previously exposed to asbestos. In addition, some countries have established surveillance systems for malignant mesothelioma (MM), a sentinel tumor for asbestos exposure. Methods: We reviewed existing literature and official websites of selected countries to understand the design of asbestos-related occupational health examination programs and MM surveillance systems. Results: In Japan, the United Kingdom, Germany and France, workers with ongoing or past occupational exposure to asbestos are eligible to participate in occupational health examination programs. These programs are financed either through workers' compensation insurance or public funds. Medical care and compensation are provided for individuals with ARDs. Surveillance programs for MM were established in Australia, France and South Korea, and MM cases identified through the programs were investigated on asbestos exposure history. Surveillance programs provide empirical evidence for prevention and compensation policies of ARDs including MM. Conclusions: The government of Taiwan should expand the scope of its occupational health examination program to include individuals with a history of occupational exposure to asbestos, and establish a surveillance mechanism for MM. This will allow Taiwan to understand the scope and impacts of ARDs. [ABSTRACT FROM AUTHOR]