English version - Fit for Work Europe

5. MSDs and health care professionals
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5.1
Costs of
MSDs to
the health
care system
Job retention and return to work programmes are contingent on patients receiving appropriate
medical care as quickly as possible. Ensuring that workers who have MSDs get access to the
appropriate treatment and support in a timely manner must be a top priority for health care
professionals. Early intervention for individuals with MSDs will help those people return to work
more quickly, avoiding the high costs of treating the condition and its comorbidities at the later
stages of disease progression.
Direct costs, compared to indirect costs, usually represent a minority of the total costs
(Dagenais, Caro and Haldeman, 2008; Kavanaugh, 2005; Kobelt, 2007; Lundkvist, Kastäng
and Kobelt, 2008). However, for RA large cross-country variation in estimates of direct costs is
found in the literature due to the different uptake of particular treatments in different countries
(Lundkvist, Kastäng and Kobelt, 2008).
Some specific evidence regarding direct costs to the health care system is associated with
musculoskeletal conditions in general, and RA and low back pain in particular, as found in
the literature, (Woolf, 2004 as cited in The Bone and Joint Decade, 2005; Kavanaugh, 2005;
Dagenais, Caro and Haldeman, 2008) are:
• Health professionals visits;
• Outpatient surgery;
• Emergency room services;
• Rehabilitation service utilisation (physiotherapists, social workers);
• Medications and alternative therapies;
• Medical equipment;
• Diagnostic / therapeutic procedures and tests: imaging and laboratory monitoring;
• Devices and aids, environmental adaptations;
• Acute and non-acute hospital facilities (with and without surgery);
• Home health care services;
• Mental health services.
Cost-of-illness estimates therefore require input from a number of different factors, and great
variation is found across different studies of the costs of MSDs. For low back pain, the most
significant direct costs are related to physical therapy, inpatient services, drugs, and primary
care (Dagenais, Caro and Haldeman, 2008). Nachemson, Waddell and Norlund (2000)
calculated that some 80 per cent of health care costs are generated by the 10 per cent of
patients with chronic back pain and disability. In Japan, for example, orthopaedic surgeons are
the second largest group of medical professionals after paediatric physicians, constituting just
under 9 per cent of all physicians in Japan (MHLW, 2008a).
Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market