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5. MSDs and health care professionals 38 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
According to the MHLW Estimates of National Medical Expenditure Survey, MSDs account for 7.5 per cent of Japan’s total general medical costs, or nearly JPY 2 trillion in 2009 (MHLW, 2009). Total expenditure on MSDs has risen throughout the last decade, from JPY 1.6 trillion in 2003, although the proportion of medical expenditure allocated to these diseases has remained relatively stable. Figure 5.1. Health care expenditure in Japan, by disease chapter Circulatory diseases Neoplasms Respiratory diseases Musculoskeletal & connective tissue diseases Genitourinary diseases Yen (billion) 0 2000 4000 6000 2088.4 1998.7 1987 MSDs and health care professionals 3399.3 5539.4 Source: MHLW (2009) As Figure 5.1 shows, musculoskeletal and connective tissue diseases are the fourth largest disease category in terms of general medical expenditure (MHLW, 2009). The costs of RA alone add up to JPY 2.4 million per patient per year, of which JPY 760,000 are indirect costs associated with the productivity loss of patients and their careers (Tanaka, 2011). With an estimated 600,000 RA patients in Japan, this results in national expenditure of over JPY 1 trillion (Tanaka, 2011). Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 39
Page 1: Fit For Work? Musculoskeletal Disor
Page 4 and 5: Contents 4 1. Executive summary 6 2
Page 6 and 7: 1. Executive summary 6 The ‘Fit f
Page 8 and 9: Executive summary 8 the data that i
Page 10 and 11: 2. Introduction 10 2.1 The global b
Page 12 and 13: Introduction 12 2.3 International c
Page 14 and 15: Introduction 14 2.5 Structure of th
Page 16 and 17: Work and MSDs in Japan 16 Figure 3.
Page 18 and 19: Work and MSDs in Japan 18 3.2 Defin
Page 20 and 21: Work and MSDs in Japan 20 3.3 The i
Page 22 and 23: Work and MSDs in Japan 22 average t
Page 24 and 25: Work and MSDs in Japan 24 RA affect
Page 26 and 27: Work and MSDs in Japan 26 3.3.4 Spo
Page 28 and 29: Work and MSDs in Japan 28 3.4 Summa
Page 30 and 31: MSDs and government 30 4.2 MSDs: Po
Page 32 and 33: MSDs and government 32 of good heal
Page 34 and 35: MSDs and government 34 Figure 4.1.
Page 36 and 37: MSDs and government 36 deliver bett
Page 40 and 41: MSDs and health care professionals
Page 50 and 51: 6. MSDs and employers 50 6.1 Costs
Page 52 and 53: MSDs and employers 52 6.2 The role
Page 54 and 55: MSDs and employers 54 Occupational
Page 56 and 57: MSDs and employers 56 The most freq
Page 58 and 59: MSDs and employers 58 levels of pai
Page 60 and 61: MSDs and employers 60 • Modified
Page 62 and 63: MSDs and employers 62 Box 2. Case s
Page 64 and 65: MSDs and employers 64 lower the mor
Page 66 and 67: 7. MSDs and individuals 66 7.1 Impa
Page 68 and 69: MSDs and individuals 68 Figure 7.1.
Page 70 and 71: MSDs and individuals 70 7.2 MSDs: I
Page 72 and 73: MSDs and individuals 72 and other h
Page 74 and 75: MSDs and individuals 74 Figure 7.4.
Page 76 and 77: MSDs and individuals 76 Cont. Kaize
Page 78 and 79: MSDs and individuals 78 reported wo
Page 80 and 81: Conclusions and recommendations 80
Page 82 and 83: References 82 American Chamber of C
Page 84 and 85: References 84 Dagfinrud, H., Mengsh
Page 86 and 87: References 86 Hori, Y., Hoshino, J.
Page 88 and 89:
References 88 Matsudaira, K., Hara,
Page 90 and 91:
References 90 Rudwaleit, M., Gooch,
Page 92 and 93:
References 92 Young, A., Dixey, J.,
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Appendix 2: Fit Note Sample 94 Sour
Page 96 and 97:
Appendix 3: Benchmarking grid 96 So
Page 98 and 99:
Appendix 3: Benchmarking grid 98 So
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Appendix 3: Benchmarking grid 100 O
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Appendix 3: Benchmarking grid Refer
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We provide: Research Advisory Consu
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