English version - Fit for Work Europe

MSDs and health care professionals
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For RA, although direct health care costs have been relatively small in the past (Lundkvist,
Kastäng and Kobelt, 2008), a number of studies indicate that direct costs increase as functional
capacity decreases – making functional capacity a major cost driver (Huscher, Merkesdal,
Thiele, Schneider and Zink, 2006; Kobelt, 2007; Leardini, Salaffi, Montanelli, Gerzeli and
Canesi, 2002). Comparing those with lower EQ-5D score (0.8) the direct costs were 369,624 and 214,644 respectively; indirect costs were 300,766 and
42,828 respectively (Igarashi et al., 2010).
In Japan, inpatient care accounts for 41 per cent of MSD-related medical costs at JPY 816.4
bn. The average length of hospital stay in Japan (for all diseases) is relatively long at 18.5 days,
compared to an average of 7.2 days for OECD countries (OECD, 2011) and the subsidised,
free-access medical system means that patients suffering from conditions such as RA tend to
seek regular and intensive treatment (Tanaka, Inoue, Mannalithara, Bennet, Kamitsuji et al.,
2010). The 2008 MHLW Patient Survey (MHLW, 2008) estimates a rate of 54 patients per day
(per 100,000 population) receiving care for MSDs in hospital, compared to 740 patients per day
receiving outpatient care. The average length of hospital stay for MSDs has been falling rapidly
over the past decade from 55.3 days in 1996 to 36 days in 2008. In a separate survey, Fukuhara
et al. (2003) calculate that patients experiencing back pain spend on average 7 days a year
receiving inpatient care and 19.7 days as outpatients. New social security policies described in
the previous section aim to reduce the costs of inpatient care by reducing the length of hospital
stays still further and focussing more strongly on the provision of rehabilitation.
Figure 5.2. Average number of days spent in hospital due to MSDs
60
50
40
30
20
10
0
55.2
44.2
41.4
37.8
1996 1999 2002 2005 2008
Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market
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Source: MHLW (2008)