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MSDs and health care professionals 40 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 36 Source: MHLW (2008)
MSDs and health care professionals According to Tanaka et al. (2010) the disability index for RA patients in Japan is lower than that of the US and as a result costs associated with hospitalisation are lower, with medication accounting for over half of the direct medical costs associated with RA. Figure 5.3. Breakdown of medical costs relating to RA Hospitalisation 13.90% Laboratory examination and imaging 22.50% Consultation 7.70% Rehabilitation 1% Medication 55.40% Source: Tanaka et al. (2010) Medical costs associated with RA have continued to increase throughout the past decade as a result of the introduction of new treatments such as DMARDs and TNF. At least 67 per cent of RA patients in Japan are categorised as having moderate to severe RA and are subsequently receiving treatment under national health insurance schemes. 57 per cent of all RA patients are receiving DMARD treatment (Miyasaka, 2011). Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 41
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 38 and 39: 5. MSDs and health care professiona
Page 42 and 43: 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.,
Page 94 and 95:
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
Page 100 and 101:
Appendix 3: Benchmarking grid 100 O
Page 102 and 103:
Appendix 3: Benchmarking grid Refer
Page 104:
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