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MSDs and health care professionals 42 5.2 Access to health care in Japan Japan operates a free-access medical system, which means that patients are not registered with a specific doctor and are free to select and visit a physician of their choice, without referral from a GP. While there are a small number of family doctors in Japan who practice in a way similar to GPs, the majority of Japanese choose to attend a specialist clinic based on their symptoms. Even though this system provides access to a wide range of treatments and affords the patient a high level of choice in the treatment process, the doctor-patient relationship remains paternalistic. Patient empowerment in Japan is a developing concept, and while progress has been made in issues such as informed consent, many patients remain reluctant to question the expertise of their physician. All residents are enrolled in a universal statutory health insurance system either through their employer (kumiai hoken) or through the national citizens’ insurance programme run by the government (kokumin hoken), which covers around 40 per cent of the population (Tatara and Okamoto, 2009). Both systems cover a minimum of 70 per cent of the cost of the majority of treatment and prescription costs, with an income-dependent cap in place (currently between JPY 80,000 and JPY 287,000 per month) in the case of long-term treatment. Extra benefits are available for the elderly and those with disabilities or on low income. In the case of MSDs there are a range of treatment options for patients. Hattori (2006) found that of those seeking treatment for chronic pain (the majority of which was caused by MSDs), 45 per cent attended an orthopaedic surgeon, 21.3 per cent – a general clinician, 15.1 per cent – a massage therapist or chiropractor, 12.4 per cent – an osteopath and only 0.8 per cent – a specialised pain clinic. A 2010 survey of patients suffering from chronic musculoskeletal pain showed that less than half (42 per cent) of those with symptoms sought medical treatment. Of those, only 19 per cent visited a hospital or clinic, while 20 per cent sought complementary therapy such as massage, or folk remedies (Nakamura et al., 2011). This apparent reluctance to seek treatment suggests a lack of awareness of treatment options for MSDs in the early stages, or a failure to recognise the serious impact of MSDs for everyday life and workplace productivity. It is important to recognise that for majority of those in employment occupational physicians are the first point of contact in case of illness. Occupational physicians should work together with other health care professionals to gain a better understanding of the physical, social and psychological risk factors for a range of work-related conditions. It is noted, however, that some delays in access to treatment occur due to the lack of communication between the occupational physicians and other health care professionals. Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market
MSDs and health care professionals Figure 5.4. Treatment choices of patients with chronic pain (including MSDs) Folk remedy 20% Hospital/clinic 19% Both 3% No answer 3% People with MSDs in Japan frequently access complementary or alternative medicines (CAM), either in place of or on top of medical care (Nakamura et al., 2011; Hattori, 2006; Kajiyama, Akama, Yamanaka, Shoji, Matsuda et al., 2006). At the same time, Kikuchi, Matsuura, Matsumoto, Inagaki and Ueda (2009) find that of 260 CAM products for osteoarthritis or RA available in Japan, only 41 CAM products had been tested in randomised controlled trials; there was no scientific evidence concerning the effectiveness of the remaining 219 CAM products. More research into the efficacy of such treatments and better communication between physicians and practitioners could aid patients in developing a comprehensive treatment strategy. The MHLW investigative committee into chronic pain found, there is little communication between physicians in this system and the need to develop a multifaceted team approach to Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 43 None 55% Source: Nakamura et al. (2011)
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 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.,
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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