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7. MSDs and individuals 66 7.1 Impact of MSDs on individuals and households Evidence on the burden of MSDs on the economy, society and organisations still underestimates the true cost of these conditions in Japan. Because of the impact on their quality of life and the experience of chronic pain, individuals are often the bearers of the largest costs associated with arthritis and musculoskeletal conditions. 28 A survey investigating chronic musculoskeletal pain found that the out-of-pocket expenses on medical treatment for most patients suffering with MSDs amount to between JPY 3,000 and JPY 5,000 each month, with some patients spending as much as JPY 10,000-15,000. Patients meet a maximum of 30 per cent of their own medical expenses, the rest being covered by health insurance, and treatment is often prolonged (70 per cent of treatment in this survey lasted over a year), indicating that MSDs can have a large effect on household budgets (Nakamura et al., 2011). Another study (Igarashi et al., 2010) finds that for individuals the annual costs of RA were: • JPY 132,000 (out of pocket to hospital); • JPY 84,000 (out of pocket to pharmacy); • JPY 146,000 (CAM); • JPY 105,000 (caregiving); • JPY 22,000 (transportation); • JPY 30,000 (self-help devices); • JPY 188,000 (house modification). Considering utilisation rates, these costs add up to JPY 262,000 and JPY 61,000 for severe and mild forms of RA respectively. At the same time, intangible costs are rarely included in cost calculations as it is almost impossible to quantify the intangible costs of pain in monetary terms (Sieper et al., 2002). The ACCJ (2011b) reports that back and neck/shoulder pain is one of the most prevalent concerns among the Japanese, reported by 27.8 per cent of population and second only to cancer. More than 20 per cent of individuals in the survey had a pain level of 5 (out of 10) or higher in the past month, with women reporting higher levels of pain than men. Of those individuals in moderate to severe pain, 21 per cent said they could not perform to their full ability at work (ACCJ, 2011b). The evaluation of intangible costs gives useful information regarding the price paid by people with MSDs in terms of quality of life (QoL), and QoL measures should be used as further 28 Expert interview Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market
MSDs and individuals indicators to measure the effectiveness of interventions (Leardini et al., 2002). Presently, two widely used QoL measures are: 1. Disability adjusted life years (DALYs). This is a measure of the disease burden which tallies the complete burden that a particular disease exacts. Key elements include age at which the disease or disability occurs, how long its effects linger, and its impact on quality of life. One DALY is equal to one year of healthy life lost. 2. Quality adjusted life years (QALYs). The QALY is also a measure of disease burden, including both the quality and the quantity of life lived. It is used in assessing the value for money of medical interventions and is based on the number of years of life that would be added by these interventions. A QALY gives a measure of how many extra months or years of life of reasonable quality a person might gain as a result of treatment, helping in the assessment of the cost-utility of treatment options. Both measures are the subject of debate, but have become accepted as helpful in making comparative judgements across different countries and medical conditions. WHO (2009) estimates that in Japan up to 10,170 DALYs were lost due to MSD per 100,000 population in 2004 (almost 8 per cent of all DALYs lost in Japan), including 583 DALYs attributed to RA. Suka and Yoshida (2005) find that the loss of QALYs due to low back pain in the Japanese adult population was estimated at 9.18 per 1,000 population. While low back pain has not received the same level of attention from health professionals in Japan as cancer and cardiovascular disease, it is suggested that low back pain substantially deprives the Japanese adult population of their quality of life. It is predicted that with the population ageing, the losses of QALYs associated with low back, hip, and knee pains per 1,000 population will increase from 17.2, 3.8, and 8.9, respectively in 2005 to 18.8, 4.5, and 11.2, respectively by 2055 (Suka and Yoshida, 2009). The most common symptom affecting quality of life among individuals with arthritis and other MSDs is chronic or recurrent musculoskeletal pain. While the Japanese report less chronic pain than Europeans (13 per cent compared to 19 per cent), 58 per cent of these people report being in constant pain, compared to only 35 per cent in Europe (Hattori, 2006). In the National Livelihood Survey of 11,507 individuals Nakamura et al. (2011) find that 15.4 per cent of the Japanese population experience chronic pain. The majority of chronic pain is due to MSDs (see Figure 3.4 above). For many the pain is severe and long-term (see Figure 7.1). Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market 67
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Fit For Work? Musculoskeletal Disor
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Contents 4 1. Executive summary 6 2
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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
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Introduction 12 2.3 International c
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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 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: We provide: Research Advisory Consu
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