FfW Bulgarian report (English language) - Fit for Work Europe

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Work and MSDs in Bulgaria 38 Figure 3.3. Expenditure on health care, as reported by National Health Insurance min BGN 200 180 160 140 120 100 80 60 40 20 0 29.1 11.9 Primary outpatient care 3.4.2 Indirect costs 22.6 13.5 Specialist outpatient care 2008 Dental care 8 months of 2009 10.3 6.7 5.2 5.7 26.8 28.5 180.2 Diagnostics Medicines Inpatients Source: National Health Insurance Fund budget statements 21 There are two main types of indirect costs most commonly measured in association with ill health in employees. These are absence from work and what is termed ‘presenteeism’ or loss of productivity in an employee while they are at work with an illness or incapacity. Presenteeism is extremely difficult to measure and we have not found Bulgarian data on presenteeism costs. However, findings from the Fifth European Working Conditions Survey (EWCS, 2010) show that almost a quarter (22.6 per cent) of Bulgarian workers attended work in the preceding 12 months when they were sick with a slightly higher proportion for people working in services (24.4 per cent) compared with industry (20.1 per cent). Although this is lower than other European countries, having any proportion of the workforce working when they are unwell is likely to have an impact on productivity. Lost productivity accounts for the largest cost of RA due to people leaving the workplace early (Lundkvist et al. 2008). Since 2007 all sickness benefits are paid to insured Bulgarian employees by the NSSI, not by employers. NSSI (2011b) reports millions of days lost due to temporary incapacity resulting from ill health. Unfortunately the list of medical conditions leading to that incapacity is not comprehensive with missing data for earlier years. Selected data are 21 See National Health Insurance Fund http://www.nhif.bg/c/ext/publications_display/get_file?p_l_id=10142&folderId=118 53&name=PBFE-136.pdf 93.9 Fit For Work?
presented in the Table 3.3 below. The reasons for incapacity are also somewhat limited and do not include recognised occupational diseases from the list developed by the NSI, indicating a lack of standardisation in recording disease across government departments. Table 3.3. Days lost and costs resulting from temporary inability to work Reason 2008 2009 2010 Damage to intervertebral disks in the neck region Damage to intervertebral disks in other regions Damage to nerve roots and plexuses Dislocation, strain or sprain of knee joints and ligaments Dislocation, strain or sprain of foot or ankle joints and ligaments Cost min BGN Number of days lost Cost min BGN Work and MSDs in Bulgaria Number of days lost Cost min BGN Number of days lost – – – – 1.25 55,497 10.23 256,529 11.38 533,337 6.9 319,936 8.85 483,826 13.92 613,578 10.45 455,309 2.99 143,225 4.47 125,644 3.66 140,324 2.0 99,827 2.69 114,532 2.09 87,898 Inter-articular knee joint damage – – 2.28 115,494 2.60 99,957 Source: NSSI (2011b) Similarly the methods of collecting sickness absence data in organisations have limitations. For example with the self-reported surveys, employees might report sickness on days when they were not due to work anyway. With employer surveys the responses are limited by the quality of the absence records employers keep (for example, employees do not always record absence accurately or categories for recording causes are not adequate). This is partially due to the low awareness of the impact of ill health on work. Employer surveys are also subject to response biases where only organisations with good methods to measure absence are likely to be able to respond quickly to the survey request. In all cases records and reports are subject to biases. Managers, for instance, tend to underreport their own absence. Not only are indirect costs associated with sickness absence and presenteeism, but indirect costs are also associated with early retirement among people with MSDs (Dagenais et al., 2008; Alavinia and Burdorf, 2008). However, these figures still underestimate the true cost of conditions such as MSDs. Most people with MSDs (even those with diagnosed conditions) continue to work (Waddell and Burton, 2006a), experiencing emotional distress of fearing to Fit For Work? 39
Page 1 and 2: Fit For Work? Rosemary Thomas Kseni
Page 3 and 4: Contents 1. Executive summary 5 2.
Page 5 and 6: 1. Executive summary The ‘Fit for
Page 7 and 8: What can be done? Executive summary
Page 9 and 10: Executive summary We have found imp
Page 11 and 12: Increasing work intensity is a very
Page 13 and 14: 2.2 MSDs: The European context Intr
Page 15 and 16: 2.4 A note on definition Introducti
Page 17 and 18: 2.5 Structure of the report Introdu
Page 19 and 20: Figure 3.1. Number of MSDs inpatien
Page 21 and 22: • Stamina and resilience; • Cog
Page 23 and 24: Work and MSDs in Bulgaria It is imp
Page 25 and 26: of RA and specific leukocyte antige
Page 27 and 28: injuries or back pain 15 ; Sieper,
Page 29 and 30: 2001). The study also found that fo
Page 31 and 32: • Local or whole-body exposure to
Page 33 and 34: workers of developing rheumatoid ar
Page 35 and 36: 3.4 The wider economic and social i
Page 37: Work and MSDs in Bulgaria Direct co
Page 41 and 42: 3.5 Summary Work and MSDs in Bulgar
Page 43 and 44: Job retention and return to work pr
Page 45 and 46: 4.2 The social security regime for
Page 47 and 48: Further indirect costs of disabilit
Page 49 and 50: 4.3 Conditionspecific interventions
Page 51 and 52: RA in Bulgaria who receive biologic
Page 53 and 54: Interventions Since it was first pr
Page 55 and 56: apart from norms of shift work. 43
Page 57 and 58: Box 2. Case Study - EPIQ Electronic
Page 59 and 60: the beliefs that both parties have
Page 61 and 62: 4.6 Summary 4.5.4 Improved employer
Page 63 and 64: 5.1 Recommendations for employers 5
Page 65 and 66: 5.3 Recommendations for GPs and spe
Page 67 and 68: Conclusions and recommendations •
Page 69 and 70: Breen, A., Langworthy, J. and Bagus
Page 71 and 72: der Tempel, H. and van der Linden,
Page 73 and 74: Guzman, J., Esmail, R., Karjalainen
Page 75 and 76: References Nachemson, A., Waddell,
Page 77 and 78: Waddell, G. and Burton, A. K., (200
Page 79 and 80: Appendix 2: Sample ‘Fit’ Note S
Page 81 and 82: Sources: Eurostat Statistical Datab
Page 83 and 84: Sources: Parent-Thirion, Fernández
Page 85 and 86: Hourly labour costs 2007 Average ho
Page 87 and 88: % sickness absence due to health re
Page 89 and 90:
Appendix 3: Benchmarking grid Refer
Page 91 and 92:
The aim of the project is to stimul
Page 93 and 94:
Appendix 4: Fit for Work Europe Wha
Page 96:
We provide: Research Advisory Consu
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FfW Bulgarian report (English language) - Fit for Work Europe

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