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

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Work and MSDs in Bulgaria 40 lost wages and jobs. 22 Additional costs are associated with the reduced ability of an individual to live independently. In addition, NSSI (2011b) reports on the number of working days lost by carers (see Table 3.4). Data held on costs relating to carers is very rarely held by countries in Europe so it is good to see this information is collected in Bulgaria. The high number of days lost and resulting costs of caring for an ill relative for carers demonstrate how indirect costs are so important to examine when considering the economic cost of MSDs. Table 3.4. Days lost and costs as a result of caring for ill relative 2008 2009 2010 Number of days lost 761,822 738,631 486,280 Cost min BGN 12.26 14.42 9.91 Such indirect costs may include hiring household help (Kavanaugh, 2005), as well as the foregone income of family members who leave the labour market to provide informal care (Pugner, Scott, Holmes and Hieke, 2000). Although informal care is difficult to identify, quantify and value (what is considered ’informal care’ by some people may be considered ’normal’ by others), Lundkvist, Kastäng and Kobelt (2008) reported that for RA the annual cost of informal care in Bulgaria was equal to 232 euros per patient. In a different study Kobelt and Kastaeng (2009) arrived at a lower estimation of 160 euros per patient, which was significantly below the European average of 2,012 euros and still well below other Eastern European countries (average 513 euros). However, when compared with the average annual salary in Bulgaria (4,085 euros in 2009) 23 it is apparent that costs of informal care are very high. 3.4.3 Total costs Calculating the costs for specific MSDs is fraught with the same difficulties as for MSDs as a whole. The majority of studies estimating the economic burden of RA have provided cost estimates specific to the US population and health care system (Cooper, 2000). The cost of AS to society is less well established (Chorus et al., 2002). More research has been done on cost in the US, Canada and other European countries, particularly the Netherlands, France and Belgium, than in Bulgaria. However, findings across countries with respect to work disability rates are generally not directly comparable given the differences in working terms and conditions, such as the length and conditions of statutory sick pay (Sieper et al., 2002). 22 Reiterated in expert interviews 23 See Eurostat http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/ Source: NSSI (2011b) Fit For Work?
3.5 Summary Work and MSDs in Bulgaria Lundkvist, Kastäng and Kobelt (2008) found that the total cost of treating RA patients in Bulgaria was 2,825 euros per patient per year resulting in 144 mln euros overall costs. A later estimation by Kobelt and Kastaeng (2009) concluded lower RA costs of 2,063 euros per patient per year, or 61.3 mln in total. These included medical costs, drug costs, non-medical costs, the costs of informal care and other indirect costs, but do not differentiate between those of working age and those above retirement age. These figures are significantly lower, per patient, than those for other Western European countries, but comparable to the Eastern European average. The limitations of data collection outlined above highlight some of the difficulties encountered in trying to cost the impact of MSDs for employers and society. In this section we have considered the impact that MSDs have on a person’s ability to work, both physically, as a result of the condition itself, and from the associated effects, such as loss of concentration from pain. We have also discussed the impact that the workplace can have on MSDs, both at onset and during the development of the conditions. Whilst there are many intrinsic risk factors for MSDs it is clear that the workplace has the potential to expose employees to other risk factors, both physical and psychosocial. Some of the well-established workplace risk factors such as vibrations and workstation ergonomics are already recognised by many employers. However, the impact of other workplace risk factors such as job quality and support of disclosure, are not as widely understood. We have also highlighted that it is important to distinguish between risk factors for the onset of MSDs and risk factors for chronic illness and disability. Whilst the physical conditions of work may cause or aggravate musculoskeletal symptoms, the impact or outcome on individuals (absence from work and disability) is strongly associated with psychosocial factors (Waddell and Burton, 2006b). Finally, we have looked at the economic and social impact of MSDs and have discussed the direct, indirect and total costs of MSDs. Direct costs of MSDs among the working age population were estimated at just over 46 million euros. Unfortunately, total cost estimates as found in the literature do not take into account the enormous intangible costs born by people with MSDs. This is due to the difficulty of expressing intangible costs in monetary terms. Total overall costs of RA were found to be 61.3 million euros for all patients over 19 years old. However, data for RA in particular, point out how direct and indirect costs increase with the progression of the disease. As a consequence, the development of strategies and interventions to stop this progression and ensure that those with MSDs are supported to enjoy full and productive working lives appears necessary. The next section will discuss for each condition the most common and appropriate interventions outside and within the workplace. Fit For Work? 41
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 and 38: Work and MSDs in Bulgaria Direct co
Page 39: presented in the Table 3.3 below. T
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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