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

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