On Thursday my colleague Ksenia Zheltoukhova and I were proud to launch the latest Fit for Work report at the Economic Forum in Krynica-Zdrój in southern Poland. We hope that the findings and recommendations of our research will increase awareness and provide a foundation for action at a national level. Now that Poland has assumed the Presidency of the European Union (EU), it has a unique opportunity to lead positive changes in the way the societal burden of chronic disease and work-related health conditions are managed. The Polish Presidency will also see the publication of a new EU Directive on Musculoskeletal Disorders (MSDs) at work, which provides another opportunity to put these issues under the spotlight.
So what is the impact of MSDs in Poland and what can be done to improve the situation?
First, we found that the prevalence of MSDs in Poland is quite high compared with other EU member states. In 2010 over 26 million sick days resulted from MSDs. Over a half of all Polish workers experience muscular pain at work at any one time and are therefore more likely to withdraw from work prematurely, and almost 10 per cent of the working age population are already inactive due to full or partial disability. As a result the employment rate among the working age population at 59.3 per cent is much lower in many European countries. On average, Polish workers withdraw from the labour market earlier than individuals in any other countries in the European Union. With support from our Polish partners CEESTACH we were able to estimate that in 2010 the total direct costs of the conditions of musculoskeletal system in Poland added up to €938 million.
Second, we found that current health spending on MSDs tends to prioritise reactive treatment, while the enormous social cost of early retirement and work incapacity associated with MSDs is often overlooked. MSDs incur at least twice as large indirect costs as the direct costs to the health care system. For example, in 2009 up to €3.6 billion were spent on the welfare benefits of the work disabled in Poland, with over 13 per cent of that expenditure associated with MSDs. Some of those costs could be avoided by a more proactive approach regarding prevention of, and early intervention for, long-term incapacity resulting from MSDs. At the same time, only €38 million of the welfare costs were devoted to preventative rehabilitation.
Third, we found that at least 12 per cent of registered unemployed people in Poland do not seek work due to poor health condition. At the same time, the longer individuals stay out of work, the more difficult it is for them to return – especially because of psychological barriers. Early action, preferably in partnership between GPs, specialist consultants, the patient and their employer, can help those with MSDs to stay in their jobs and to achieve a balance between the individual’s need for respite and their need to work. For some MSD patients early diagnosis and subsequent access to physiotherapy and to drug therapies can reduce the severity, impact or progression of the condition – a delay in diagnosis or treatment can make recovery, job retention or rehabilitation much more difficult. Patient groups may be a valuable source of support and information on dealing with long-term health conditions.
Fourth, while people with MSDs in Poland do not have problems accessing treatment options once a diagnosis is established, we found that waiting for an appointment with a specialist consultant and receiving the correct diagnosis may take a long time. For people with rheumatoid arthritis (RA), for example, the average waiting time between the onset of the disease and a visit to a rheumatologist is 3 to 6 months. Without appropriate and timely treatment half of patients with RA withdraw from the labour market within five years of the onset of the disease. Premature withdrawal from the labour market is a significant issue in Poland. Currently the average age of recipients of rehabilitation benefits in Poland is 46 years meaning that, increasingly, more Polish citizens of prime working age will require support for managing their long-term conditions.
So what can be done to improve the situation and prepare Poland for the challenges ahead? We think it is important that people with MSDs are able to stay in work as long as possible, and that they have a right to expect fulfilling work which uses their skills. We have found that many GPs and employers in Poland mistakenly believe that employees have to be 100 per cent fit to return to work and to perform their jobs effectively. However, evidence suggests that workplace accommodations which allow job retention or a gradual return to work can help improve individuals’ health condition and help recovery from MSDs.
In order to achieve the goals set in the Europe 2020 strategy with regard to primary prevention of chronic disease, Poland has to invest in early interventions which will reduce the costs of poor health and ageing to its health care and the welfare systems by taking steps to ensure that more of its workforce can remain in, or return to work, even if they have work-limiting health problems.
In order to encourage ‘joined-up’ thinking and action which focuses on the MSD patient as a worker, on the capacity rather than the incapacity of people with MSDs and on societal burden of MSDs in addition to their direct cost, the Polish government should play their part in tackling the burden of MSDs by developing and executing a National Plan – perhaps driven forward by a National Clinical Director for MSDs – which brings together health policy, active labour market policy and welfare policy to coordinate and monitor action which promotes early intervention, job retention and return to work for people of working age with MSDs.
Policy-makers should also acknowledge that current health and social policies do not currently prioritise job retention or return to work as important clinical outcomes, leading to inefficient allocation of health care and welfare resources. A National Plan will go some way to resolving these systemic problems and contribute to a reduction in the economic and societal burden of MSDs in Poland.
Our report also recommends that policymakers in Poland should:
– Review the way the health care budget is allocated. For example, current funding structure may incentivise some doctors to hospitalise patients unnecessarily to help them access treatment earlier. The costs of such treatment would be much higher in the long run due to the cost of ‘bed days’ that could be avoided.
– Invest in the education GPs to recognise MSDs early and assist patients to return to work even if they are not 100 per cent fit.
– Aim to reduce variation in access to health care between rural and urban areas of Poland.
– Align treatment practices with the priority to return people to work as soon as possible, providing optimal intervention at the early stages of the condition or disease.
– Learn from the best practice examples already in place in Poland. In 2010 an Early Arthritis Clinic for early diagnosis of rheumatoid arthritis was launched in Bydgoszcz. It is important to establish similar clinics throughout the country to ensure faster access of patients with rheumatic diseases to appropriate treatment.
– Recognise that ‘cost-control’ approach is only a short-term reactive measure to reduce the impact of MSDs on the Polish society. Preventive measures in clinical practice and in workplaces need to be prioritised in order to anticipate and reduce the disability-related burden of these conditions for both the healthcare system and for employers.
As in many other member states, fundamental changes need to occur in Poland in the way policy-makers, medical professionals, employers and even individuals themselves approach the management of long-term conditions. Work has to become more of a priority outcome, as job retention and return to work can positively affect physical health and psychological well-being, and reduce the social burden of disease in Poland. Better mechanisms of timely diagnosis and vocational rehabilitation need to be developed in order to prevent and minimise the long-term impact of musculoskeletal conditions on work productivity, healthcare costs and social exclusion.
Our research in Poland has reassured us that there are many experts and policy-makers who accept our analysis and who are committed to coordinated action. We are optimistic that, with a National Plan, more of Poland’s workforce can be Fit for Work.
This entry was posted on Monday, September 12th, 2011 at 4:09 pm and is filed under Europe, Policy. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.