Last month I spoke at the 1st Macedonian and 4th Adriatic Congress on Pharmacoeconomics and Outcomes Research in the beautiful resort of Ohrid in Macedonia. The Congress examined a range of topics relating to healthcare decision-making in the lower-income countries of the Adriatic and Balkans region. These included the contribution of health insurance to the cost-effective use of medicines, the health economics of personalised medicines and case studies of health technology assessment practices (HTA) in Serbia, Croatia and Bosnia and Herzegovina (Fit for Work has also conducted a series of case studies on the Societal Perspective in HTA).
My presentation focused on the issue of early healthcare interventions which promote workability and labour market participation. I used Musculoskeletal Disorders (MSDs) as an example and also focused on the Fit for Work research we have conducted in Slovenia to illustrate my conclusions.
In Slovenia, as illustrated by the graph below, MSDs account for a very large proportion of days lost to sickness absence – 2.5 million each year.
Almost 49 per cent of Slovenian workers report work-related back pain, and over 38 per cent of Slovenian workers report that they have experienced muscular pain in their neck, shoulders and upper limbs. There are over 13,000 people with RA – with an annual cost of treatment of €126m. Unlike some countries, the social insurance system in Slovenia extends support to people with MSDs which are not caused by work or workplace injuries (unlike some Worker Compensation schemes around the world). This means that vocational rehabilitation is an important priority. However, there can be delays in accessing treatment which supports return to work (eg physiotherapy, spa therapy, drug treatments) because referral rates to secondary care – especially Orthopaedic specialists in the case of people with MSDs – by GPs are very high, causing long waiting times. As yet GPs in Slovenia – as in most countries – do not have any incentive to regard work as a clinical outcome of care or as a commissioning priority. In addition, there are few incentives in the welfare system for people to remain in work as the disability replacement wage rate id quite high.
My presentation, however, indicated that earlier intervention for Slovenian workers with MSDs could result in an additional 2,800 being available for work each day. This estimate was derived from data produced by Dr Juan Angel Jover and his colleagues in Madrid where an early intervention clinic for people with MSDs reduced temporary work disability by 39 per cent. With the potential for such significant increases in productive capacity and human capital utilisation, I argued that the economic and social benefits of early clinical interventions should be disseminated widely to clinicians and healthcare decision-makers.