Reducing the costs of work-related musculoskeletal disorders: targeting strategies to chronic disability cases

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Abstract

Musculoskeletal disorders impose a significant direct cost burden on health care systems in the US and Canada and account for even greater indirect losses of productivity. The overall prevalence of musculoskeletal disorders is high, but a disproportionate share of costs is associated with a small number of cases with chronic pain. This is especially true for cases of occupational back pain, the single most common and costly musculoskeletal disorder in the workplace. A number of studies identify workplace characteristics associated with prolonged disability among cases of work-related back pain. These characteristics include: failure to receive job accommodations, receipt of disability benefit payments, and employment in high-risk industries or jobs that require heavy lifting. Research on the predictors of high-cost cases is limited, however, because of the lack of high-quality data and the need for a multidisciplinary approach. A new study, the Arizona State University Healthy Back Study, addresses some of these issues and promises new insights into effective strategies to reduce the proportion of high-cost claims.

Introduction

Musculoskeletal disorders are a leading cause of work disability and productivity losses in the USA and other developed nations. The disorders, including back pain, cumulative trauma, and other common conditions, impose a large annual cost burden on health care and workers’ compensation systems, and on government and private disability programs. The overall prevalence of musculoskeletal disorders is high, but a disproportionate share of costs is associated with a small number of cases with chronic pain. Much of the literature on musculoskeletal disorders focuses on prevention, through ergonomic changes in the workplace, for example, and on the costs and outcomes of specific medical interventions for acute cases. There is a smaller literature on factors associated with chronicity, and on strategies to reduce the proportion of high-cost cases.

The extent of the losses associated with musculoskeletal disorders depends on the severity of the condition, the nature and quality of health care received, and on characteristics of the patient, such as age and general health status. Patient characteristics are the focus of the traditional biomedical paradigm of the outcomes of illness or injury. Numerous studies demonstrate, however, that non-health-related characteristics, such as psychosocial factors, workplace characteristics, and the availability of disability compensation, are also important determinants of the losses associated with musculoskeletal disorders. A broader paradigm, encompassing both health-related and non-health-related characteristics is, therefore, more appropriate than the traditional bio medical model for analyzing long-term disability associated with musculoskeletal disorders.

This article analyzes the problem of chronic disability associated with musculoskeletal disorders from an economic perspective, focusing on the small fraction of cases with extraordinarily high costs. I review the evidence on the costs of musculoskeletal disorders in general, and back pain in particular, identifying the sources of disproportionately high costs. Then, focusing on work-related back cases, I review the empirical evidence on workplace characteristics and economic incentives associated with long-term disability and large productivity losses. Finally, I describe a new study of work-related back pain, now completing data collection, that addresses some of the limitations of previous research.

Section snippets

Costs of musculoskeletal disorders

Most of the information on the total costs of musculoskeletal disorders comes from cost-of-illness studies. From an economic perspective, resources are valued in terms of their opportunity costs, that is, the value of the resources in their next best alternative use. Typically, opportunity costs can be measured by market prices, but this measure fails when resources are not exchanged in competitive markets. Estimating the cost of illness is not, therefore, a straightforward exercise. This

Cost statistics

Back problems are a major cause of disability in industrialized societies. Back pain is common both inside and outside the workplace, and the distinction between work-related and non-work-related back pain is often uncertain. Approximately 65 to 80% of adults, including persons outside the labor force, experience one or more episodes of back pain during their lifetimes [3], [5], while approximately 8% of the working-age population experiences a disabling episode of low back pain in any given

Workplace characteristics and chronic disability

This section summarizes recent literature on the importance of work-related characteristics as determinants of disability following an occupational back injury. To be included, studies must be empirical studies of the risk factors associated with chronic disability following an occupational back injury, that include work-related characteristics among the analysis variables. Studies of the costs or outcomes of particular medical interventions for back pain, and studies of ergonomic interventions

Workers’ compensation benefits and chronic disability

In addition to paying the medical costs of work-related injuries, workers’ compensation systems provide financial assistance to injured workers who are temporarily or permanently unable to work. The goal is to set benefit rates high enough to assure adequate income for workers as they recover from their injuries, yet research shows that workers who incur the greatest losses are often badly under-compensated. Raising benefit rates, however, can create moral hazard problems among less seriously

Discussion

Research on the economic costs of work-related back pain has focused primarily on quantifying the total cost burden of the condition, and on identifying characteristics associated with lower probabilities of return to work or longer spells of first work absence. Given the disproportionate share of costs associated with a small share of chronic disability cases, an important direction for future research is to identify early predictors of high-cost claims, so that timely interventions to prevent

Marjorie L. Baldwin is a Professor in the School of Health Administration and Policy in the W. P. Carey School of Business at Arizona State University. Dr. Baldwin is a health economist whose research interests focus on work disability, disability-related discrimination, and the costs and outcomes of work-related injuries. She was a co-investigator for the Zenith project, a comprehensive study of the medical care costs of work-related injuries, and one of the principal investigators for a

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    Marjorie L. Baldwin is a Professor in the School of Health Administration and Policy in the W. P. Carey School of Business at Arizona State University. Dr. Baldwin is a health economist whose research interests focus on work disability, disability-related discrimination, and the costs and outcomes of work-related injuries. She was a co-investigator for the Zenith project, a comprehensive study of the medical care costs of work-related injuries, and one of the principal investigators for a three-state study of the impact of managed care on workers’ compensation medical and disability costs. She is currently one of the principal investigators for the ASU Healthy Back Study, the largest prospective study of work-related back injuries ever conducted in the US.

    Dr. Baldwin is the recent recipient of a grant from National Institutes of Mental Health to study persons with mental disorders in the labor market. Her work has also received support from National Institute for Disability and Rehabilitation Research, Canadian Studies Research Program, and Northwestern/University of Chicago Joint Center for Poverty Research.

    She has presented her research in numerous forums, including an invited presentation on “The Influence of Economic Factors on Work-Related Musculoskeletal Disabilities”, for the Panel on Musculoskeletal Disorders and the Workplace, sponsored by the National Academy of Science.

    Professor Baldwin received her PhD from the Maxwell School at Syracuse University in the Department of Economics.

    Prepared for the State-of-the-Art Research Symposium: Perspectives on Musculoskeletal Disorder Causation and Control, Ohio State University Institute for Ergonomics, May 21–22, 2003.

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