How to Smartly Invest in Health Care

 In ART Articles, Educational Links, Uncategorised

ART logo webART Literature Review:
by Everett Johnson, DC, ART

Investing in Health Care.

Companies spend great amounts of money each year to maintain the equipment they use to produce the goods and services they provide. If equipment fails the company loses money in lost production time and employee wages. The longer machinery goes without maintenance typically, more time and money is needed to find the problem and fix it. Most companies try to calculate their maintenance expenses as a percentage of estimated replacement value of equipment. This percentage ranges from 3% to 5% depending on service or goods produced, and obviously lower numbers are better. Add to this a specialized team trained to maintain the equipment and this cost goes up. Now, apply all of the information above to the employees of corporations.

Health-Care-highrise-welderEmployees need maintenance too. Pain is a burden on employee health and productivity that affects most employers. The expense of worker related health issues to companies has been the subject of research and governmental agencies for several years 1. Employees performing occupations with high levels of physical loading have a higher incidence of pain, injury and loss of work than individuals with lower exposure to physical workloads. There also appears to be a strong relationship between the incidence of musculoskeletal disorders and exposure factors in “high-exposure” occupational settings.

Musculoskeletal disorders (MSDs) are described by the National Institute for Occupational Health and Safety (NIOHS) as2:

  • Disorders of the muscles, ligaments, tendons, nerves, joints cartilage or spinal discs.
  • Disorders that are typically not the result of an acute or instantaneous event, but are more gradual in nature. (though they do recognize falls and other acute injuries as contributors)
  • Disorders with distinct features or described by location.

NIOHS describe work-related musculoskeletal disorders (WMSDs) as MSDs attributable to the work environment and the performance of work, and MSDs that are made worse or may last longer due to working conditions. WMSDs are the most prevalent lost time injuries in most industries, with those involving the low back being the most costly. The NIOSH acknowledges that WMSDs decrease productivity in the workplace and the quality of the products and services provided by the company, due to the aches and pains experienced by the workers.

MSDs are common all over the world and account for the most visits to see a physician. And though they are not all completely caused by work, the employee may show up to work with a musculoskeletal disorder that may be aggravated during the work day as they perform their required duties. The most common body regions involved in MSDs are the low back, shoulder, neck and arm3. Upper extremity MSDs appear to be more prevalent in occupations with intense manual labor 2, while back and lower limb disorders are more prevalent in truck drivers, construction and warehouse workers 4. Jobs with the highest frequency of risk factors for MSDs include rapid-paced work with repetitive motion patterns, insufficient recovery time, and heavy lifting and forceful manual exertions 3.

Health-Care-FactoryOne of the largest studies ever conducted in the United States examined health-related lost productivity and assessed the implications of the cost to manage health of workers 5. The study included over fifty thousand employees, and examined over 1.1 million insurance claims made. The researchers made associations between health conditions related to absenteeism (missing work) and presenteeism (coming to work, but not being productive). What they found was that, on average, decreased productivity due to health related issues where significantly greater than medical and pharmacy costs by 2.3 to 1. Among the important causes of productivity losses are musculoskeletal complaints such as back and neck pain. The authors concluded that a strong link exists between health and productivity. It is suggested that looking at production and health data of employees may be a way to develop workplace health investment strategies.

Health-Care-backThis study combined the direct cost that are easy for companies to measure and the indirect costs, which may be over-looked. Direct cost would include things such as medical office visits, medical bills and rehabilitation. The indirect costs associated with workplace health include replacing the employees’ lost hours on the job through hiring and/or training a new employee, hikes in insurance rates, administrative time, and company reputation. Indirect costs are somewhat difficult to predict, with some entities estimating up to 4 times the actual cost of an injury. Add the direct and indirect costs together and the total cost of an injury is revealed.

A 2005 study looked at the burden of pain on employee health and productivity 6. The aim of this study was to identify target areas within a company and to reduce the burdens of pain in those areas. They found that 28.6% of the employees had pain that reduced their overall physical and mental health, five time increase in health-induced limitations, and over three workdays lost over a four week period. The researchers concluded that the prevalence of pain and the impact it has on performance of workers is an area with many opportunities for improving health and productivity. They state that musculoskeletal diseases are a great target for intervention by corporations.

Another study looked at the effects of presenteeism in chronic occupational musculoskeletal disorders 7. The researchers looked at two sets of subjects during the study, presentees and absentees. The groups participated in a functional restoration program. Results of the study found that employees classified as presentees were more likely to complete the treatment and return to work. The authors conclude that employers and employees benefit from the injured employee staying at work post injury versus taking disability leave. Though the employees reported to work at a diminished capacity, it was found to be more beneficial to the employee and the employer over the period of time it took the employee to get well.

Employers wishing to invest in the health of their workforce can do so by taking some simple steps to uncover issues that may indicate a problem. First, look for signs a particular job or department may be contributing to increased rates of WMSDs. Employees complaining of strain, fatigue and discomfort that is not resolved after overnight rest. Pay attention to first aid complaints of aches and pains from certain work assignment areas. Look at jobs that involve known high risk activities such as repetitive and forceful actions, awkward working positions, overhead work or the use of vibrating equipment.

The next step in the process would be to gather pertinent data to look for indicators. Knowing the health status of the company’s workforce may help to predict work injuries or WMSDs. Older workers are more susceptible to injuries, especially repetitive motions and shift work. Identify job risk factors for each set of tasks performed within the company, as not all areas are going to have the same rate of reported complaints. Look for areas of known involvement, such as repetitive motion and heavy lifting. Review proposals for upgrading work lines to ensure the process does not increase strain on the employees. Involving workers in workplace modification is important, as they can help to determine troubled areas. Worker involvement also increases worker motivation, job satisfaction and increases their knowledge of the organization.

Health-Care-Upper-Ext-cartonThe final step is implementation and management of new programs to decrease worker reported pain. Company health care management should emphasize prevention through early detection processes and prompt intervention. It is important that employers create an environment in which employees are encouraged to seek early evaluation of complaints. Training and providing education to employees regarding how to recognize the symptoms and signs of WMSDs is an important part of this process. According to the NIOSH, “the earlier symptoms are identified and treatment is initiated, the less likely a more serious disorder will develop.”

Health-Care-StretchPast research investigating the effectiveness of stretching programs at work has been contradictory, but recent publications suggest that these programs can be beneficial to workers experiencing pain. A recent study (2010) looked at the effects of stretching exercises at work on musculoskeletal pain 8. The study used paper-based and computer generated software to remind employees to stretch through the day. The study found that employees reminded to do stretches through a computer system had a 72% reduction in pain and the group using the hard copy version had pain reduction of 64%, while the control group that did no stretches increased in pain scores by 1%. Another study looking at the reduction of cumulative trauma disorders 9 suggests that successful ergonomics programs should include training, administrative actions and exercise programs. Other studies suggest employees take multiple breaks through the work day to stretch as a way to prevent injury 10, 11.

There is no simple solution to the problems associated with employee pain. At best it is a multifaceted issue. MSDs are very prevalent in the working society and several steps should be taken to reduce and prevent employee pain and discomfort at work. Simple maintenance programs should be implemented to ensure employees are knowledgeable of the risk factors, signs and symptoms of MSDs and when to seek help. It takes time and resources to implement changes to the work environment and transition from being reactive to employee well-being to a proactive approach, but the investment is worth it.


1. Work-Related Musculoskeletal Disorders: A Review of the Evidence. Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base Committee on Human Factors. Commission on Behavioral and Social Sciences and Education National Research Council. National Academy Press. Washington, DC 1998.
2. Cohen A et. al. Elements of ergonomics programs: A primer based on workplace evaluations of musculoskeletal disorders. US dept of health and human services. Public health service. Centers for disease control. National institute for occupational safety and health. March 1997.
3. Punnett L, Wegman D. Work related musculoskeletal disorders: the epidemiologic evidence and the debate. Journal of Electromyography and Kinesiology. 14 (2004) 13-23.
4. Pope MH, Anderson G, Frymoyer J, Chaffin D, Mosby-year Book, Inc, St. Louis, MO, 1991.
5. Loeppke R, Taitel M, Haufle V, Parry T, Kessler RC, Jinnett K. Health and productivity as a business strategy: a multiemployer study. J Occup Environ Med. 2009 Apr;(4):411-28.
6. Allen H; Hubbard D; Sullivan S. The burden of pain on employee health and productivity at a major provider of business services. J Occup Environ Med, 2005 Jul; 47(7): 658-70.
7. Howard KJ; Mayer TG; Gatchel RJ. Effects of presenteeism in chronic occupational musculoskeletal disorders: stay at work is validated. J Occup Environ Med, 2009 Jun; 51 (6): 724-31.
8. Marangoni AH. Effects of intermittent stretching excersises at work on musculoskeletal pain associated with the use of a personal computer and the influence of media on outcomes. Work 2010 36(1): 27-37.
9. Carson R. Reducing cumulative trauma disorders: use of proper workplace design. AAOHN Journal. 1994Jun; 42(6): 270-276.
10. Seckman C. Ergonomics and indexing. Key Words. 2008 Oct-Dec; 16(4): 121-122.
11. Sonographer occupational musculoskeletal disorders: What are they and how can they be prevented. Sound ergonomics LLC and Biodex medical systems, Inc.

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