Justification for the choice of the topic
The topic was arrived at following to extensive consultation of the available literature on the costs incurred by insurance firms in the treatment of musculoskeletal issues. Having read the available literature, the following conclusions were arrived at: to begin with, one of two adults in the United States of America currently suffers from a musculoskeletal condition. 7.4% of the nation’s budget is dedicated to the treatment and management of musculoskeletal conditions. With a population that is aging fast and a sedentary lifestyle, the burden of musculoskeletal care is expected to rise with time. Insurance firms have to bear the bulk of this huge burden; a burden that is likely to become too heavy to bear in the future. Having learnt of this worrying trend through literature, the researcher settled on the aforementioned topic as a research project.
Musculoskeletal conditions are quite common in the USA with one out of every two adults suffering from a musculoskeletal disease. With such high incidences, it follows that musculoskeletal diagnostic claims are the third largest medical claims. It is projected that by the year 2030, 60 million people in the USA will be suffering from musculoskeletal conditions. While death rarely occurs as a direct result of these conditions, the conditions have a detrimental effect on quality of life, mobility and productivity.
There are three main categories of cost that are associated with musculoskeletal diseases namely: direct costs, indirect costs and intangible costs. Direct costs refer to the costs that are incurred in the course of pursuing medical treatment and management of the conditions. These costs are measured through various methods. Some of these methods include counting the number of health care services that are accessed by the patient and assigning a standard charge to each service. These costs often have tobe met by insurance providers. According to the Medical Expenditure Panel Survey (2009), musculoskeletal conditions account for 244, 000,000 visits to the hospital per annum. The total medical expenditure on musculoskeletal diseases, according the survey, was approximately 93 billion. The survey also estimates that the average cost of musculoskeletal care is about $ 1,421.
The direct costs are often dependent on the type of musculoskeletal condition that an individual suffers from. Rheumatoid arthiritis is said to cost $ 1-2 billion per year; a figure that is two to three times higher than what is associated with other individuals in the same age group and gender in the general population. The largest component of these costs is dedicated hospitalization (40-66%). Management and treatment of osteoarthritis and other related conditions cost about $ 300 million per annum.
As the number of people suffering from the condition increases, the burden of musculoskeletal care on HMO’s continues to increase. It is therefore imperative to find cost effective ways that will ensure that patients still have access to care. Studies have shown that even with the existence of guidelines that spell out treatment strategies, the efficacy of the existing treatments has often been a subject of debate. Questions also abound about the access to the treatment, the timing of medical imaging and the timing of referral for therapy .
Significance of the study to the society
Through this study, HMO’s can make significant savings in musculoskeletal care. This has been done before through the implementation of Patients Advocate Program. In 2008, a program that sought to identify patients who are at risk of suffering from neck, back and joint conditions and injuries was implemented. During the program, a nurse advocate identified the patients who were then taken through several medical screenings in order to determine the risk of suffering from the aforementioned conditions.
The patients were then subjected to strict diet and exercise the risk in order to minimize the risk that could have been a result of their weight. Following the implementation of the program, significant savings were made on the expenses on neck and back injuries.
Musculoskeletal conditions have a significant impact on employment. As a result of this, there are indirect costs that are associated with musculoskeletal care. Indirect costs are costs that are incurred as a result of loss of productivity, disability and absenture from work due to the debilitating effects of musculoskeletal conditions. These costs may, at times, exceed the direct costs. This study will address aspects of treatment with regard to cost effectiveness and preventative measures. The implementation of these measures is likely to result in a reduction in the indirect costs of musculoskeletal care.
Intangible costs refer to the costs that are associated with reduction in the quality of life, increase in pain and the loss of function. One of the most notable outcomes that are associated with musculoskeletal conditions is disability. The provision of effective treatment and care to musculoskeletal care is one of the ways of reducing intangible costs. The recommendations of this project will include effective treatments in terms of costs and efficacy. The intangible costs associated with musculoskeletal care will therefore be addressed.
This project will add to the body on knowledge on musculoskeletal care that currently exists. Scholarly works undertaken by other researchers in the future can build up on the findings of the study.
Implications to current practice
In current practice, there are regional variations among medical providers who offer musculoskeletal care treatment and management services. At times, there are variations even among doctors who are practice within the same facility. There are also debates about different aspects of musculoskeletal care and treatment. Questions abound on the efficacy of treatment, the timing of imaging, the timing of referral as a treatment option and the appropriateness of the treatments that are offered.
This project has the following implications on the current practice: medical practioners to recommend more cost effective treatments for their patients. The high cost of musculoskeletal care calls for an accurate evaluation, design and implementation of a course of treatment. This is particularly beneficial to patients who have to undergo cyclic treatments that often end up being expensive. Unnecessary tests, the use of high tech equipment, expensive prescription drugs are just some of the elements that add to cost of musculoskeletal care.
Cost efficacy is dependent on the condition of the patient. There are musculoskeletal conditions that can be addressed more cost effectively through the administration of one time expensive treatment while others can be addressed through cyclic or episodic low cost treatment. An evaluation of different types of treatment used during the care of rheumatoid arthritis patients revealed that a onetime expensive treatment regimen administered over a short duration resulted in a more effective and durable response as compared to a cost effective regimen spread over a longer duration of time. The results of this project will enable the medical practioners to make such comparisons with ease based on the information that will be available from the study.
Practical implications of the project
The findings of the study will be relevant to the following stakeholders: It will be relevant to insurance service providers who will use the findings as a basis for tailoring their products and services. The findings of this study will make easier for the insurance service providers to identify areas in which they can make savings. It will also enable them to improve the quality of their services.
The findings of this study will also be relevant to medical practioners. It will enable them to establish professional networks that will provide them with an opportunity to debate on the aspects of musculoskeletal care that are subject to debate. Aspects such as timing of imaging, appropriateness of treatment options, and efficacy of the treatment options can be discussed during conferences with insurance providers as they present their findings on cost effective measures. The doctors can also harmonize the treatment options offered within hospitals and across geographical regions.
The findings of this study will also be relevant to scholars. Based on the findings, future works can build up on specific aspects of the study such as ways of addressing indirect costs or intangible costs associated with musculoskeletal care.
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