[Four years on a waiting lists for surgery--an expensive option. Millions in lost production while waiting for an orthopedic intervention]

Abstract

This study was performed in order to determine the cost to society (in terms of loss of production) of having patients on paid sick-leave while on a waiting list for elective orthopedic surgery. All patients on surgical waiting lists receiving sick-leave benefits for the same diagnosis as for the planned procedure, specifically for lumbar disc herniation, lumbar spinal stenosis, and certain knee and shoulder diagnoses (not including arthritis), were identified at two large Swedish orthopedic clinics. These diagnoses were chosen since there is evidence that surgery can reduce pain and disability and also improve work ability. The number of days on sick-leave was determined individually as was each subject's reimbursement from universal health insurance. These benefits were treated as equal to the production losses caused by their inability to work according to the so-called Human Capital Method. 159 patients on the waiting lists were on sick-leave. The average waiting time varied between one and two years for the diagnoses included. Forty-four of the patients were granted temporary or permanent disability pensions while awaiting surgery. The costs for paid sick-leave together with future costs for those granted permanent disability pensions were almost 90 million SEK (almost 90 million USD). This amount corresponded to the cost of more than 2000 disc operations or more than 1000 total hip replacements. Instead of being spent on sick-leave this money ought to be used to shorten the waiting time for surgery.