Estimates of Direct Health Care Expenditures Among Individuals With Shoulder Dysfunction in the United States.
Johnson MP, Crossley KL, O’Neil ME, Al-Zakwani IS.

Introduction/Purpose: Shoulder pain is a common musculoskeletal condition that frequently requires the attention of health care professionals, including physical therapists (PT). Prevalence of shoulder pain in the general population has been estimated to range from 1.7% to over 25%. Shoulder problems accounted for approximately 12 million visits to physicians’ offices in 2000, as well as substantially contributing to the $215 billion overall cost of musculoskeletal disorders in the U.S. Overall costs include lost productivity, disability payments and direct health care expenditures. Despite its pervasiveness, there is little information regarding the direct health care costs associated with shoulder pathology in the U.S. The Medical Expenditure Panel Survey (MEPS) is a nationally representative survey, consisting of four components. Variables within the Household Component (HC) (i.e. provider, services rendered, ICD-9-CM, cost related to treatment, etc.) provide data relevant to this type of a cost analysis. The purpose of this study was to estimate direct health care expenditures associated with shoulder dysfunction and describe population characteristics using data from the 2000 MEPS. Methods /Subjects: A secondary analysis of the 2000 MEPS HC using the Outpatient and Office-based Medical Provider Visits sections was performed. The population comprised survey respondents identified by ICD-9 codes related to musculoskeletal shoulder dysfunction, specifically: 726, 810, 811, 812, 831, 840, 880, 912, 923, 927, and 955.  The weighted sample size represented 4 million individuals. Results: Descriptive statistics were used to calculate 1) total expenditures, 2) total expenditures/episode of care, 3) total visits, 4) total visits per provider type and 5) frequencies by age, gender, race, health status and education level. The total direct costs for shoulder dysfunction in 2000 were $7 billion dollars. The mean costs per episode of care were $1,667 and $3,011 in the outpatient and hospital-based settings respectively. These costs resulted from 21 million visits, most of which were provided by physicians (11 million) and PT’s (7.5 million).  The mean age (SD) of the population was 46.5 (19.1) years, with over 60% in the range of 22 – 59 years. Most reported being in good to excellent health (>80%), 57% were female, less than 25% had a college degree and the majority was Caucasian (89%).

Conclusion: $39 billion dollars were spent in total direct care costs for patients with musculoskeletal disease in 2000. Therefore, shoulder dysfunction represents nearly 19% of all direct care costs associated with musculoskeletal disease. Those most affected appear to be within the working class segment of the population.

Clinical Implications: As advocates for our patients and profession, we are working hard to build an evidentiary base to support our clinical practice. This study identifies the magnitude of the problem related to specific costs for shoulder care. Therefore, it should help in elevating the priority for and promoting greater funding and support of further research into the area of shoulder dysfunction.