How much do workers' health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations

Abstract

Objective: Despite no evidence in favour, routine workers' health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals.

Methods: Cross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n=539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers.

Results: Response rate 53% (n=285). According to more than 70% of respondents the health surveillance system isn't cost-effective, doesn't meet the goal of early detection of health damage related to work, and doesn't contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services).

Conclusions: This study raises serious concerns about how health examinations are performed within our workers' health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose.

Keywords: Administración de la Seguridad; Asignación de Recursos; Cross-sectional studies; Estudios Transversales; Lugar de Trabajo; Medicina del Trabajo; Occupational Medicine; Occupational health; Occupational health services; Public health surveillance; Resource allocation; Safety management; Salud Laboral; Servicios de Salud del Trabajador; Vigilancia en Salud Pública; Workplace.