Much of the increase in the economic impact of treating musculoskeletal conditions is due to the increased prevalence and increased cost per case. As to the latter, the increase is due to increased use of surgical interventions and the expansion in the number and cost of prescription medicines.  However, research has indicated that the prevalence rate need not increase in exact proportion as the increase in the overall population. There are preventive measures that have been discovered, such as the impact of weight loss on the prevalence of many musculoskeletal conditions, and of environmental agents in several of the conditions. In addition, researchers have uncovered several behavioral interventions that reduce the impact of the conditions once they arise, such as evidence-based exercise programs and self-management. However, relatively few resources are devoted to discovering additional behavioral interventions to reduce the prevalence and impact of these diseases. In addition, research into the causes of many of the conditions, which made substantial progress in treatment over the last several decades, has been adversely affected by the decrease in Federal basic science funding. An example is the biological agents for the treatment of autoimmune conditions such as rheumatoid arthritis.

As noted, there is likely to be a dramatic increase in the number of persons with musculoskeletal conditions seeking access to health care as a result of the ACA. This may result in increased use of mechanisms to limit access to select providers. It may also result in increased cost sharing required of those with insurance to limit their use.

The dramatic increase in the prevalence of musculoskeletal conditions would provide a challenge to the health care system even in the absence of the major changes in health care occurring as a result of the Affordable Care Act (ACA). Earlier in the chapter, it was noted there were almost 9 million persons with musculoskeletal conditions who lacked health insurance. As many of these individuals obtain insurance through the ACA, it will place additional strain the existing care system. Presently, health care expenditures for the uninsured are only about a quarter of the cost of those with public insurance, and about a third the cost of those with private insurance. As medical care access increases for the previously uninsured, result will be greater utilization of health care resources. Health insurers may respond by making it more burdensome for patients to access some resources such as specialists or they may increase the amount the insured have to pay out of pocket.

The pipeline to expand the number of health care providers able to serve persons with musculoskeletal conditions is a long one. For someone to be trained as an orthopedic surgeon may require 15 years or more, including medical school; it may take only slightly fewer years for someone to be trained as a rheumatologist. The increased access to health insurance as a result of the ACA may, therefore, strain the existing workforce.