A comparison between two systems for pre-employment medical assessment in the Royal Netherlands Army by a randomized, controlled study

In 1998, the basic medical requirements for the Royal Netherlands Army were introduced as a standard for the assessment of the medical suitability of military personnel, consisting of 43 dichotomized points of judgment. This system replaced the old physical capacity, upper limbs, locomotion, hearing, eyesight, and emotional and mental state system, based on the detection of diseases and infirmities. We compared the two different examination systems for their ability to identify suitable recruits. For the latter purpose, we used the two operational measures of availability and health care costs. We performed a randomized, controlled study in which 352 soldiers were monitored for 2 years after being declared fit by one of the pre-employment medical assessment systems in question and having passed their general military training. We found that the pre-employment medical assessment system was the dominant factor for predicting the number of days fit-for-duty, as well as for the health care costs incurred. Those declared fit by the new system showed a statistically significant higher mean number of days fit-for-duty (648 compared with 612) and incurred significantly lower mean health care costs (6396 compared with 746 Euro). In this study, we were not able to uncover the mechanism by which the "basic medical requirements" examination system led to an improvement in outcome. For the present, this mechanism is interpreted because of differences between the two systems.