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New Study Reveals Cost Savings With Use of Chiropractic
Gregg C. Anderson, D.C.

     It is no secret that just one condition that chiropractic can help, back pain, accounts for more than $100 billion in annual US health care costs.  It represents the second leading cause of physician visits and hospitalizations, second only to childbirth for hospitalizations.
 
    As a Sacramento chiropractor, I clearly understand that back pain is the most prevalent chronic medical problem, the number one cause of long-term disability, and the second most common cause of restricted activity and use of prescription and nonprescription drugs.  I guess you could say then, that it's not only a pain, but also a drain. 
 
    A recent study published in the Archives of Internal Medicine, looked at the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal specific utilization of health care resources within a large managed-care system.

    The study involved a 4-year retrospective claims data analysis that compared more than 700,000 health plan members with an additional chiropractic coverage benefit, and 1 million members of the same health plan without the chiropractic benefit.

   The results were interesting. The members with the additional chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year).
 
    Having chiropractic coverage was associated with a 1.6% decrease in total annual health care costs at the health plan level.

    This study found that individual members with chiropractic coverage had a 12% lower annual medical care cost, not adjusting for member risk characteristics.

   This translates to a 12% reduction in annual costs incurred by the managed care organization on members with chiropractic coverage.

   The researchers concluded that access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care.

   Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.

   Some additional findings included:
 
  Back pain patients with chiropractic coverage had fewer inpatient hospital stays than did those without chiropractic coverage (9.3 vs 15.6 stays per 1000 patients).

   Patients who had coverage for chiropractic care for back pain had fewer magnetic resonance imaging tests compared with those without chiropractic coverage (43.2 vs 68.9 magnetic resonance images per 1000 patients).

  The rate of lower back surgery among patients with chiropractic coverage was lower as well (3.3 vs 4.8 surgical procedures per 1000 patients).

   What is interesting is that prescription drug claims and physical therapy claims were not included among the health care costs.  It's no secret that some of the common drugs prescribed, like Celebrex (and Vioxx before it was found to be literally killing people and pulled from the market) are quite expensive.  Additionally, any claims for back surgery were excluded from the analysis, because such cases are likely to have complications for which chiropractic care would not theoretically be appropriate.   

   Clearly, the dollars spent on just one surgery could probably buy thousands of chiropractic visits.  It is likely that the costs of drugs and physical therapy are the most expensive component of medical care.
 
    A comprehensive overview of the literature reveals that it is essentially unanimous in reporting that chiropractic care is associated with significantly higher patient satisfaction compared with patients who receive conventional treatments.  It feels good and it works! 
 
    It is estimated that 21 million to 28 million people now receive chiropractic services each year, with approximately 192 million annual visits to Doctors of Chiropractic.  Between 1990 and 1997, chiropractic use increased. With growing public demand, utilization is expected to increase 21% to 35% by 2008.

   It has also been noted that potential employees, particularly those who maintain a healthier lifestyle may have been more likely to seek employment in companies that offer benefits covering complementary care (eg, chiropractic or acupuncture) that can be perceived as less aggressive treatment modalities.

   Chiropractic insurance coverage is now being offered to most American workers who are covered by health insurance.  Interestingly, the patients who were included in this study were all members of a "managed care" organization.  What that means is that they were faced with fairly restricted access to the care that they did manage to receive. 

    It would be awesome to look at the overall health care costs savings of patients who get more than just "patch" care, but also receive corrective and maintenance chiropractic care.  For example, many of my patients, get and stay pretty healthy, and are certainly reducing or eliminating many of their costly medications.  In addition, I conservatively treat many patients who have been given surgical recommendations, and are able to ultimately avoid it altogether. 

    Chiropractic care is becoming increasingly prevalent in the American health-care system. The increasing acceptance of chiropractic care as a source of comprehensive complementary care for neuromusculoskeletal problems is reflected in that the chiropractic field is the fastest growing among all doctoral-level health professions. Chiropractors now represent the third largest segment of health care practitioners in the United States, with 50,000 practitioners in 2000 according to the Bureau of Labor Statistics.
 
    Lastly, it is notable that despite the evidence for safety, effectiveness, and growing public demand, health insurance coverage for chiropractic care continues to remain restricted.  The truth is, with each passing year, health insurance costs escalate, and covered services for all types of health care are decreasing.  Employers are passing along the costs to employees now more than ever. 

   A recent analysis I read in the financials revealed that the average person, age 65, can expect to spend $225,000, out-of-pocket, on necessary health care services, not covered by insurance, by the time they die. 

   If you read this far, you'll hopefully be the one who makes every effort to get and stay healthy, and can spend that 225K on traveling, grandkids and fun stuff, instead of doctor visits, treatments and pills. 

Comparative Analysis of Individuals With and Without Chiropractic Coverage, Patient Characteristics, Utilization, and Costs
Antonio P. Legorreta, MD, MPH; R. Douglas Metz, DC; Craig F. Nelson, DC, MS; Saurabh Ray, PhD; Helen Oster Chernicoff, MD, MSHS; Nicholas A. DiNubile, MD
Arch Intern Med. 2004;164:1985-1992.

Copyright, Gregg C. Anderson, 2008

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