|
 Today's escalating medical costs, particularly of occupational low-back injuries, reflect a growing legal, health care and economic crisis in the United States. Estimates of the total annual loss, including lost productivity, due to back pain in the United States range from $20 to $50 billion.2 To address this issue, over the past two decades, a great many scientific studies have been published in peer reviewed journals, government publications and other resources demonstrating significant cost savings obtainable through chiropractic. By one estimate, the increasing rate of serious back injuries per year is 1,400 percent greater than the rate of population growth. 3
A recent Louisiana study demonstrated chiropractic's cost-effectiveness in managed care settings. Researchers retrospectively evaluated the cost of care for back or neck pain for members of the Community Health Network of Louisiana who sought chiropractic health care and compared these with the costs of members who sought traditional medical care. Differences between the groups in surgical rates, use of diagnostic imaging and patient satisfaction were noted. The cost of health care for back and neck pain was substantially lower for chiropractic patients. Use of prescription drugs and diagnostic imaging was significantly higher in the medical group whereas surgical rates and patient satisfaction were identical. The authors conclude that properly managed chiropractic care can yield outcomes, in terms of surgical rates and patient satisfaction, that are equal to those of medical care, at a substantially lower cost per patient.4
 Yet another study confirms chiropractic's lower cost in treating lumbar and low back pain. Using two years of insurance claims data, a newly published study examines 6,183 patients who visited medical or chiropractic first-contract providers. Total insurance payments were substantially greater for episodes with a medical first-contact provider. Analysis of recurrent episodes indicates that exposure to a different provider type during early episodes significantly affects retention rates for later episodes. Patients choosing chiropractic and medical care were comparable on measures of severity and in lapse time between episodes.
|
The lower costs for episodes in which chiropractors serve as initial contact providers, along with the favorable satisfaction and quality indicators for patients, suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payors to control health care spending.5 |
Regarding workplace cost savings achieved through chiropractic, a Utah study of workers' compensation claims reported in The Journal of Occupational Medicine found that chiropractic patients return to work ten times sooner after an injury compared to patients receiving traditional medical treatment. The study involved 3,062 separate injury cases. The sample consisted of 40.6 percent of the 7,551 estimated back injury claims from the 1986 Workers' Compensation Fund of Utah.6 And a study published in the March 1996 issue of the American Journal of Managed Care found that the average cost per patient for chiropractic treatment over a one-year period was $539 while cost per patient for medical care coverage averaged $774. In addition, chiropractic care resulted in patient outcome and satisfaction levels identical to that of medical care.7
Perhaps the most comprehensive cost comparison research with particular significance for North Carolinian health care professionals is the MEDSTAT project.
MEDSTAT is an independent study of the cost of treating many common neuromusculoskeletal conditions conducted in 1993 under the direction of Miron Stano, Ph.D., a health care economist and professor at the School of Business, Oakland University, Rochester, Michigan. The database developed for this study contained statistical information on more than two million beneficiaries in the fee-for service sector, making it the largest known source of private-sector information on chiropractic claims payment. The database contained claims for 396,000 patients, with data from medical and chiropractic claims for 493 diagnostic codes.8
|
DISTRIBUTION OF TOTAL COST PER CASE FOR SELECTED ICD-9 CODES (MEAN VALUES) |
|
ICD-9 CODES |
TOTAL COST
(MEDICAL) |
TOTAL COST
(CHIROPRACTIC) |
| 722.10 |
Lumbar Disc |
$ 8,175 |
$ 1,065 |
| 724.40 |
Neuritis/Radiculitis |
$ 2,154 |
$ 531 |
| 846.00 |
Sprain/Sacroiliac |
$ 813 |
$ 537 |
| 847.00 |
Sprain/Strain Cervical |
$ 968 |
$ 586 |
| 847.10 |
Sprain/Strain Thoracic |
$ 487 |
$ 474 |
| 847.20 |
Sprain/Strain Lumbar |
$ 969 |
$ 523 |
|
| Total Cost of Selected Cases |
$ 13,556 |
$ 3,716 |
| Average Cost Per Case |
$ 2,259 |
$ 619 |
|
|
|
Research across medical settings and national boundaries shows dollars-and-cents proof that incorporating chiropractic care in health care plans, managed care environments, private practices, hospitals and other medical facilities can dramatically reduce costs to both patient and health care payors. |
Results of the MEDSTAT analysis for North Carolina demonstrated cost savings from chiropractic-comparable to those at the national level. Most significantly, for patients receiving both medical and chiropractic care, the MEDSTAT North Carolina results showed:
- 31 percent lower hospital admissions rates;
- 43 percent lower inpatient payments; and
- 23 percent lower total health care costs.
Research across medical settings and national boundaries shows dollars-and-cents proof that including chiropractic care in health care plans, managed care environments, private practices, hospitals and other medical facilities can dramatically reduce costs to both patient and health care payors. Authors of the study concluded that " ... the wide gap in the overall cost experience between chiropractic and medical patients cannot easily be dismissed even by skeptics of the chiropractic profession."9
In the United States, studies like these are leading private health care providers, insurers, managed care organizations, hospitals and other medical groups to incorporate or recommend chiropractic as part of their service offering. Indeed, spinal manipulation is now one of two treatment protocols given the highest recommendation for the treatment of neuromusculoskeletal conditions, particularly of the lower back, by the Agency for Health Care Policy and Research (AHCPR), an arm of the U.S. Department of Health and Human Services.10
Within North Carolina, health care administrators can experience similar positive financial impact as they continue to incorporate chiropractic care into their service offerings.
|
Spinal manipulation is now one of two treatment protocols given the highest recommendation for the treatment of neuromusculoskeletal conditions, particularly of, the lower back, by the Agency for Health Care Policy and Research (AJHCPR), an arm of the U.S. Department of Health and Human Services.10 |
The Journal of Manipulative and Physiological Therapeutics published an article in 1997 of 278 patients showing pain and functional improvement. See the graphic below
|