Costs and recurrences of chiropractic and medical episodes of low-back care.

OBJECTIVE: To compare health insurance payments and patient outcomes for recurrent episodes of care for nine common lumbar and low-back conditions initiated with chiropractic treatment vs. episodes initiated with medical treatment. DATA AND METHODS: Retrospective analysis of episodes constructed using 208 ICD-9-CM codes from 2 yr of insurance claims data for a large population of beneficiaries in the private fee-for-service sector. A total of 7077 patients were represented within 9314 episodes of care, of which 8018 episodes were initiated by clearly identified chiropractic or medical physicians. There were 1215 patients with initial physician or chiropractic-initiated episodes who had recurrent episodes. Outcome measures included total insurance payments, total outpatient payments, lengths of initial and recurrent episodes, consistent use of initiating providers for recurrent episodes and time lapsed between episodes. RESULTS: Total insurance payments within and across episodes were substantially greater for medically initiated episodes. Analysis of recurrent episodes as measures of patient outcomes indicated that chiropractic providers retain more patients for subsequent episodes, but that there is no significant difference in lapse time between episodes for chiropractic vs. medical providers. Chiropractic and medical patients were comparable on measures of severity; however, the chiropractic cohort included a greater proportion of chronic cases. CONCLUSION: Patients who "cross over" between providers for multiple episodes are more likely to return to chiropractic providers, which suggests that chronic, recurrent low-back cases may gravitate to chiropractic care over time. The findings from this and related studies point out the importance of appropriately operationalizing cost and outcome variables in analyses of care for conditions such as chronic and/or recurrent low-back pain.

Chiropractic and medical costs of low back care.

This study compares health insurance payments and patient utilization patterns for episodes of care for common lumbar and low back conditions treated by chiropractic and medical providers. Using 2 years of insurance claims data, this study examines 6,183 patients who had episodes with medical or chiropractic first-contact providers. Multiple regression analysis, to control for differences in patient, clinical, and insurance characteristics, indicates that total insurance payments were substantially greater for episodes with a medical first-contact provider. Most of the cost differences were because of higher inpatient payments for such cases. Analysis of recurrent episodes indicates that chiropractic providers retain more patients for subsequent episodes and that patient 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 payers to control health care spending. More research is needed, especially in developing alternative measures of health status and outcomes.

Further analysis of health care costs for chiropractic and medical patients.

OBJECTIVE: To compare the health care costs of patients who have received chiropractic treatment in insurance plans that do not restrict chiropractic or medical benefits with those treated solely by medical and osteopathic physicians. DESIGN: Retrospective statistical analysis of 2 yr of claims data on total insurance payments and total outpatient payments. OUTCOME MEASURES: Total insurance payments and total outpatient payments, each adjusted for sociodemographic characteristics. RESULTS: Patients receiving chiropractic care experienced significantly lower total health care costs as represented by adjusted third-party payments in the fee-for-service sector. Total adjusted cost differences ranged from $291 to $1722 over the 2-yr period. Total adjusted outpatient costs tended to be slightly lower for medical patients but lower hospital utilization for chiropractic patients more than offsets the additional outpatient costs associated with chiropractic care. CONCLUSIONS: The analysis of well-insured patients in plans that do not restrict the chiropractic benefit strengthens results previously reported. In this study, therefore, the favorable cost patterns for chiropractic patients cannot be attributed to insurance restrictions limiting reimbursement for chiropractic services relative to other services. Because adjustments for patient characteristics systematically reduce the cost advantages of chiropractic patients as compared to mean differences derived from unadjusted data, the results also demonstrate that adjusted values should be used for meaningful comparisons between the two groups of patients.

A comparison of health care costs for chiropractic and medical patients.

OBJECTIVE: To compare the health care costs of patients who have received chiropractic treatment for common neuromusculoskeletal disorders with those treated solely by medical and osteopathic physicians. DESIGN: Retrospective statistical analysis of 2 yr of claims data on various categories of utilization and insurance payments for a large national sample of patients. SETTING: Ambulatory and inpatient care. PATIENTS: A total of 395,641 patients with one or more of 493 neuromusculoskeletal ICD-9 codes. OUTCOME MEASURES: Hospital admission rates and 10 categories of insurance payments. RESULTS: Nearly one-fourth of patients were treated by chiropractors. Patients receiving chiropractic care experienced significantly lower health care costs as represented by third party payments in the fee-for-service sector. Total cost differences on the order of $1,000 over the 2-yr period were found in the total sample of patients as well as in subsamples of patients with specific disorders. The lower costs are attributable mainly to lower inpatient utilization. The cost differences remain statistically significant after controlling for patient demographics and insurance plan characteristics. CONCLUSIONS: Although work is in progress to control for possible variations in case mix and to compare outcomes in addition to costs, these preliminary results suggest a significant cost-saving potential for users of chiropractic care. The results also suggest the need to reexamine insurance practices and programs that restrict chiropractic coverage relative to medical coverage.

The growing role of chiropractic in health care delivery.

The number of U.S. chiropractors grew by two-thirds between 1978 and 1988, and new data show that more than 5 percent of Americans used chiropractic during a six-quarter period, spending an annual average of $411. As U.S. policymakers debate creation of standard or minimum benefit packages, these new findings may help to determine whether chiropractic meets the criteria of clinical efficacy and cost-effectiveness.

The chiropractic services market: a literature review.

This article surveys the economic literature on chiropractors. Chiropractors provide a substantial amount of care for those with various neuro-musculo-skeletal disorders and represent the fastest growing segment of the professional health services market. Yet the study of the profession has been neglected in the health services research literature. The goals of this article are to take stock of the existing literature and data sources. After providing background information, including recent developments in antitrust, I merge various data sources to assess the growth of expenditures for chiropractic care and the proportion of the population using this care. Other data sources and features are also described. I conclude with a discussion of the significance of further research on the profession to existing policy efforts to contain costs and improve health care delivery.