Utilization and expenditures on chiropractic care in the United States from 1997 to 2006.

OBJECTIVE: To investigate national utilization and expenditures on chiropractic care between 1997 and 2006. DATA SOURCE: The nationally representative Medical Expenditure Panel Survey (MEPS). STUDY DESIGN: We performed descriptive analyses and generated national estimates from data obtained from U.S. adult (>or=18 years) MEPS respondents who reported having visited a chiropractor (annual sample size between 789 and 1,082). For each year, we examined the estimated total national expenditure, the total number of U.S. adults who received chiropractic care, the total number of ambulatory visits to U.S. chiropractors, and the inflation-adjusted charges and expenditures per U.S. adult chiropractic patient. PRINCIPAL FINDINGS: The total number of U.S. adults who visited a chiropractor increased 57 percent from 7.7 million in 2000 to 12.1 million in 2003. From 1997 to 2006, the inflation-adjusted national expenditures on chiropractic care increased 56 percent from U.S.$3.8 billion to U.S.$5.9 billion. Inflation-adjusted total mean expenditures per patient and expenditures per office visit remained unchanged. CONCLUSION: The large increase in U.S. adult expenditures on chiropractic care between 1997 and 2006 was due to a 57 percent increase in the total number of U.S. adult chiropractic patients that occurred from 2000 to 2003. From 2003 to 2006, the total number of U.S. adult chiropractic patients has remained stable.

States facing interests: struggles over health care policy in advanced, industrial democracies.

Given alarming fiscal imperatives, states and interests in all advanced industrial democracies have struggled over health care policy. I explore the interface between state autonomy in health care policy and the political mobilization of provider interests, especially physicians. Evidence from Germany, Japan, Canada, and Great Britain suggests that, longitudinally, policy makers everywhere have tried to increase state autonomy in health care, and this has generally triumphed over even effectively mobilized providers. The countries that have most successfully restrained the growth of health care expenditures--while still providing ready access to relatively high-quality care--are those where states have most actively restrained both demand- and supply-side system interests in policy making. In each country, states have increasingly articulated their own greater capacities in health care policy, pushed to do so by the imperatives, especially fiscal, embedded in the policy domain.

[Unconventional medical procedures--a contribution to cost control?]. / Unkonventionelle medizinische Verfahren--ein Beitrag zur Kostendämpfung?

Firstly, it is explained that doctors, in accordance with the "Bundesmantelvertrag" and the so-called "Wissenschaftsklausel" of private insurance companies, are required to attend to cost-saving treatment and prescriptions, and that these regulations are also valid with regard to unconventional medical methods and medications. Further, it is exemplified by quotations, how some adherents of unconventional methods assert excessive pretension towards the general public as well as in medical periodicals. Accordingly, high fees are asked, which is also illustrated by some examples. Finally, users as well as non-users of disputed medical methods are called upon to occupy themselves more intensively with these problems and not to leave their solution to insurance bodies and the courts.