One of the reasons many companies are hesitant to include coverage for services such as chiropractic is the claim that inadequate scientific data verify the effectiveness of these forms of care. A new study published in the Archives of Internal Medicine,1 combined with the results of a survey conducted by the Kaiser Family Foundation,2 may finally put an end to the question of how chiropractic affects the cost of health care, and whether it is more effective than traditional medical procedures for the treatment of back pain.
"Prior to this, no study had ever linked chiropractic benefits to lower utilization levels in a real-world employee setting," commented Douglas Metz, DC, a co-investigator on the Archives paper. "Our study shows that systematic access to managed chiropractic care may prove to be not only clinically beneficial, but can reduce key cost factors that drive up employer health costs in traditional care settings."3
The Archives study was sponsored by American Specialty Health Plans (ASHP) - an organization that offers coverage for alternative health care providers such as chiropractors, acupuncturists and massage therapists, which is added to traditional insurance policies - and was conducted by Health Benchmarks, an independent health services research organization. Health Benchmarks reviewed four years of claims data on back pain from two groups: one group of 700,000 health plan members with chiropractic care coverage, and a second group of 1 million members who were in the same health plan as the first group, but who had no chiropractic coverage. Aside from chiropractic care, patients in both groups had access to the same physician network; the same rules on referral to specialty care, diagnostic tests, and hospital and surgery approval; and the same exclusions and limitations.
The analysis found wide discrepancies in health care costs for patients with and without chiropractic coverage:
| Percentage of covered workers in conventional, HMO, PPO and point-of-service plans with chiropractic benefits by firm and size, 1999-2004.* | ||||||||||||
| 1999 | 2000 | 2002 | 2004 | |||||||||
| Firm/plan Firms | Small Firms | Large Firms | All Firms | Small Firms | Large Firms | All Firms | Small Firms | Large Firms | All Firms | Small Firms | Large Firms | All Firms |
| Conventional plans | 80% | 89% | 86% | 80% | 76% | 77% | 83% | 78% | 79% | 88% | 91% | 90% |
| HMO plans | 43% | 73% | 68% | 57% | 79% | 74% | 58% | 75% | 72% | 65% | 83% | 78% |
| PPO plans | 71% | 92% | 86% | 79% | 91% | 88% | 75% | 89% | 85% | 87% | 95% | 92% |
| Point-of-service plans | 61% | 87% | 79% | 71% | 86% | 81% | 59% | 86% | 76% | 68% | 90% | 82% |
| * The 2001 and 2003 Kaiser Family Foundation surveys did not examine chiropractic as a benefit. | ||||||||||||
"In our study population of 0.7 million members who had chiropractic coverage in the medical plan, we estimated an annual reduction of approximately $16 million as a result of lower utilization of higher costs," the investigators observed. They added that the cost-savings "appear to more than offset the amount spent to cover the associated costs of the chiropractic benefit."1
"Focusing on low back pain diagnoses that were selected specifically for comparability between medical and chiropractic practice, our analysis found that patients with chiropractic coverage had significantly lower rates of use of resource-intensive technologies, such as X-ray examinations, MR image, and surgery, and lower use of more expensive patient care settings, such as inpatient care," they continued. "This is reflected in the significantly lower cost, at both the episode level and the patient level, of providing care for back pain."1
Making Strides in the Insurance Setting: Latest Survey Highlights Growth in Employer Coverage of Chiropractic
Recent studies suggest that the percentage of companies offering health insurance for employees has decreased over the past few years. The latest estimates show that only about 60 percent of adult workers in the U.S. receive health benefits through their employer. There are a variety of reasons for this decline, including drastic increases in insurance premiums, which have risen as much as 59 percent since 2000.
During the same time frame, as complementary and alternative medicine (CAM) has moved closer toward the mainstream of health care, employers have begun to recognize the benefits some forms of CAM have to offer, and have started to integrate these therapies into their existing insurance plans. The latest example of this trend is featured in a survey released by the Kaiser Family Foundation and Health Research and Educational Trust. The survey, published in September 2004, revealed that employer coverage for chiropractic care increased 8 percent from 2002 to 2004, making chiropractic the most-covered CAM therapy for American workers with health benefits.
The survey included 3,017 randomly selected public and private firms (with three or more employees) that responded to a telephone survey containing up to 400 questions. The survey included questions on insurance costs, coverage, eligibility, health plan choice, covered benefits, and other factors. In addition, all firms were asked whether they offered or contributed to a health insurance program as a benefit to employees.
Among the survey's findings:
"There are some employers out there who are saying, 'No new benefits of any type,' said George DeVries, chief executive officer of ASHP. "But there are many employers who are saying, 'Adding a low-cost (benefit) actually helps us in a time when we're increasing deductibles and co-pays and co-insurance."4
As the Kaiser survey and the Archives of Internal Medicine study show, insurance providers and employers are beginning to realize what the chiropractic profession has known for decades. The Archives study provides one of the first real comparisons between patients who have insurance coverage for chiropractic and those who don't, and reveals what kind of effect chiropractic coverage (or the lack thereof) can have on costs of care and patient well-being. The Kaiser survey, meanwhile, shows that some insurance companies are moving forward and giving patients what they want: health care coverage that provides chiropractic and other viable alternatives to more "traditional" - and costly - forms of medicine. In a sense, the Archives study supports the findings of the Kaiser report, confirming the decision by many firms to offer chiropractic as a covered benefit in their insurance plans.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
