Chiropractic and Health Care Reform: An Uncertain Future or an Opportunity?

The United States is currently experiencing a health care crisis. Much of the current health care system focuses limited resources on the treatment of disease, and very few resources are aimed at primary and secondary prevention. Although 70 percent of factors influencing health are environmental and behavioral, and only 10 percent of the factors attributed to health are associated with access to health care, the actual reimbursement for health services accounts for 96 percent of the $2.3 trillion spent each year.¹ Thus, we need to take a closer look at health care reform and how doctors of chiropractic will approach this changing landscape.

In March 2010, the Patient Protection and Affordable Care Act was law signed into law. The intention of the act is to put "in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans."² However, it is not exactly clear how this will be done or if the promised goals will be met, especially during this time of reduced funding and economic crises.

Chiropractic is one of the largest complementary and alternative medicine professions, and one of the largest licensed health care professions in the United States.^3-4 It is considered to be a holistic and wellness-oriented profession, traditionally not using drugs or surgery to help patients maintain health. Care typically incorporates wellness, lifestyle and prevention approaches with patient management, and focuses on the body's natural ability to heal itself. Services provided by doctors of chiropractic have demonstrated high patient satisfaction, cost-effectiveness and parity compared to other types of care for similar conditions.

For these and other reasons, the chiropractic profession has much to offer health care reform. However, for the most part, the profession appears to have been marginalized in the health care reform process up to this point in time. It is important for all stakeholders that the chiropractic perspective be represented and that chiropractic leaders and practitioners be participants in health care reform.

At present, the direction of health care reform is still being determined. The chiropractic profession can become more involved and contribute in a positive way as health care reform moves forward. One way to be more involved is to participate in the American Public Health Association (APHA). In March 2011, the APHA held a midyear meeting to focus on health care reform. More than 600 public health practitioners attended the meeting to learn how the Affordable Care Act will impact public health, wellness and prevention. Attendees participated in workshops and presentations including enlightening discussions of topics like fiscal repercussions, technology, legal challenges, roles of policy-makers, and communication.

As representatives of the Chiropractic Health Care (CHC) section, we attended the APHA midyear meeting and developed a report in response to a request from the top leadership of the APHA. The invitation for us to attend demonstrates that chiropractors can be involved in national public health, have the opportunity to do something about health care reform, and have established the credibility to merit a seat at the table as an active participant in the field of public health. The report generated by the CHC from that meeting provides a summary of the meeting and materials related to how the chiropractic profession can be a positive contributor to health care reform. The overall themes in this report include:

• The current health care reform environment is complex and better communication is needed.
• There is a need to develop educational materials to better inform chiropractic leaders and doctors in the field about current health care reform.
• There is a need to develop a strategy for the chiropractic profession to improve collaboration with other entities.
• There is a need to develop an action plan to better communicate with all constituents (policy-makers, doctors of chiropractic, other health care and public health providers, and community leaders, patients) to help engage people in the process and disseminate information about health care reform as it relates to the chiropractic profession.

The aim of the CHC summary report is to facilitate the current dialogue and help better inform the APHA Chiropractic Health Care members and the chiropractic profession about incorporating needed strategies from this meeting. To view the complete report and for more information about the CHC section, please visit the APHA-CHC Web site.

The CHC is looking for those in the chiropractic profession who would like to participate and make a difference in how chiropractic is represented in health care reform. We invite you to join the chiropractic public health community. If you are already a member of the American Public Health Association's Chiropractic Health Care section, you know how important the relationship is between public health and chiropractic. If you are not currently a member, consider joining and becoming active in this exciting organization. For further information on participating in the public health effort by joining APHA, click here.

References

1. Valdovinos E, Srikantharajah J, Pañares R, et al. "Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention." The Prevention Institute, 2011.
2. Understanding the Affordable Care Act. Full text, key features and more. Available on Healthcare.gov.
3. Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine, 2002;136:216-227.
4. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Outlook Handbook, 2010-11 Edition: Chiropractors.