Spending More, Feeling Worse

As the cost of health care continues to spiral beyond what the United States can afford, one has to wonder when it will stop being a political issue and start being an economic one. When will the cost of unnecessary, less-effective care be so great that politicians stop listening to the medical / drug /insurance / surgical-device lobbyists and start doing the math?

The research has already been published. The handwriting is already on the wall. All we need now is a cure for our national myopia. Here are three studies you should be aware of, particularly as you talk with your patients. These are not chiropractic studies, but they are powerful, just the same:

Spine Costs Rise, Health Status Stays the Same

"Expenditures and Health Status Among Adults With Back and Neck Problems."¹ This study appeared in the Journal of the American Medical Association in 2008. The authors looked at the cost of "inpatient, outpatient, emergency department, and pharmacy expenditures related to back and neck problems in the United States from 1997 through 2005 and [examined] associated trends in health status." They discovered that "total estimated expenditures among respondents with spine problems increased 65% (adjusted for inflation) from 1997 to 2005, more rapidly than overall health expenditures."

While a 65 percent increase in medical costs for spine care in only eight years is certainly bad news, that's not the worst of it. The study also determined that "self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997." (emphasis added) Their conclusion after looking at the data: "These spine-related expenditures have increased substantially from 1997 to 2005, without evidence of corresponding improvement in self-assessed health status."

More Drugs, Higher Hospital Costs

"Trends in Health Care Expenditures, Utilization, and Health Status Among U.S. Adults With Spine Problems."² This study, published in Spine a year later, builds on the one above, but zeros in on which of the expenditures caused the greatest increase in the cost of spine care. What the authors found will not surprise you: "From 1997 to 2006, the mean adjusted per-user expenditures were the largest component of increasing total costs for inpatient hospitalizations, prescription medications, and emergency department visits, increasing 37% (from $13,040 in 1997 to $17,909 in 2006), 139% (from $166 to $397), and 84% (from $81 to $149), respectively."

So it's easy for even the most naïve politician to see why this country is paying so much for spine care that leaves patients in poorer health. In a nine-year period, we had a 37 percent increase in average per-user expenses for hospital costs (including surgery), an 84 percent increase in average per-user emergency-room costs and a whopping 139 percent increase in average per-user drug costs. Need we say more?

Ineffective Spine Surgeries

"Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy."³ Just in case anyone misses the point regarding the lack of effectiveness of most spine surgeries, here is a classic study, again from Spine. The investigators looked at the "differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program."

Again, not surprisingly, they found that "compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery." (emphasis added)

Think how much more effective this study would have been had the researchers compared chiropractic instead of PT. Even so, adding surgery to physical therapy offered no benefit for the patients, and probably introduced side effects and the potential for additional surgery – generating additional revenue for the insurance company, hospital, surgeon and surgical device manufacturer(s).

It's easy to see from the above that the scientific literature already contains the necessary data to give politicians a platform to make better choices when it comes to how we spend our health care dollars. But because of the intricacies of our current health care model, making these changes will be similar to making a U-turn with a dual-trailer semi truck in a blind alley: there will be a lot of back-and-forth before we see much progress. However, if we begin to educate our patients, they can help enable their legislative representatives to make choices that benefit people, rather than special interests. Grassroots opinion combined with economic crises can be very powerful.

References

1. Martin BI, Deyo RA, Mizra SK, Turner JA, et al. Expenditures and health status among adults with back and neck problems. JAMA, 2008:299:656-664.
2. Martin BI, Turner JA, Mizra SK, Lee MJ, et al. Trends in health care expenditures, utilization and health status among US adults with spine problems, 1997-2006. Spine, 2009;34:2077-2084.
3. Peolsson A, Söderlund A, et al. Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up. Spine, 2013:38:300–307.

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