Effects of Inclusion of a Chiropractic Benefit
on the Utilization of Health Care Resources
in Managed Health Care Plan

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Craig F Nelson, DC, MS, Doug Metz, DC,
Antonio Legorreta, MD, MPH, Thomas LaBrot, DC

Health Services Research Consulting

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Introduction:   Health insurance coverage for chiropractic care is restricted compared to most other health care services. A barrier to insurance plan coverage of chiropractic care is the lack of data regarding the effects of such coverage on overall health care utilization and costs. The study evaluates the effects of chiropractic coverage on selection (age, gender, comorbidities), total health care costs, rate of utilization of specific high-cost procedures, cost of management of specific NMS conditions, and whether chiropractic care is used as substitution care or add-on care.

Methods:   A four-year longitudinal study using administrative claims data compared 700,000 health plan members with chiropractic coverage to 1 million health plan members without chiropractic coverage. There are six distinct cohorts of patients that are evaluated and compared in this study:

Cohort A: Patients in health plans that do cover chiropractic care.
Cohort B: Patients in health plans that do not cover chiropractic care.

Cohort A1: Patients in health plans that cover chiropractic care who had any treatment for NMS conditions.
Cohort B1: Patients in health plans that do not cover chiropractic care who received medical treatment for their NMS conditions.

Cohort A1a: Patients in health plans that do cover chiropractic care who received chiropractic treatment for their NMS conditions.
Cohort A1b: Patients in health plans that do cover chiropractic care who received medical treatment for their NMS conditions.

Results:   Members with chiropractic coverage were younger (mean age = 33 vs. 36 years, p<0.0001) and less likely to have specific comorbid medical conditions (-<0.0d for six selected medical conditions) as compared to those without chiropractic coverage. Total health care costs for members with chiropractic coverage was 12% lower than plan members without coverage. Among all health plan members who were treated for NMS conditions, total health care costs were 13% lower among those with coverage compared to those without. The cost of treating episodes of low back pain was 28% lower in the group with chiropractic coverage, and the aggregate cost of back pain care per patient over the four-year period was 8% lower in the covered group. Back pain patients with chiropractic coverage had fewer inpatient stays than did those without chiropractic coverage (9.3 vs. 15.6 stays per 1,000 patients, p<0.001). The MRI rate was also lower for back pain patients with chiropractic coverage as compared to those without chiropractic coverage (43.2 vs. 68.9 MRIs per 1,000 patients, p<0.001). The rate of lower back surgery among patients with chiropractic coverage was lower as well (3.3 vs. 4.8 surgeries per 1,000 patients, p<0.001). Back pain patients with chiropractic coverage also received fewer radiographs (17.5 vs. 22.7 per 1,000 patients, p<0.001) than did back pain patients without chiropractic coverage. The data also demonstrate that most chiropractic care is substitution for medical care within the health plan.

Conclusion:   This study demonstrates that the inclusion of a chiropractic benefit in a managed health care plan results in a reduction in the overall utilization of health care resources, and thereby, cost savings. There are four mechanism that produce this cost reduction: 1. A favorable selection process; 2. A substitution effect of chiropractic care for medical care; 3. Lower rates of use of high cost procedures; 4. Lower cost management of care episodes by chiropractors.

CREDITS:   This article was provided by FCER, and has been submitted for publication to Archives of Internal Medicine. It will be presented as a poster presentation at the World Federation of Chiropractic's Congress, to be held in Orlando, Florida, on May 1-3, 2003.

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