Table 4
Summary table for access and insurance papers.
| Name | Ref | Design | N/Np | Main results |
| Cleary-Guida | 71 | Phone survey | 70/43 (61%); NY, NJ, CT | Most insurers cover chiropractic, but to what level is not clear. |
| Metz | 72 | Analysis of claims data | 3,129,000 with DC coverage; 5,197,000 without | Cohorts with chiropractic coverage had a rate of 162 complaints per 1000 member years, compared to 171.3 per 1000 for the group without coverage; patients use chiropractic are as a direct substitute for medical care, and not an add-on. |
| Shekelle | 73 | Analysis of data from the RAND Health Insurance Experiment | Chiropractic care was sensitive to price; levels of coinsurance of 25% or more led decreases in chiropractic expenditures by 50% or more; free access to care increased chiropractic use. | |
| Gordon | 74 | Mail survey | 1996–15,777; 1999–15,985; CA | Chiropractic was the third most CAM used, at 9.8%, but this more than doubled when looking at CAM use for musculoskeletal problems, to 21%. |
| Stano | 75 | Analysis of claims data | 395,461 patients with appropriate ICD-9 codes | About 25% of patients were treated by chiropractors; those that did experienced lower health costs in the fee-for-serve sector, due to lower in-patient utilization. |
| Stano | 76 | Analysis of claims data | 434,763 | DCs were first contact providers for about 25% of all first episodes and 30% of all episodes. Costs for episodes with first medical contact were higher. |
| Lind | 78 | Analysis of claims data | 601,044/104,358 (17%) | 55% had at least one visit to a CAM provider; 65% of CAM visits were for LBP; 75% of visits for LBP were to chiropractors. |
| Thomas | 79 | Mail survey | 5010/2893 (58%) | 10.6% had sought care form at least 1 CAM provider; use declined in older age groups; chiropractic use in the last 12 months was 3.6%, but lifetime was 10.3%. Estimated total number of visits to chiropractors in the last year 7.48 million. |
| Phelan | 80 | Retrospective claims review | 43,650 | 85% of claims were treated solely by MDs, 1% by DCs and 5% by both. Average treatment cost for medical care was $3519, and $663 for DC care alone; the combined group amounted to $4425 for the MD and $748 for the DC. Time to discharge for those receiving medical care was substantially longer than for the chiropractic care. Average total costs for claims was far lower in the DC group compared to the MD group or the combined DC-MD group. |
| Arcury | 81 | Mail survey | 1059 | Herbs, teas and other edible/drinkable remedy rated highest; chiropractic was used by 6.7% of the population surveyed. |
| Gray | 82 | Mail survey | 5107/4404 (86%) | 42% used at least 1 CAM therapy; chiropractic was used by 8%, and of those, 90% reported positive results. |
| Sarnat | 83 | Analysis of claims data | 21,743 | When CAM is integrated with conventional medicine, there is a 43% decrease in hospital admissions, fewer outpatient surgeries and reduced drug costs. |
| Legoretta | 84 | Analysis of claims data | 700,000 with chiropractic benefits; 1,000,000 without | Those with chiropractic coverage had reduced annual costs compared to those without ($1463 vs. $1671); coverage led to a 1.6% decrease in total annual health costs. |
| Thomas | 85 | Mail survey | 1226/964 (79%) | 60% of those surveyed provided access to CAM; 21% offered CAM from another member of their team; 24% made referral to CAM practitioners (of which, 7.1% were referred to either a DC or a DO). |
| Hansen | 86 | Mail survey | 500/191 (38%) | 95% of those responding indicated satisfaction with chiropractic care. |
| Stewart | 87 | Comparison of benefit plans | 1091 | Only 1% of members used CAM during the study period, though the rate was higher in the PPO (1.2% compared to the HMO (0.6%). |
| Sawni-Sakand | 88 | Mail survey | 1013; pediatric | Herbs and prayer used most, but chiropractic used by 18% of the study population. |
| Wilson | 89 | Telephone survey | 1000/361 (36%); adolescents | 54% used at least 1 form of CAM; massage most common (13.7%), and chiropractic at 6.7%. |