How Chiropractic Helps the Insurance Industry
Report
suggests covering chiropractic care of neck and low back
pain increases value-for-dollar of health benefit plans.
By Peter W. Crownfield, Executive Editor
Insurance companies and others hesitant to expand coverage
of chiropractic care should review a copy of
a report commissioned by the Foundation for Chiropractic
Progress
and prepared by Mercer Health and Benefits, a San
Francisco-based human resources and financial advisor. The
report, "Do Chiropractic Physician Services for Treatment of
Low Back and Neck Pain Improve the Value of Health Benefit
Plans?" concludes that chiropractic care "is likely to
achieve equal or better health outcomes at a cost that
compares very favorably to most therapies that are routinely
covered in U.S. health benefit plans" and that covering
chiropractic services for neck and low back pain "will
likely increase value-for-dollar by improving clinical
outcomes and either reducing total spending (neck pain) or
increasing total spending (low back pain) by a smaller
percentage than clinical outcomes improve."
Study Parameters
Niteesh Choudhry, MD, PhD, assistant professor at Harvard
Medical School, and Arnold Milstein, MD, MPH, chief
physician at Mercer Health and Benefits, evaluated the
peer-reviewed literature and constructed an economic model
to estimate the likely impact of expanding chiropractic
coverage for neck and low back pain within U.S. health
plans, including the relative cost-effectiveness of coverage
of chiropractic physician services compared to coverage only
for medical physician services (medical doctors, osteopathic
doctors, physical therapists and others).
Dividing differences in total costs of care per episode of
care between chiropractic and other care modalities by
differences in their effectiveness provided the authors with
estimates of effectiveness measured in dollars per
quality-adjusted life years (QALY) units. According to the
report, estimates based on dollars per QALY units "are a
common currency for assessing the value of health care
interventions and thus facilitate the comparison of
chiropractic care for spinal disorders with other treatments
for these conditions as well as unrelated disorders."
To calculate unit prices payable by U.S. insurers for the
coverage of low back and neck pain care, the authors pulled
billing data from Mercer HealthOnline, which houses data for
more than 80 large employer-sponsored health plans covering
nearly 3 million members. Of note, prescription drug
expenditures were
not
included in the analysis; inclusion of said expenditures
presumably would have increased non-chiropractic costs of
care significantly.
Take-Home Points
§
Chiropractic care is widely used, with almost half of all
patients with persistent back pain seeking this form of
treatment.
§
"Chiropractic care is
more effective
than other modalities for treating low back and neck pain."
§
Chiropractic care for the treatment of low back and neck
pain "is
highly
cost-effective, represents a good value in comparison to
medical physician care and to widely accepted
cost-effectiveness thresholds."
§
"Insurance coverage for chiropractic physician care ... is
likely to drive improved cost-effectiveness of U.S. care."
§
These findings "support the value of health insurance
coverage of chiropractic care for low back and neck pain at
average fees currently payable by U.S. commercial insurers."
To download a complete copy of the Choudhry and Milstein
report, visit
www.f4cp.com/MercerReport.htm.
To review other recent study findings suggesting the
cost-effectiveness and clinical value of chiropractic care,
read "The Research You've Been Waiting for? (Aug.
26 issue)
and "Cost-Effective Care: The Evidence Mounts" (Sept.
9 issue).
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