Comparative Analysis of Individuals with and without Chiropractic Coverage

Perhaps the best comparative evidence on medical and chiropractic health care costs for a full scope of chiropractic practice appears in two studies by Stano and Smith, US health economists, analyzing records from the Michigan Health Benefits consulting firm MedStat Systems Inc. At that time MedStat monitored coverage for 2 million patients across the US. Analysis are for the 2 years period July 1988 to June 1990 and:

1. The studies look at chiropractic and medical use and costs for various conditions in patients who were equally free to choose medical or chiropractic care for these conditions under the terms of their employment health benefits plans. The entire claims history and all costs for these patients were known.
2. After analysis to ensure matching populations in all material respects the study group was 7.077 patients.
3. Medical care costs were significantly higher. For the back and sacroiliac disorders including disc degeneration and sciatica, medical payments were 47% higher for outpatient care, 61% higher for total care.
4. In 2004 Antonio Legorreta, MD MPH, from the School of Public Health, University of California, Los Angeles and colleagues presented a four year claims data analysis for approximately 1.7 million members of a large regional managed care network in California. This study, much larger than any previous one, addressed clearly for the first time the question of whether insured chiropractic benefits, even if potentially cost-effective, would actually be used as a substitute for medical services by patients who could choose either. Would there be substitution of services, or would chiropractic services simply end up as an addition to total services and costs?

This could be determined because all 1.7 million members had a plan with identical services, but 700.000 members also had access to a chiropractic benefit. It was found:

• Virtually all chiropractic services used by plan members with access to them were used in direct substitution for medical services.
• This applied not only for back pain but for all conditions seen by chiropractors.
• A large number of those with access to medical and chiropractic benefits were willing to choose, and did choose, chiropractic care. Of those with NMS (neuro-muscular-complaints), 34.4% or approximately 1 in 3 used chiropractic care. For back pain, both uncomplicated and complicated, 45,9% or nearly half chose chiropractic care.
• The 700.000 patients with the added chiropractic benefit had significantly lower claims costs per person than the other 1 million, not only for back pain and NMS (Neuro-Muscular Symptoms) problems, but also for total health care costs. At the most conservative estimate the overall annual saving was $ 16 million.

With back pain, for example, the savings in the 700.000 cohort with chiropractic care available were:
Overall cost reduced by 28%
Reduced hospitalization of 41%
Reduced back surgeries of 32%
Reduced cast of medical imaging, such as x-rays or MRI’s, of 37%.
These figures actually underestimate the savings achieved, as overall cost do not include medications since that data was not captured.

( Doctors of Chiropractic and CAM oriented MD’s are PCPs – primary care providers)

Sources: Stano M, Smith M, (1996). Chiropractic and Medical Costs For Low-Back Care 34: 191-2004.
Smith M, Stano M. (1997). Cost and Recurrences of Chiropractic And Medical Episodes Of Low-Back Care, J. Manipulative Physiol Ther, 20:5-12.
Legorreta AP, Metz RD, Nelson CF et al. (2004) Comparative Analysis of Individuals with and Without Chiropractic Coverage, Patient Characteristics, Utilization and Costs, Arch Intern Med 164:1985-1992.