Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs.
BACKGROUND
Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations. This study ascertains the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system.


METHODS
A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit.


RESULTS
Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year, P<.001). Having chiropractic coverage was associated with a 1.6% decrease (P = .001) in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs (17.5 vs 22.7, P<.001), low back surgery (3.3 vs 4.8, P<.001), hospitalizations (9.3 vs 15.6, P<.001), and magnetic resonance imaging (43.2 vs 68.9, P<.001). Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001).


CONCLUSIONS
Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.
Department of Health Services, UCLA School of Public Health, Los Angeles, Calif, USA. alegorreta@healthbenchmarks.com
Antonio P
AP
Legorreta
R Douglas
RD
Metz
Craig F
CF
Nelson
Saurabh
S
Ray
Helen Oster
HO
Chernicoff
Nicholas A
NA
Dinubile
D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000191:economics / Q000628:therapy*; D002140:California; D002648:Child; D002675:Child, Preschool; D002684:Chiropractic / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007342:Insurance Benefits / Q000191:economics*; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies