title: The selection effects of the inclusion of a chiropractic benefit on the patient population of a managed health care organization.
abstract: OBJECTIVE
  The aim of this study is to measure the selection effects of the inclusion of a chiropractic benefit on a managed care health plan.
  
  
  METHODS
  An analysis of enrollment data from a managed care health plan over a 4-year period was conducted. Employers could select the managed care plan with or without a chiropractic care benefit. Comparisons of demographic and comorbid characteristics were made between employees who had the chiropractic benefit and those who did not, and between individuals who self-selected chiropractic care and those who self-selected medical care.
  
  
  RESULTS
  The cohort with chiropractic coverage was younger with fewer subjects in the older age group (>65 years; 6.5% vs 9.6%) and more subjects in the younger age group (0-17 years; 31.9% vs 26.2%). The mean age of the group with coverage was 32.9 compared with 35.5 in the group without coverage. Comparing self-selected chiropractic patients to self-selected medical patients, there were fewer subjects older than 65 years in the chiropractic group (4.9% vs 9.2%) and fewer subjects aged 0 to 17 years (9.4% vs 19.4%). In 6 of the 8 comorbid conditions studied, the rates were lower in the cohort with chiropractic coverage compared with the group without coverage. The rates of comorbid conditions in self-selected chiropractic patients were lower in all 8 categories compared with self-selected medical patients.
  
  
  CONCLUSIONS
  The inclusion of a chiropractic benefit in a health plan produces a modest favorable selection processes resulting in a slightly younger patient population with fewer comorbidities. At the level of patient self-selection, chiropractic patients are considerably younger and healthier than comparable medical patients.
authors.affiliation: American Specialty Health, San Diego, CA 92101, USA. craign@ashn.com
authors.forename: Craig F
authors.initials: CF
authors.lastname: Nelson
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Metz
authors.forename: Thomas M
authors.initials: TM
authors.lastname: LaBrot
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Pelletier
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002684:Chiropractic; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007342:Insurance Benefits; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010361:Patients / Q000706:statistics & numerical data*