The effect of acupuncture utilization on healthcare utilization.
OBJECTIVE
To determine whether acupuncture is a complement to or substitute for various medical services.


METHODS
This study used managed care claims data from a midsize metropolitan insurance company from 2002. Zip code level data from the 2000 US Census was also incorporated. The original dataset contained medical and drug claims data for every eligible acupuncture user (n = 1688) and every 18th eligible nonacupuncture user (n = 16,282) covered by the data provider.


METHODS
Simultaneous equations models with an exclusion restriction were used in this cross-sectional study. The influence of acupuncture utilization was assessed independently on each conventional service of interest, controlling for numerous clinical and demographic characteristics. Bivariate probit models were estimated using distance to the nearest acupuncturist as the exclusion restriction.


RESULTS
Acupuncture was a statistically significant (P < 0.05) substitute for primary care, all outpatient services, pathology services, all surgery, and gastrointestinal medications. Acupuncture seemed to complement numerous therapies, particularly chiropractic and physical therapy; however, acupuncture did not statistically significantly complement any therapies after controlling for unobservable characteristics that influence the use of acupuncture and/or conventional medicine.


CONCLUSIONS
Acupuncture is an economic substitute for some medical services and pharmaceuticals, a finding of some importance to insurers, healthcare practitioners, and policy makers. The fact that acupuncture has an effect on other medical services needs to be explored more fully with an emphasis on how this substitution impacts patient health.
Bonafede
Machaon
M
Department of Pharmacy Practice, Albany College of Pharmacy, Research Institute for Health Outcomes, Albany, New York 12208, USA. bonafedm@acp.edu
Dick
Andrew
A
Noyes
Katia
K
Klein
Jonathan D
JD
Brown
Theodore
T
D015670:Acupuncture Therapy / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005252:Fees, Pharmaceutical; D005260:Female; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D014481:United States