Chiropractic care is the largest drugless healing profession in the United States and the world. It has offered the benefits of a conservative and natural method of healing without the use of drugs or surgery for over 100 years. Chiropractic practitioners are licensed in all 50 states with recognition by the Federal Government in the Medicare, Medicaid and Workmen`s Compensation programs. There are approximately 50,000 Doctors of Chiropractic (D.C.`s) in the United States with 12.5 million citizens availing themselves of their care over the course of a year.
The basic premise of Chiropractic is that proper nerve supply is needed to regulate body function. A disturbance of the nervous system may cause disease. Derangement of the musculoskeletal structure (primary the spine) may disturb nerve function. Thus, loss of normal alignment may result in nerve dysfunction causing not only back and neck pain but a wide variety of non-spinal disorders. The Chiropractor adjusts (corrects) the spinal displacement, restoring proper nerve function, allowing 100% expression of health.
Both laboratory research and clinical assessment studies through the years find Chiropractic care to be both clinically effective and financially efficacious for care of numerous health concerns that can range from neck and lower back problems to individual body system functions. An expanding number of individual case studies to beneficial effects of chiropractic care on many aspects of health and wellness.
Chiropractic Care Reduces Total Health Care Costs
Research shows that patients receiving chiropractic care have significant lower total health care expenses than those individuals who go strictly to M.D.`s. MEDSTAT Systems Inc., a health care information company, compiled a database of 396,000 patients including 93,000 who had gone to Doctors of Chiropractic. Review of this data showed that over a 2 year period patients served by chiropractors had $1,000 less in total medical insurance payments than those going strictly to medical physicians. It also reports that broader coverage of chiropractic services results in dramatically lower health care costs; for example, 35% lower hospital admission rates, 42% lower inpatient payments, and 23% lower total health care costs. It was also found that reduced utilization of prescription drugs in chiropractic patients showed monetary savings. MEDSTAT confirms the D.C. hypothesis that chiropractic care tends to substitute for other forms of outpatient and inpatient care.
M. Sano, Ph.D. "J. Manip. Physiological Therapeutic"
June 93, A Comparison of Health Care Cost for
Chiropractic & Medical Patients
Further Analysis of Health Care Costs For Chiropractic and Medical Patients
The analysis of well-insured patients in plans that do not restrict the chiropractic benefit strengthens results previously reported. In this study, therefore, the favorable cost patterns for chiropractic patients cannot be attributed to insurance restriction limiting reimbursement for chiropractic services relative to other services. Because adjustments for patient characteristics systematically reduce the cost advantages of chiropractic patients as compared to mean differences derived from unadjusted data, the results also demonstrate that adjusted values should be used for meaningful comparison between the two groups of patients.
J. Manipulative Physiological Therapeutic 1994 Sept;17(7): 442-446
Comparative Analysis of Individuals with and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
A 4 year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P,.001). The authors concluded: "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."
Arch Intern Med 2004, October11;
Cost-Effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain
Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic low back pain (LBP). Chiropractic and medical care performed comparable for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain.
J. Manipulative Physiol Ter 2005 (October) 28(8): 555-563
The largest HMO in the Southeastern United States conducted a study of 100 patients it sent to chiropractor, Mark Silverman. Eighty patients in this group were "medical failures" seeing an average of 16 M.D.'s without results. Twelve were diagnosed as needing disc surgery. After receiving chiropractic adjustments 86% of the entire group were corrected. All 12 of the disc problems were corrected without surgery. None were made worse. The medical doctor at the AV Med. who conducted the study, concluded that Chiropractic saved the HMO $250,000 and kept it from operating at a loss. This figure dosen't include pain, suffering and medical complication.
Herbert Davis, M.D., AV Med HMO, Miami FL 1982
In the Group Health Cooperative, a Seattle HMO, a research project showed a high level of patient satisfaction with chiropractors when compared to M.D.'s. D.C.'s were given a 3:1 advantage in: patient satisfaction to care, doctor concern for patient and doctor confidence in diagnosis. Chiropractic patients also reported quicker recoveries from their illnesses than the average.
March 89 Western Journal of Medicine
JFK, a Chicago hospital, studied low back pain in orthopedic wards and found that patients who utilized chiropractic care were released, on average, one week before those who did not receive any chiropractic care. (Lutheran General Hospital) The chiropractic patients leaving pain-free in 5-7 days compared to the 14 days for the others.
P. Frietaga: U.S. District Court of Northern Illinois, Eastern Division, May 1987
Clinical and Cost Outcomes of an Integrative Medicine IPA
Analysis of clinical and cost outcomes on 21,743 member months over a 4 year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame.
J. Manipulative Physiol Ther 2004, June 27(5): 336-347
Effects on Inclusion of a Chiropractic Benefit on the Utilization of Health Care Resources in Manage Health Care Plan
A 4 year longitudinal study using administrative claims data compared 700,00 health plan members with chiropractic coverage to 1 million health plan members without chiropractic coverage. This study demonstrates that the inclusion of a chiropractic benefit in a managed health care plan results in a reduction in the overall utilization of health care resources, and thereby, cost savings. There are four mechanisms that produce this cost reduction:
1. A favorable process,
2. A substitution effect of chiropractic care for medical care;
3. Lower rates of use of high cost procedures;
4. Lower cost management of care episodes by chiropractors.
Craig F. Nelson, D.C., M.S.
Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain
For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care and plain-film radiographs. This effect was greater on a per-episode basis than on a per-patient basis.
J. Manipulative Physiol. Ther 2005, October 28(8): 564-569
Workmen`s Compensation Savings
Numerous workmen`s compensation studies point out the cost-effectiveness of chiropractic care in the injured work setting:
The Texas Study
In 2002, the Texas Chiropractic Association (TCA) commissioned an independent study to determine the use and effectiveness of chiropractic with regard to worker`s compensation, the results of which were published in February. According to the report, Chiropractic Treatment of Worker`s Compensation Claimants in the State of Texas, chiropractic care was associated with significantly lower costs and more rapid recovery in treating workers with low back injuries. They found: Lower back and neck injuries accounted for 38 percent of all claims costs. Chiropractors treated about 30 percent of workers with lower back injuries, but were responsible for only 17.5 percent of the medical costs and 9.1 percent of the total costs. These findings were even more interesting: The average claim for a worker with a low-back injury was $15,884. However, if a worker received at least 75 percent of his or her care from a chiropractor, the total cost per claimant decreased by nearly one-fourth to $12,202. If the chiropractor provided at least 90 percent of the care, the average cost declined by more than 50 percent to $7,632.
The Utah Study
A 1991 study of workers` compensation claims comparing medical care to chiropractic care and reported in The Journal of Occupational Medicine collated 3,062 separate injury cases for conditions with identical diagnostic codes. The sample studied 40.6% of the 7,551 estimated back injury claims from the 1986 Worker`s Compensation Fund of Utah.
This study, like many others reviewing the shorter disability and lower costs for patients under chiropractic care for various health concerns, showed dramatic differences in chiropractic efficacy in comparison with medical management for the same condition. In fact, the number of workdays lost under medical care was nearly ten times higher than for those receiving chiropractic care.
This study also examined cost comparisons between medical an chiropractic providers for back-related injuries with identical diagnostic codes. If found compensation costs for work time lost were only $68.38 for patients who received chiropractic care compared to $668.39 for medically managed patients receiving standard, non-surgical medical treatment.
This comparison study also found that chiropractic patients return to work ten times sooner after an injury-at ten times less cost. The researchers reported "for the total data set, cost for care was significantly more for medical claims and compensation costs were ten-fold less for chiropractic claims.
Journal of Occupational Medicine, Kelly Jarvis, DC, 1991, 33,8:847-852
The 1997 Utah Study
A 1997 study of injured workers in the Utah Worker Compensation Fund published in the Journal of Manipulative Physiological Therapy, also favorably contrasted the cost of care by chiropractors in a managed care pre-authorization system with the comparatively escalated costs of treatment by medical physicians.
This retrospective review of 5,000 claims from 1986 and 1989 of injured workers found that costs of cases managed by chiropractors increased only 12% between 1986 and 1989, while the costs of treatment in cases managed by medical physicians increased 71%. In the same time period, compensation costs (wage replacement) only increased 21% for the chiropractic group, while there was a 114% increase for the medical group.
Journal of Chiropractic Medicine
Jarvis KB, Phillips RB & Danielson C
Oregon and California Studies
Studies in Oregon and California also showed that Chiropractic was able to return people back to work at 1/2 the time at 1/2 the costs than allopathic medicine.
California Worker`s Compensation Records, Richard Wolf, MD, 1972
Oregon Worker`s Compensation Records, Rolland Martin, MD, 1971
The Richmond Study
A comparison of costs of chiropractors versus alternative medical practitioners conducted in 1992 summarized its extensive economic analysis with the finding that "chiropractic care is a lower cost option for several prominent back-related ailments." It concludes that "if chiropractic care is insured to the same extent as other specialties, patients with certain conditions seeking chiropractic care as a first option could very well result in a decrease in overall treatment costs."
University of Richmond, VA
DH Dean and RM Schmidt, January 13, 1992
The Virginia Study
This extensive study of mandated health insurance and chiropractic coverage concluded that while chiropractors may see their patients more frequently in certain clinical cases, their care has lower overall costs for many conditions. The study evaluated multiple parameters of cost and effectiveness that repeatedly demonstrated chiropractic care provides important therapeutic benefits at economical costs. These multiple benefits did not produce any notable increase in the costs of health insurance.
The report concludes that mandating chiropractic care into health insurance coverage provisions would not increase but instead potentially reduce them.
The College of William and Mary
LG Schifrin, January 1992
The Nevada Study
A Nevada Work Comp. Study (covering the 1988-1990 period) found that the average individual cost for Medicare was $2,142 compared to $892 per chiropractic case. That`s a 260% cost difference with loss time 1/3 less for the chiropractic cases. It also found that chiropractic eliminates the concern of unnecessary surgery (found in 17% of cases reviewed), inappropriate hospitalization (found in 22% of the time) improper use of medication (23%) and high utilization of narcotic analgesics.
Nevada State Industrial Insurance Systems
The Florida Study
This major 1988 study examined 10,652 closed cases of patients with back related injuries who were covered by Florida`s workers` compensation law, comparing chiropractic case management with standard medical case management. The results indicated that the duration of temporary total disability was 58.8 percent lower for the chiropractic care. In addition, 52.2 percent of all medical patient claimants were hospitalized compared to only 20.3 percent of chiropractic patients.
Foundation for Chiropractic Education and Research,
S.Wolk, Arlington VA, September 1988
The North Carolina Study
Average cost of treatment, hospitalization, and compensation payments were higher for patients treated by MDs than for patients treated by DCs. Average number of lost workdays for patients treated by MDs was higher than for those treated by DCs. Combined care patients generated higher costs than patients treated by MDs or DCs alone.
J. Manip. Physiological Therapeutic, June 2004
Additional studies in Kansas and Iowa also point out why Chiropractic care should be integral in the work compensation arena.
The RAND Study
The RAND Corporation, one of the largest on-university health sciences research programs in the country, prepared a comprehensive report in 1991 on The Appropriateness of Manipulation for Back Pain. The report discusses findings from a multi-disciplinary group of back pain experts evaluating spinal manipulation. Two RAND panels-one panel of only chiropractic experts and one panel using a mixed group of medical and chiropractic experts-determined that spinal manipulation is an appropriate approach for many patients with low-back pain.
A second independent multidisciplinary report from RAND titled The Appropriateness of Manipulation and Mobilization of the Cervical Spine, published in 1996, supports the reviews of effectiveness of manipulation and mobilization with a report on ratings by an expert panel on appropriateness of cervical manipulation for specific conditions. The panel found that cervical manipulation is far safer than "a number of medical treatments" given for analogous symptoms. The report also determined that manipulation is appropriate for many common categories of neck pain and headache.
RAND/R-4025/1-CCF/FCER, Santa Monica, CA, 1991
RAND/R-4025/2-CCR/FCER, Santa Monica, CA, 1991
RAND/MR-781-CCR, Santa Monica, CA, 1996
The Federal AHCPR Study
A landmark federal study, conducted by the Agency for Health Care Policy and Research of the U.S. Department of Health and Human Services, published their assessment and treatment guidelines in 1994 with the conclusion that chiropractic spinal adjustments are a recommended and effective form of treatment for acute low back problems in adults.
This study validates spinal adjustments as a highly effective form of care and concludes that conservative chiropractic care should be pursued prior to any surgical procedures or prescription drugs. In addition, the study conclusions specifically recommend against procedures such as surgery and prescription medication for acute low back problems.
HCPR Publication No 95-0642 Clinical Practice
Guideline Number 14 Rockville MD, December 1994
The CHAMPUS Report
A comprehensive evaluation of the relevant professional literature collected between 1930 and 1981 examined 18 randomized clinical trails involving chiropractic care that all met the strict research specifications delineated by the Midwest Research Institute. This document noted that, clinically, there was "greater mobility following manipulation" and also "improved lateral flexion and rotation." In addition, this report found that "manual therapy was superior to placebos" and that "the duration of treatment was shorter for the manipulated groups."
This literature review also found that "numerous case studies throughout the literature report the satisfaction of chiropractic patients with the outcome of treatments."
OCHAMPUS;24, January 1986
Annals of Internal Medicine Article
The article on "Spinal Manipulation for Low-Back Pain" published in 1992 in the third widest-read medical journal in America, reviewed the efficacy of spinal manipulation for low-back pain. The article reported that spinal manipulation was efficacious, and repeatedly found that spinal manipulation was very helpful to patients with acute low-back pain. It specifically called for more research to evaluate the beneficial effects of chiropractic.
P Shekell, A Adams, Annals of Internal Medicine
Chiropractic has been recognized throughout the world as an effective cost savings alternative to standard allopathic medicine.
British Medical Journal
Research in the "British Medical Journal", June 1991, stated that for low back pain, Chiropractic care is more effective (up to 2:1) than hospital based care. Inclusion of Chiropractic care in their National Health Service would save their country $31 million.
British Medical Research Council
TW Mead, FRCP, 1990
An extended follow-up research study published in 1995 in the "British Medical Journal" found chiropractic care achieves superior results as compared with standard hospital clinic care for treatment for low back pain. This study randomly assigned 741 patients with low back pain to either standard outpatient care at the hospital or chiropractic care over a 3 year period. The chiropractic patients consistently showed superior results and also reported a 29% overall improvement compared with standard hospital care.
British Medical Journal, TW, Meade, 1995
A 1987 comparative study over 17,000 M.D. and D.C. patients in Italy found that the chiropractic patients had 87.6% less hospitalization. Chiropractic was found to help current problems and also showed benefits through its preventative and rehabilitative functions.
Prof. F Spendor, Italy, 1987
A University of Saskatchewan study of 171 chronically disabled low back suffers had 87% showing improvement within 2-3 weeks with Chiropractic care and they remained pain free one year later.
David Cassidy, DC, Kirkalday Willis, MD
University of Saskatchewan 1985
A respective study of work related mechanical low back pain claims in the state of Victoria, Australia also shows the efficacy of Chiropractic. Over 12 months they found:
1. Significant reductions in the number of claimants requiring compensation when
Chiropractic care was utilized.
2. Fewer compensation days for those under Chiropractic care.
3. More patients progressed to a chronic condition when standard medical care
4. Average payment per claim was greater with medical management.
Chiropractic Journal of Australia
P. Ebrall, June 1992
The Canadian province of Ontario released a study call the "Manga Report" which also investigated the cost-effectiveness of chiropractic care in management of low back pain. The conclusion was that Chiropractic care was clinically valid, safe and cost-effective in caring for low back conditions. Patients were satisfied with Chiropractic care with a significantly higher rate than those going to M.D.`s. The recommendations included encouraging patients to seek chiropractic care through full inclusion in the Ontario Health Insurance Plan and full integration into the national health care system.
P. Manga, Univ. of Ottawa, Oct. 1993
A comparison study published in the "British Medical Journal" in 1992 evaluated the effectiveness of manipulation for the treatment of persistent back and neck complaints. The chiropractic group showed greater improvement in the primary complaint-as well as physical function-with fewer visits compared to physical therapy. It also demonstrated that manipulation and physical therapy are not interchangeable. This study concluded that manipulative therapy was better than "general practitioner and placebo treatment." The longitudinal benefits of chiropractic were also demonstrated, with manipulative therapy showing better results than physiotherapy under study-re-evaluations after 12 months.
British Medical Journal
BW Koes, LM Bouter, 1992
We have shown that Chiropractic care is cost-saving, safe and effective. It is a drug-free, surgery-free alternative to Allopathy. Presently it accounts for less then 2% of total insurance payouts, so it can hardly be lamed for our current health care crisis. Chiropractic should be part of the remedy!
Currently Chiropractic utilization is reduced by HMO fiat (need of a referral) and lower "insurance" coverage of D.C. care. "If Chiropractic care is insured to the extent other specialists are stipulated this could lower treatment costs." Chiropractic also requires fewer referrals for (cost intensive) specialist and outside procedures. ("Virginia Cost Comparison Study", D. Dean, Ph.D., Univ. of Richmond, VA) Chiropractic care through its efficacy and cost-effectiveness, can show benefits with minimal, even negligible impact on costs of health insurance. ("The Virginia Study of Mandated Insurance", L. Schifrin, Ph.D., College of William & Mary)
As a conservative, natural, outside the hospital protocol, Chiropractic needs to be available to more people. Chiropractors should be Primary Care Providers freely accessible at a reasonable cost to anyone who may desire it.
The Illinois Prairie State Chiropractic Association would like to extend our thanks to the International Chiropractors Association (ICA) and Chiro.org on their assistance on assembling the above information.