MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Several investigations have suggested that chiropractic care can be cost-effective. A recent review of 25 studies, for instance, concluded that cost comparison studies suggest that health care costs were generally lower among patients whose spine pain was managed with chiropractic care. However, its authors cautioned that the studies reviewed had many methodological limitations. Better research is needed to determine if these differences in health care costs were attributable to the type of HCP managing their care.

Better research might come from the US ‘Centers for Medicaid and Medicare Services’ (CMS); they conduced a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head.

The demonstration was conducted in 2005–2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework.

Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa.

The authors concluded that the demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.

In view of such results, I believe chiropractors should stop claiming that chiropractic care is cost-effective.

7 Responses to Chiropractic care increases costs to Medicare

  • “demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.”

    I like it, this type of study is acceptable when degrading chiropractic, but not acceptable when showing the benefits. Oh, and the quoted text, think about that. Your conclusion is based on a short term trial that didnt even weigh in on cost to the consumer.

    http://www.miamiherald.com/news/local/article85254512.html

    I would say these $900 Million in bogus charges are more of a burden to Medicare than chiropractic. Excellent biased reporting though

    • “the studies reviewed had many methodological limitations. Better research is needed to determine if these differences in health care costs were attributable to the type of HCP managing their care.”

    • A review of poor studies revealed that chiro was “generally” better (i.e. not always). From this we have chiros claiming that whatever treatment they provide is cost effective. A large 2 year study revealed mixed results about cost effectiveness. Edzard is simply saying that the evidence indicates chiros cannot make the claim of “cost effectiveness”. This study doesn’t “degrade chiropractic”. You are simply interpreting the text through a lens of bias.

  • I would agree that Chiropractors can’t claim to provide cost-effective treatment due to the point highlighted above by Prof Ernst i.e. the studies reviewed had many methodological limitations.

    However, the other study referred to in the blog post and in the title of the blog post did not seek to to assess whether chiropractor care per se was cost-effective. Rather, it sought to assess whether expanded chiropractor care was cost-effective compared to traditional chiropractor care. It is important for the results of that study not to be overstated.

    • @ AN Other on Friday 29 July 2016 at 12:26

      “did not seek to to assess whether chiropractor care per se was cost-effective”

      What is the point if it isn’t efficacious?

      Hasn’t the tyre on the barrow you push worn out by now?

      I didn’t ever respond to the reply you posted about being a receptionist at an alt-med place. Please remind me where it is so I can tear you AN Other one?

  • @ Frank

    Like one of the other posters on this blog (Blue Wode), I prefer to stay anonymous. You don’t seem to complain about Blue Wode’s anonymity. Also, why the threat of violence? Feel better soon. All the best.

    • @ AN Other

      If you check the rules, “Libellous statements are not allowed.” Stalking and threats of physical violence are fine. Just type quietly, so as not to provoke him.

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