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Dynamic Chiropractic – April 8, 2008, Vol. 26, Issue 08
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Dynamic Chiropractic

Paying More for More of the Same

Spine Care Expenditures Jump 65 Percent; "No Improvement" Seen in Health Status

By Editorial Staff

A recent study reveals that health care costs - particularly for prescription medication - for back and neck problems increased substantially over an eight-year span from 1997 to 2005, but without significant improvement in health outcomes such as functional limitations or work disability.1

The investigators examined data from the Medical Expenditure Panel Survey (MEPS), defining patients with spine problems as those with ICD-9-CM codes commonly used for back or neck problems, disk disorders and back injuries. They also assessed where those health care dollars were spent, and how total costs and distribution of costs have changed.

In 1997, the mean age- and sex-adjusted costs for patients with spine (back and/or neck) problems were $4,695 (inflation-adjusted to 2005 dollars). Those without spine problems only spent an average of $2,731 for their health care needs. This places the additional health care costs for those with spine problems at $1,964 for that year.

The cost of spine problems jumped dramatically in 2005. The medical expenditures for those with spine problems grew to $6,096, compared with only $3,516 for those without spine problems. This difference takes the average additional health care costs for those with spine problems to $2,580 per year.

The estimated percentage of individuals with back or neck problems increased from 20.7 percent in 1997 to 24.7 percent in 2005. Combined with the increase in average medical expenditures per patient, these trends resulted in an estimated 65 percent inflation-adjusted increase in total national expenditures for spine problems in adults.

Which Spine Problems Are Most Prevalent?
Percentage of MEPS respondents with spine problems assigned to each ICD-9-CM diagnosis:
ICD-9-CM Code Description 1997 2005
720 Ankylosing spondylitis and other inflammatory spondylopathies 0.5 0.4
721 Spondylosis and allied disorders 2.9 5.2
722 Intervertebral disk disorders 11.6 15.9
723 Other disorders of cervical region 7.7 8.5
724 Other and unspecified disorders of back 53.9 52.9
724.0 Spinal stenosis, other than cervical; 724.1 Pain in thoracic spine; 724.2 Lumbago; 724.3 Sciatica, excluding lesion; 724.4 Thoracic or lumbosacral neuritis or radiculitis; 724.5 Backache, unspecified; 724.6 Disorders of sacrum; 724.7 Disorders of coccyx; 724.8 Other symptoms referable to back; 724.9 Other unspecified back disorders
737 Curvature of spine 2.8 3.0
805 Fracture of vertebral column without mention of spinal cord injury 2.0 3.1
806 Fracture of vertebral column with spinal cord injury 0.1 1.8
839 Other, multiple, and ill-defined dislocations of spine 2.3 2.3
846 Sprains and strains of sacroiliac region 1.6 1.4
847 Sprains and strains of other and unspecified parts of back 14.7 9.3
Note: Total percentage is greater than 100 because categories are not mutually exclusive (i.e., an individual may have multiple diagnoses). All percentages are estimated from a weighted sample using complex survey design methods.
Abbreviations: ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification; MEPS: Medical Expenditure Panel Survey.

Average Chiropractic Expenditures Per Patient

In 1997, average health care expenditures were $1,964 per adult and $52.1 billion overall. Of that, the average amount spent on chiropractic care was only $94 per spine patient or 4.8 percent of the average health care expenditures per person.

In 2005, average health care expenditures per person rose to $2,580. This brought the total health care expenditures for spine problems to $85.9 billion. (To put this in context, the latest figures for annual health expenditures for cancer and diabetes are $89 billion and $98.1 billion, respectively.) While the average amount spent for chiropractic care rose to $157, percentage wise, this was only a growth from 1.3 percent to 6.1 percent of the average expenditures per person.

By contrast, the average expenditures for physical therapy grew from $115 in 1997 to $127 in 2005. But by percentage, the amount spent on physical therapy actually declined - from 5.9 percent of average health care expenditures to 5 percent.

$ In Billions (inflation-adjusted to 2005) isvertical header; Years is horizontal footer.
Year Total Inpatient Outpatient Emergency Dept Pharmacy
1997 52.1 19.0 17.8 1.8 7.3
1998 45.9 13.9 17.8 1.3 7.2
1999 59.0 21.5 17.6 1.3 9.3
2000 58.7 19.6 21.7 1.6 9.8
2001 55.1 15.6 21.2 1.7 11.0
2002 60.5 16.5 22.6 2.1 12.7
2003 79.6 26.4 26.0 2.6 17.3
2004 102.0 32.7 35.7 3.8 20.4
2005 85.9 23.7 30.8 2.6 19.8
*Summing expenditures of all service categories (inpatient, outpatient, pharmacy, ED) does not equate with total expenditures because "other" and "dental" categories are not included.

There were substantial increases in the expense factors relating to spine problems. The percentage of total expenditures related to prescription medication increased dramatically over the eight-year period - more rapidly than expenditures for the other major services. Pharmacy expenditures related to spine problems increased from $7.3 billion in 1997 to $19.8 billion in 2005, a 177 percent increase.

The average expenditure per pharmacy event more than doubled, from $25 in 1997 to $58 in 2005. The authors noted: "When combined with the increase in the number of pharmacy events among patients with spine problems, these differences account for an estimated 423 percent increase in the expenditure for spine-related narcotic analgesics from 1997 to 2004."

Sadly, the increase in health care costs did not result in better outcomes. The authors again noted: "Despite rapidly increasing medical expenditures from 1997 to 2005, there was no improvement over this period in self-assessed health status, functional disability, work limitations, or social functioning among respondents with spine problems."

With all this in mind, one has to wonder how long the current explosive increases in pharmaceutical expenses will be allowed to persist before someone questions the wisdom of this approach. Given that these are the primary patients who would likely seek chiropractic care, it seems the need for chiropractic and chiropractic's potential to impact the current situation are continuing to grow.


  1. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA, 2008;299(6):656-64.

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