A Great Way to Drive Down Health Care Costs

Including CAM in new delivery systems may help slow spending.

By Peter W. Crownfield, Executive Editor

A study published in the January 2013 issue of Health Affairs provides detailed insight into utilization and expenditure trends for chiropractic and other forms of complementary and alternative medicine.

According to the study by Matthew Davis, et al., from 2002-2008, "use and spending on these services, previously on the rise ... largely plateaued," suggesting that "any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best." What's more, according to the authors, cutting CAM / chiropractic coverage could actually have the opposite effect because excluding services currently funded through public and private insurance could "trigger increased spending."

Analysis of the Medical Expenditure Panel Survey revealed a CAM-wide trend toward increased utilization of services (6 percent increase from 2002-2008; 15.2 million adult users in 2002 vs. 16.1 users in 2008). Overall, use was relatively stable across CAM disciplines with the exception of acupuncture, which saw a 16 percent increase in adult visits. Chiropractic users increased from 11.5 million in 2002 to 11.9 million in 2008.

However, while visits to chiropractors and other CAM providers increased, total visits decreased, ranging from a 3 percent decrease in chiropractic visits (98.6 million visits in 2002 vs. 96.1 million visits in 2008) to a 16 percent decrease in acupuncture visits (6.4 million visits in 2002 to 5.4 million visits in 2008). The authors suggest that "the higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth."

In terms of the costs of chiropractic and other CAM services, inflation-adjusted chiropractic expenditures increased from 6.2 billion in 2002 to 6.9 billion in 2008, while inflation-adjusted expenditures on acupuncture, massage and other CAM services remained stable (0.4 billion in acupuncture expenditures in 2002 and 2008; 1.0 billion in massage expenditures in 2002 and 2008). Per-user annual expenditures (inflation-adjusted) also increased for chiropractic and massage users ($447 to $552 and $259 to $305, respectively), while decreasing for acupuncture ($360 to $325) and other CAM services ($301 to $214).

When putting this data into the national health care perspective, the authors make several interesting points:

• "As health care policy-makers, payers, and other stakeholders attempt to reduce waste in health care systems, they should recognize that excluding currently covered complementary and alternative medicine services would, at best, produce only meager cost savings. Operating under more free-market conditions, the pricing of complementary and alternative medicine services appears to be more self-regulating than that of the conventional health care sector. This difference suggests that payment systems that encourage consumers to make educated decisions under the constraint of a budget may help constrain health care spending growth."
• "Considering that complementary and alternative medicine appears to be relatively inexpensive when compared to allopathic medicine, if medical care providers are willing to collaborate with local complementary and alternative medicine service providers, offering at least some complementary and alternative medicine services could help accountable care organizations achieve their objectives."

Finally, with the data showing chiropractic not only as the predominant source of CAM utilization and expenditures, but also reflecting increased total and per-user costs over the study period, chiropractic might be considered by some a prime candidate to be excluded from health insurance as a cost-reduction strategy. However, the authors suggest just he opposite, concluding: "Health care policy- makers need to consider the potential 'offset effects' of patients' substituting for the excluded services with other covered services at equal or even greater cost."

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Source: Davis MA, et al. U.S. spending on complementary and alternative medicine during 2002-2008 plateaued, suggesting role in reformed health system. Health Affairs, 2013;32(1):45-52.