On May 18, 2004, the provincial government of Ontario, Canada, announced its intention to delist chiropractic services from the Ontario Health Insurance Plan (OHIP), the province's health care plan, effective Dec. 1, 2004. And despite the heroic efforts of the Ontario Chiropractic Association (OCA) and other organizations, the government remained steadfast in its decision, bringing an end to more than 30 years of public funding for chiropractic services in Ontario.
The decision by the legislature to delist chiropractic flew in the face of previous evidence that suggested coverage of chiropractic care could reduce overall health care costs. A 1993 study funded by the Ontario Ministry of Health, for example, found that enhanced OHIP coverage of chiropractic treatment could save Canada's health care system an estimated $380 million a year in direct costs, and up to $1.2 billion per year in indirect costs attributed to short- and long-term disability.
In September 2004, a report prepared by Deloitte Consulting Services for the OCA reinforced the findings of the 1993 study. It concluded that delisting chiropractic services could end up costing Ontario's residents up to $125 million a year in payments, and that more than half of the people who currently visit a chiropractor for care would be discouraged from doing so if they had to pay for all of the costs of care out-of-pocket.
"The recent government announcement to de-list chiropractic services has potential implications on access to, cost of, and quality of care for Ontario residents," the report stated. "Although de-listing appears to offer cost savings, there are far greater drawbacks that may impact the entire health care system in Ontario."
According to the report, about 1.2 million people in Ontario visit a chiropractor an average of 10 times per year, resulting in approximately 12 million patient visits. A typical visit to a chiropractor cost approximately $20, after adjusting for OHIP coverage. By delisting chiropractic, however, the average patient visit would rise to $30; extrapolated over a year, costs would increase by $100 per person.
While some residents have extended coverage through their place of employment, most Ontarians depend on OHIP to help provide payment for chiropractic services. For people on fixed incomes or tight budgets, the added costs could result in fewer visits to the chiropractor for routine or maintenance care, or force some residents to stop seeing a DC altogether.
"It is anticipated that de-listing will reduce the number of visits to chiropractors," the report noted. "A significant proportion of these visits will shift to physicians, who are ill-equipped to meet this additional demand."
The Deloitte report also found that medical physicians would likely charge much more for providing the same type of care. A cost-analysis in the report showed that a visit to a family doctor for treatment of neuromusculoskeketal disorders would cost almost $100 - between three and five times the average cost of a visit to a DC. Seeking treatment at a hospital emergency room would cost even more - an average of $143 per patient.
"These studies suggest dramatic benefits for Ontarians and for our health care system from continuing to cover chiropractic services," said Dr. Dean Wright, president of the OCA, which represents approximately 2,500 chiropractors in the province. "Given this further unequivocal evidence - and the benefits to the public, the health system and government finances - there is no reason for government to proceed with the plan to eliminate funding."
"We Think This Is a Huge Mistake"
As the Dec. 1 deadline neared, concerns over the legislature's decision grew. In November, two chapters of the Canadian Auto Workers union (CAW) and Dr. Paul Vagners, a chiropractor in Tilbury, Ontario, joined forces and launched a petition drive to protest the delisting. Dr. Vagners collected more than 10,000 signatures from patients and concerned residents, including approximately 1,000 signatures from employees whose companies have contracts with the union.
On Nov. 16, 2004, the OCA made a final push to have the government reconsider its decision. Representatives of the association arrived at Queen's Park, the official location of the Ontario legislature, and delivered several dozen cartons of documents, including letters and petitions signed by more than 600,000 people asking the government not to delist chiropractic. Dr. Wright delivered the documents to the legislature personally, emphasizing that delisting chiropractic would end up costing the government (and Ontario's citizens) more money in the long run.
"At the very least, we call upon Health Minister George Smitherman to delay the planned implementation date - currently set for December 1st - and to examine in detail both this latest evidence and alternative options that the OCA has presented to him for consideration," Wright proclaimed. "We share the government's goal of providing the most effective care for Ontarians in the most cost-effective manner. We again call on the McGuinty government to work co-operatively with us toward achieving that goal."
Upon hearing of the petition drive, Smitherman admitted that he has used a chiropractor in the past, and that many people find chiropractors "therapeutically beneficial." He added that many of his friends and constituents - and even some family members - had complained about the delisting and asked him to reinstate chiropractic coverage, but he insisted that the government could not afford to reconsider its decision.
"We Are Still Here"
While the long-term impact of the Ontario government's decision to delist chiropractic services will not be realized for some time, the OCA has pledged to keep providing affordable, high-quality chiropractic care to those who need it.
"Despite this short-sighted decision, the province's chiropractors want Ontarians to know that we are still here to provide highly effective treatment for back pain and other ailments," Dr. Wright said. He added that patients who may not be able to afford care due to the delisting should speak with their individual chiropractor about ways to treat back pain and other conditions.
"If affordability is a problem, a patient should discuss their situation with their chiropractor to see what options are available - because ultimately, we all want to see patients get the necessary care to end their pain and get back on their feet again."
- Ontario removes chiropractic from provincial health plan. Dynamic Chiropractic, July 1, 2004: www.chiroweb.com/archives/22/14/06.html.
- Impact of Delisting Chiropractic Services. Final Report. Prepared by Deloitte Consulting Services for the Ontario Chiropractic Association. Published September 2004.
- Perkel C. Delisting has hidden costs: chiropractors. New report warns load will shift to physicians; plan to make patients pay for care may backfire. Toronto Star, Sept. 20, 2004.
- Robinet D. CAW gets behind chiropractic services campaign. Chatham This Week, Nov. 10, 2004.
- More than half a million patients show their opposition to funding cuts. Ontario Chiropractic Association press release, Nov. 16, 2004.
- Ont. can't afford to pay for chiropractic care. Canadian Press, Nov. 16, 2004.
- Patients protest chiropractic de-listing. Ontario association brings petitions to Queens Park. Canada.com News, Nov. 16, 2004.
- Health care's "second tier" grows again tomorrow as government removes public funding for chiropractic treatment. Ontario Chiropractic Association press release, Nov. 30, 2004.