Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-year Update
J Manipulative Physiol Ther 2007 (May); 30 (4): 263–269

      A new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.


Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain
J Manipulative Physiol Ther 2005 (Oct); 28 (8): 564–569

      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.


Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain
J Manipulative Physiol Ther 2005 (Oct); 28 (8): 555–563

      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 LBP. Chiropractic and medical care performed comparably 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. There are more articles like this in the Low Back Pain Page.


Cost Effectiveness of Physical Treatments for Back Pain in Primary Care
British Medical Journal 2004 (Dec 11); 329 (7479): 1381 ~ FULL TEXT

      We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice. Indeed, as we trained practice teams in the best care of back pain, we may have underestimated the benefit of physical therapy (spinal manipulation) when compared with "usual care" in general practice. The detailed clinical outcomes reported in the accompanying paper reinforce these findings by showing that the improvements in health status reported here reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life, and beliefs about back pain.(1) Read more about this on the UK BEAM Trial Page


Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
Arch Intern Med 2004 (Oct 11); 164 (18): 1985–1892

     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).

     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." You may also enjoy this recent press release and this glowing review on WebMD.


Cost Effectiveness of Physiotherapy, Manual Therapy, and General Practitioner Care for Neck Pain: Economic Evaluation Alongside a Randomised Controlled Trial
British Medical Journal 2003 (Apr 26); 326 (7395): 911 ~ FULL TEXT

     A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to this study. After seven and 26 weeks, they found significant improvements in recovery rates in the manual therapy group compared to the other 2 groups. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group. You may also enjoy this WebMD review titled: Manual Therapy Eases Neck Pain, Cheaply.


Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial
Ann Intern Med 2002 (May 21); 136 (10): 713-722

      Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. In this study, manual therapy was a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.

An Evaluation of Medical and Chiropractic Provider Utilization and Costs: Treating Injured Workers in North Carolina
J Manipulative Physiol Ther 2004 (Sep); 27 (7): 442–448

     These data, with the acknowledged limitations of an insurance database, indicate lower treatment costs, less workdays lost, lower compensation payments, and lower utilization of ancillary medical services for patients treated by DCs. Despite the lower cost of chiropractic management, the use of chiropractic services in North Carolina appears very low.


Clinical and Cost Outcomes of an Integrative Medicine IPA
J Manipulative Physiol Ther 2004 (Jun) ; 27 (5): 336–347

     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.


Effects of Inclusion of a Chiropractic Benefit on the Utilization of Health Care Resources in Managed Health Care Plan
Craig F Nelson, D.C., MS

     A four-year longitudinal study using administrative claims data compared 700,000 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 mechanism that produce this cost reduction: 1. A favorable selection 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. You might also enjoy this sidebar article on this topic.


Chiropractic Care: Is It Substitution Care or Add-on Care in Corporate Medical Plans?
J Occup Environ Med 2004 (Aug); 46 (8): 847-855

     An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. These results (of this file review) indicate that patients use chiropractic care as a direct substitution for medical care.


Preliminary Findings of Analysis of Chiropractic Utilization and Cost in the Workers' Compensation System of New South Wales, Australia
J Manipulative Physiol Ther 1995 (Oct); 18 (8): 503–511

      The methodology used was found to be able to provide a basis for comparison of costs for care apportioned to chiropractic and other interventions. An analysis of 20 randomly selected cases from the WCA suggested that chiropractic intervention for certain conditions may be more cost-effective than other forms of intervention.


A Comparison of Health Care Costs for Chiropractic and Medical Patients
J Manipulative Physiol Ther 1993 (Jun); 16 (5): 291–299

      Nearly one-fourth of patients were treated by chiropractors. Patients receiving chiropractic care experienced significantly lower health care costs as represented by third party payments in the fee-for-service sector. Total cost differences on the order of $1,000 over the 2-yr period were found in the total sample of patients as well as in subsamples of patients with specific disorders. The lower costs are attributable mainly to lower inpatient utilization. The cost differences remain statistically significant after controlling for patient demographics and insurance plan characteristics.


Further Analysis of Health Care Costs for Chiropractic
and Medical Patients
J Manipulative Physiol Ther 1994 (Sep); 17 (7): 442–446

     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 restrictions 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 comparisons between the two groups of patients.


Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian WorkCare Scheme
Chiropractic Journal of Australia 1992 (Jun); 22 (2): 47–53

     Comparisons of costs and outcomes were made between the two samples with the results being: (i) a significantly lower number of claimants requiring compensation days when chiropractic management was chosen, (ii) fewer compensation days taken by claimants who received chiropractic management, (iii) a greater number of patients progressed to chronic status when medical management was chosen, and (iv) a greater average payment per claim with medical management.


Economic Case for the Integration of Chiropractic Services
into the Health Care System
J Manipulative Physiol Ther 2000 (Feb); 23 (2): 118-122

     For much of its history, chiropractic care has been both an alternative therapeutic paradigm and separate from or marginal to the mainstream health care system. Over the past decade, the situation has changed somewhat in that chiropractic care is gradually being integrated within a variety of health care delivery organizations. According to Triano et al,1 by the application of evidence-based health care and good business, there is a surge in cooperation and integration among chiropractors, allopathic physicians, allied health care providers, ancillary therapists, and respective support staff. There is, however, no quantification of the level of integration. Integration may also be more true of the United States than elsewhere. The overall position of chiropractic care as alternative and separate still predominates. This situation does not serve the interests of the chiropractic profession nor the public well. There is a persuasive economic case for a radical shift in the role of chiropractic care to one that may succinctly be described as alternative and mainstream. The chiropractic profession must preserve its identity and its unique therapeutic paradigm and continue to be seen as an alternative to other health care professions, especially medical doctors. However, it should also become mainstream and thus widely available and accessible to the public by being integrated into the wide variety of health care delivery organizations that collectively constitute the health care system.