Each year the Bureau of Health Professions releases an annual report on the current activity of the Health Education Assistance Loan (HEAL) program.
The fiscal year (FY) report ends on September 30 of each year. Due to the recent federal budget battles and the ensuing government shutdown the FY 1995 report was delayed until budget appropriations could begin to pay for the labor to print the report. This report consists of the current activity of the HEAL program. Although the chiropractic schools are moving away from this financial vehicle and opting for the Chiroloan program, there are still practitioners repaying HEAL loans.1
This paper is written to adequately inform the profession of statistics that are vital to the profession. Several of these statistics may even be classified as "economic indicators."1
Eleven health disciplines, including chiropractic, are utilizing the HEAL program. A comparison between allopathy, osteopathy, and chiropractic will be made to correlate and compare the different trades as they relate to the statistics. Where possible statistics of value from the other professions will be made. The other eight disciplines (which include optometry, pharmacy, veterinary, public health, podiatry, dentistry, clinical psychology, and health administration) will be classified as "others."
The Statistics
The figures that are presented in the FY 95 annual report are broken down into the following categories: disbursements, litigation, claims, loan refinancing, and additional information.
While these figures make up a major portion of the report, a section on the federal organization, definitions of federal loan language, and the history of the HEAL program is also included. This section will not be discussed due to its length, but several key facts must be noted to fully understand the concepts of the statistics that are presented.
A Very Brief History of the HEAL Program
The HEAL program was enacted under Public Law (P.L) 94-484 and took effective on October 12, 1976. In December 1977, the program required that medical, osteopathic, and dental schools increase their enrollments to qualify for a capitation grant.2 On August 13, 1981, P.L. 97-35 became a reality. Students of chiropractic, health administration and clinical psychology could became HEAL borrowers (1,2). It allowed students to borrow $12,500 per year and up to $50,000 aggregate.2
The reader should take into consideration when reviewing these statistics the number of practitioners in the U.S. for each profession: 670,000 medical doctors; 50,000 chiropractors; 36,500 osteopaths.3
Disbursements
For FY 95, total HEAL disbursements were $274.4 million in principle allotted for the 11 eligible professions.4 This in comparison with FY 94 was up $15.1 million, or a 5.8 percent increase.4 In 1994, total disbursements were down $70.2 million or 21.3 percent.2 Chiropractic borrowing in FY 94 only accounted or 796 students and $2.6 million, or 83.2 percent less than FY 93 borrowing.2 For FY 95, 236 chiropractic students borrowed $1.2 million, less than one percent of all borrowers.4 Parker College of Chiropractic for FY 95 topped the list for chiropractic with 156 students using the program.4
For FY 95 the Top 10 schools accounted for $88.1 million or 32.1 percent of the total borrowed.4 No chiropractic school was listed in the Top 10. The last chiropractic school to be listed in the Top 10 was Parker College in 1990 at the number seven position, accounting for $5.2 million or 1.9 percent.5 Allopathy, dentistry, and osteopathy comprised 34.7, 24.5, and 22.5 percent respectively for FY 95.4
The concentration of HEAL borrowers as reported in the 1995 annual report lists California with the most borrowers (23,792), followed by New York (17,088), and Pennsylvania (16,085).4
In comparing the disbursements of private vs. public schools the bureau has noted that the chiropractic and podiatry professions are the only trades that do not have any participating public schools.4 Allopathy, osteopathy, and dentistry and several others have significant higher private school borrowing as compared with public schools. This may be attributed to the fact that public schools of a professional nature are situated in land-grant institutions, or are tax-supported, lending itself to lower tuitions.1
Since the inception of the program in 1979, 156,116 individuals have borrowed approximately $3.54 billion. Chart one represents the individual number by discipline being studied.
Chart 1
| Borrowers | Percent | Dollars | Percent | |
| Allopathy | 66,431 | 42.5 | 1,391 mil | 39.3 |
| Osteopathy | 17,737 | 11.4 | 591.3 | 16.7 |
| Chiropractic | 20,586 | 13.2 | 349.8 | 10.0 |
| others | 51,362 | 32.9 | 1,209.2 mil | 34.0 |
Litigation
The figures for litigation will be discussed in the following charts. The figures below represent the outstanding balance at the time litigation is initiated.4 These numbers more than likely include principle and interest.
As of September, 1995 (FY 95) 14,042 individuals were litigated against for a total of $613.1 million.4 Chart two represents the disciplines studied.
Chart 2
| Borrowers | Percent | Dollars | |
| Allopathy | 3721 | 26.5 | $149.2 |
| Osteopathy | 823 | 5.8 | 53.8 |
| Chiropractic | 4,568 | 32.5 | 176.2 |
| others | 4,930 | 35.2 | 233.9 |
For FY 94, chiropractic had 4,040 practitioners or 32.2 percent litigated against for $155 million. These numbers for FY 95 indicate that 528 individuals were added to the existing figures of 1995, accounting for $21.2 million.
The annual HEAL report gives what is called "cures by reason." The "cures by reason" for all borrowers (47.6 percent or $128.9 million) were by forbearance. Repayment of a past due loan accounted for 13.7 percent; deferment accounted for 18.5 percent.4
The bureau was surprised that many borrowers did not take advantage of those repayment aids until lawsuits were filed against them.4
The Bureau's annual report lists the Top 10 schools with borrowers entering HEAL litigation, as of September 1995. Four chiropractic schools were listed in the Top 10 with three podiatry schools, two dental schools and one medical school.
The four chiropractic schools and their respected rank with dollar amounts are listed as follows:
Chart 3
| Life College | #1 | $35.6 million |
| Palmer College | #2 | 24.3 |
| Cleveland-KC | #4 | 18.6 |
| LACC | #7 | 15.6 |
For FY 94, Life College held the number one position, having borrowers owing $33.4 million; Palmer College holding the second rank at $21.6 million; Cleveland-KC and LACC dollar figures were at $16.7 million and $13.3 million respectively for FY 94.2
References
- Mirtz, TA. Student loans: Facts and figures from the Bureau of Health Professions, unpublished manuscript.
- Federal Health Education Assistance Loan Annual Report Fiscal Year 1994. Bureau of Health Professions.
- Mirtz, TA, Student loans: An analysis of the Federal Register and chiropractic viewpoints. Dynamic Chiropractic, Vol 13, No. 12, June 15, 1995.
- Federal Health Education Assistance Loan Annual Report Fiscal Year 1995. Bureau of Health Professions.
- Federal Health Education Assistance Loan Annual Report Fiscal Year 1990. Bureau of Health Professions.
Timothy Mirtz, DC
Lawrence, Kansas