1 Workers' Comp and Chiropractic: A Solution for Skyrocketing Health Care Costs in America
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Dynamic Chiropractic – September 9, 2010, Vol. 28, Issue 19

Workers' Comp and Chiropractic: A Solution for Skyrocketing Health Care Costs in America

By Mark Studin, DC, FASBE(C), DAAPM, DAAMLP

Health care costs are such a burden on the economy that as of 2008, it accounted for 16.2 percent of the national gross domestic product (GDP).1 The recently enacted health care reform legislation addresses many issues in the health care reform arena, including ensuring that every American has health care coverage; however, leaving politics aside, there is a potential that health care costs as a percentage of GDP will rise.

With mushrooming annual budgets that include multi-billion-dollar shortfalls, most individual states are now pressured to cut costs and prevent unnecessary spending. One of the largest areas of expenditure in every state's budget is health care through workers' compensation and Medicaid. If those state governments put politics aside and looked at the hard numbers, they would see chiropractic not as the scapegoat for many of our states' health care financial problems, but as a solution.

One political argument in California during the quest to remove chiropractic from the workers' compensation system was that chiropractors pander to lawyers who want higher fees to win their cases. The detractor, an MD with a long anti-chiropractic history, should realize, as should the California legislature, that there will always be a certain number of unscrupulous people in any system; medicine and chiropractic are no different in that regard. This should not be a political argument. The metrics of health care outcomes and the financial savings is what should be judged.

As to the health care metric, that argument is long over, as chiropractic has been proven effective. The cost metric has to go beyond the simple office visit to the orthopedist or medical back care provider. The real costs accrue from the medical office visits and the drugs often used over a lifetime, and even the potential for addiction from such use. The metric also covers durable medical equipment, physical therapy and all of the associated ancillary requirements, surgeries and high cost of hospital stays. Then we need to account for the lifetime of disabilities that could have been avoided. Every one of those costs needs to be accounted for when comparing the cost-effectiveness of medical care and chiropractic care.

With that being said, there are many times medical intervention and all of its wonderful tools are needed, because no one doctor can care for every ailment. However, the progression of treatment should be drugless first, drug administration second and surgery as a last resort. In states like California, the less expensive, largest, most effective drugless option is no longer available to its residents. In other states like New York, the reimbursement is so low that chiropractors are emigrating from the state in alarming numbers, leaving a void for injured people to seek appropriate care and lower the cost of health care, reducing the financial burden to the NYS workers' compensation system.

An obvious pragmatic strategy would be utilizing services for injured workers that have been proven to be more effective at lower costs. Past history would suggest that if such a method were identified, tax credits or other incentives could be offered to ensure workers received this care, thereby reducing costs to the system and creating a more competitive business environment.

Chiropractic care has been shown repeatedly in government and private studies conducted around the world to be more effective at helping injured workers return to work faster and with significantly lower costs (see table). As a result of these studies and many more nationally and globally, governments, both federal and state, should be offering tax incentives for our brightest young minds entering the health care educational arena to become chiropractors; and urging every injured citizen to be under chiropractic care because it works and saves the system money.

The hard part is getting the legislators to see through the special interests to the facts. Fair and equitable access and reimbursement serves the needs of the millions of chiropractic patients nationally and affords fiscal savings for the government. It is also in the best interest of all to keep existing chiropractors and encourage new chiropractic practices in the marketplace.

Chiropractors aren't the ones who want to be treated different; it's the people who are being denied the care they need, and the government, which epitomizes the adage of being "penny wise and billions of dollars foolish." These studies and more indicate that chiropractic saves every system in the world money. If governments put rhetoric aside and opened their eyes, they would fight to lower the GDP by offering incentives to any injured person who sought chiropractic care.

Research Suggesting Effectiveness And Reduced Costs Attributable To Chiropractic Care For Spinal-Related Injuries And Conditions
Study / Source Summary of Findings
Utah Workers' Compensation Board Study2 Total treatment costs for back-related injuries averaged $775.30 per case when treated by a chiropractor; $1,665.43 when injured workers received standard medical treatment.
North Carolina Workers' Compensation Patients3 Average medical care cost for lumbosacral sprain was $3,425, but only $634 when treated with chiropractic.
Ministry of Health, Ontario, Canada4 "Injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."
American Journal of Managed Care5 Health care costs for back and neck pain were substantially lower for chiropractic patients than patients receiving medical care ($539 versus $774, respectively)..
Medical Care Journal6 1. Mean total payments were lower for chiropractic care ($518) versus medical care ($1,020).

2. Favorable satisfaction and quality indicators suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending.
University of Ottawa7 1. Chiropractic treatment was signifi cantly more effective than hospital outpatient treatment, especially in patients with chronic and severe back pain. Signifi cantly fewer patients needed to return for further treatments at the end of the fi rst and second years when receiving chiropractic care vs. medical care (17 percent vs. 24 percent).

2. Highly signifi cant cost savings could be achieved if more management of low-back pain was transferred from physicians to chiropractors.
Oakland University Study8 Health insurance claims for 395,641 chiropractic and medical care patients indicated that patients who received chiropractic care, solely or in conjunction with medical care, experienced signifi cantly lower health care costs compared with those who received only medical care. Total insurance payments were 30 percent higher for those who elected medical care only.
Medical College of Virginia9 By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefi ts at economical costs. Additionally, these benefi ts are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.
Florida Workers' Compensation Board10 Of 10,652 back-related injuries occurring while on the job, individuals who received chiropractic care compared with standard medical care experienced a (1) 51.3 percent shorter temporary total disability duration; 2) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case); and 3) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.
Australian Workers' Compensation Study11 Individuals who received chiropractic care for their back pain returned to work four times faster (6.26 days vs. 25.56 days) and had treatment that cost four times less ($392 vs. $1,569) than those who received treatments from medical doctors.
VU Medical Center Extramural Medicine12 Total costs of manual therapy (447 Euro) were around one third of the costs of physiotherapy (1,297 Euro) and general practitioner care (1,379 Euro) for neck pain.
Journal of Manipulative and Physiological Therapeutics13 For the treatment of low back and neck pain, the inclusion of a chiropractic benefi t resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-fi lm radiographs.

References

  1. "U.S. Health Care Costs." The Henry J. Kaiser Family Foundation. www.kaiseredu.org.
  2. Jarvis KB, Phillips RB, Morris EK. Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine, August 1991;33(8):847-852.
  3. Devitt M. "Work Comp Study: Chiropractic Less Expensive, More Effective Than Medical Care." Dynamic Chiropractic, Nov. 18, 2004;22(24).
  4. Meade TW Dyer S, Browne W, Townsend J, Frank, AO. Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment. British Medical Journal, June 2, 1990;300(6737):1431-1437.
  5. Mosley CD, Cohen IG, Arnold RM. Cost-effectiveness of chiropractic care in a managed care setting. The American Journal of Managed Care, March 1996;2:280-282.
  6. Stano M, Smith M. Chiropractic and medical costs of low back care. Medical Care, March 1996;34(3):191-204. 
  7. Manga P, Angus DE, Papadopoulos C, Swan WR. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain.
  8. Stano M. Stano/Medstat Research, Oakland University.
  9. Dean DH, Schmidt RM. A comparison of the costs of chiropractors versus alternative medical practitioners, 1992.
  10. Wolk S. An analysis of Florida workers' compensation medical claims for back related injuries, 1988.
  11. Ebrall PS. Mechanical low-back pain: a comparison of medical and chiropractic management within the Victorian work care scheme. Chiropractic Journal of Australia, 1992;22:47-53.
  12. Korthals-de Bos IBC, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, April 26, 2003;326(7395):911.
  13. Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. Journal of Manipulative and Physiological Therapeutics,October 2005;28(8), 564-569.

Dr. Mark Studin is an adjunct associate professor at the University of Bridgeport School for Chiropractic, teaching advanced imaging and triaging chronic and acute patients; and an adjunct postdoctoral professor at Cleveland University-Kansas City College of Chiropractic. He is also a clinical instructor for the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Office of Continuing Medical Education. Dr. Studin consults for doctors of chiropractic, medical primary care providers and specialists, and teaching hospitals nationally. He can be reached at or 631-786-4253.

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