The effectiveness of chiropractic care

Cost and effectiveness of chiropractic care

Numerous studies have been carried out throughout the world to evaluate chiropractic and its economic impact. The first publications date back to the early 1970s. Industrial Back injury by C. Richard Wolf,M.D. Dec 1972. 

Here are a few examples of chiropractic studies:

In 1985, a remarkable clinical trial on the impact of chiropractic care on work disability was conducted at the University Hospital of Saskatoon (Canada). 202 patients (81%) out of 238 (who had been unable to work for an average of 7 years) returned to normal work after intensive treatment by a doctor of chiropractic. Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low back pain.

In the United States, in March 1996, a report on the “cost effectiveness” of chiropractic treatment over the period October 1994-October 1995 for members of an HMO (an organisation acting in the role of social security and mutual insurance company) was published. The article concludes: “We are surprised by the relatively low proportion of members of this HMO who chose chiropractic for their back problems. This phenomenon deserves more attention in the future. Indeed, if only half of the patients treated in the other circuit had been managed by chiropractic, the savings for the year would have been greater (for our sample of 1957 people) than 215,000 dollars (175,000 euros). We believe that chiropractic treatment is an extremely promising method of treating back problems and neck pain. We recommend that it be used as widely as possible by the HMO system and by the community of healthcare practitioners.

A saving of €175,000 for 2,000 people in one year! And a more effective result.

Mosley Cdet al. Cost effectiveness of chiropractic in a managed care setting.American Journal of Managed Care 1996;2:280-282.

The Manga Report: Report commissioned by the Ontario Ministry of Health in 1993.  

After an analysis that had a profound impact on the recognition of chiropractic, both in Ontario and in the rest of Canada, the report concluded “that chiropractic treatment for people with low back pain is more scientific and safer than medical treatment, is more popular with these people and is very cost-effective. The government could save hundreds of millions of dollars each year if it changed its policies in favour of chiropractic services for the majority of people suffering from low back pain”. The main authors of the report are two health economists from the University of Ottawa: Professor Pran Manga and Professor Doug Angus.

Manga The effectiveness and cost-effectiveness of chiropractic management of low back pain 1993

At a time when care is being rationalised, public authorities and paying bodies, whether public or private, profit-making or not, can no longer ignore the economic data on the treatment offered to users of the healthcare system. Other studies compare chiropractic treatment with other medical treatments. :  

AUMED (HMO), a health insurance company, referred a panel of 100 patients to a chiropractic centre, 12 of whom were awaiting spinal surgery for herniated discs. The results were conclusive, with an 86% recovery rate and no need for surgery.

The author of the report (a doctor) concluded that this chiropractic treatment saved the insurance company $250,000 ($250,000 for 100 patients!). It was therefore decided that all policyholders of this HMO should consult a doctor of chiropractic before any hospitalisation for spinal pain.

Chiropractic Report AUMED Jan. 1988.                         

• In 1994 a comparison of chiropractors’ patients with doctors’ and osteopaths’ patients in insurance contracts highlighted the substantial savings for patients receiving chiropractic care. This study found that the total cost difference ranged from $291 to $1722 per patient over a 2-year period. Stano M.Further analysis of health care cost for chiropractic and medical patients.J.M.P.T.,Vol 17,number 7, sept. 1994,442-446.
• In 1988, a study was carried out in Florida among policyholders of the same insurance company in order to compare the chiropractic management of cases of back pain with the medical management of these cases. The average number of days of temporary total disability was reduced by 48.7% and the cost of care was reduced by 55.3% when care was provided by a doctor of Chiropractic.
• Huas and Col carried out a study in 2005 on the treatment of 2,780 patients with low back pain by 60 doctors of chiropractic and 111 doctors of medicine. The result was an improvement in pain and work incapacity in patients treated by a doctor of chiropractic. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. HaasM et al. JMPT,2005 Oct;28(8):555-63.
• In 2004, Phelan examined 43,000 work-related accident files relating to musculoskeletal pathologies. The average cost of treatment was 3,519 dollars per patient for medical treatment, 5,173 dollars for multidisciplinary treatment and only 663 dollars for chiropractic treatment. The difference between the 2 types of treatment also concerned lost working days. The authors conclude their study as follows: “The differences in the cost of the different types of treatment suggest that these results suggest a lower cost of treatment, fewer lost working days, less use of other medical services, and less compensation for patients treated by a doctor of chiropractic”. Phelan SP et al An evaluation of medical and chiropractic provider utilization and costs:treating injured workers in North Carolina.JMPT, Sept. 2007;27:442-8
• Comparable results were presented by Ebralis in Australia for 1996 work-related accidents causing mechanical low back pain. On average, the cost of medical treatment was $1,569, with 25.56 days off work, compared with $392 and 6.26 days off work for chiropractic treatment. Ebralis P.S. Chiropractic Journal of Australia. Vol 22, June 1992, pages 47-53.
• In order to avoid the pitfalls associated with differences in pathology, 3062 records supplied by the Utah workers’ compensation fund (U.S.A.) were selected. The authors obtained perfectly comparable populations for chiropractic and medical treatment. The cost of time off work was 10 times higher in the group receiving medical treatment (an average of $688) than in the group treated by doctors of chiropractic (an average of $68). Jaris Journal of Occupational Medicine Vol 33, number 8, August 1991, p.847-852.
•  A study carried out in Florida in 1988 among policyholders of the same insurance company showed that the length of the benefit period, represented by the average number of days of temporary total disability, was reduced by 48.7% when care was provided by doctors of chiropractic. The cost of chiropractic care was reduced by 55.3% compared to medical care. Steeve Wolk, PH.D. Director of Research, the Foundation for Chiropractic Education and Research. Sept. 1988. “A cost analysis of disability and treatment for back-related workers compensation cases.”
• In 2007, Sarnat and Col published a study on the use by patients of doctors of chiropractic as referral practitioners in the context of health cover. This 7-year study involved a group of 70274 members. Compared with the control group, which was comparable in all respects except for the referring practitioner, a clear reduction in hospital admissions, length of stay in hospital, drug prescriptions and recourse to surgery was observed in favour of the doctors of chiropractic. Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update. Sarnat et al 2007 JMPT May;30(4):263-9.

Over the last 20 years, health policy decision-makers in many countries have commissioned various reports on the benefits of chiropractic treatment and its integration into health care systems:

• The first European evaluation dates back to 1977 in Switzerland. It concluded that chiropractic treatment was beneficial(2). In Switzerland, doctors of chiropractic now have the status of a medical profession. Dr Urs Xalter La Chiropratique vue par les patients 1977. Institute of Preventive and Social Medicine, University of Zurich.
• In 1984, doctors of chiropractic in Australia were integrated into the health system and hospitals following a report by the Medicare group insurance scheme. Second Report Medicare Benefits Revew Committee. Thompson CJ. Commonwealth government Printer, Canberra,Australia. chapter 10-June 1986.
• In 1990, a major study was carried out in England. It looked at the management of 741 patients either by doctors of chiropractic or in hospital. The difference between the two types of care was significant in favour of chiropractic care. The authors concluded that the introduction of chiropractic care into the healthcare system should be considered. Chiropractic was recognised in 1994. It was integrated into the health care system. T.W.Meade et al,British Medical Journal,300,2,6,1990,1431-1437.
• In 1988, the Italian government completed a 2-year study of 17,000 patients treated by doctors of chiropractic in 22 medical clinics. This study showed that chiropractic care reduced the length of hospitalisation by 87% and time off work by 75%. Chiropractic is now a medical profession in Italy. F. Splendori: L’efficacité des soins chiropratiques/ impact social, incidence sur les congés maladie et hospitalisation,1988.

There are hundreds of other studies demonstrating the effectiveness of Chiropractic, and the best proof is the recognition of this profession throughout the industrialised world despite enormous political pressure…