Insurance reimbursement levels greatly affect use of chiropractic services
Healthcare Costs and Financing
About 7 percent of persons in the United States visit chiropractors, the
third largest group of health professionals after medical doctors and
dentists. An increasing number of health insurance plans are covering
chiropractic services. But the amount the plan reimburses a patient for
these services greatly affects their use, according to a recent study
supported in part by the Agency for Health Care Policy and Research
(HS06920). It shows that when patients have to share 25 percent or more
of the cost, they decrease their chiropractic expenses by half.
This pattern makes chiropractic care more sensitive to cost than overall
health and dental care and about as sensitive as outpatient mental
health services, concludes Paul G. Shekelle, M.D., Ph.D., of RAND, principal
investigator of the study. The researchers analyzed data from the RAND
Health Insurance Experiment, a randomized controlled trial on the
effects of cost sharing on use of health services. Families in six U.S. sites
(Dayton, OH, Seattle, WA, Fitchburg and Franklin County, MA, and
Charleston and Georgetown County, SC) were randomized to receive
fee-for-service (FFS) care that was free or required one of several
levels of cost sharing, or to receive care from a health maintenance
organization. Families were followed for 3 or 5 years, and chiropractic
use among persons in the HMO and FFS plans was compared.
In the fee-for-service plans, persons who had to pay coinsurance of 25
percent or more decreased chiropractic expenditures by about half.
Access to free chiropractic care among HMO enrollees increased chiropractic use
nine-fold, compared with a contemporaneous sample of HMO enrollees who
faced 95 percent cost sharing for chiropractic care. Among this latter
group, access to free medical care in the HMO decreased by over 50
percent their use of chiropractic care relative to persons who faced 95
percent cost sharing for both medical and chiropractic care. This
suggests that there is a substitution of medical care for chiropractic
care, depending on price.
See "The effect of cost sharing on the use of chiropractic services," by
Dr. Shekelle, William H. Rogers, PH.D., and Joseph P. Newhouse, Ph.D.,
in Medical Care 34(9), pp. 863-872, 1996.