Research on Chiropractic

Cost Effectiveness Studies


It was estimated that 1992 low back pain costs in the US were a staggering $60 billion when production lost
was taken into consideration. Research has indicated that low back pain disability is growing 14 times faster
than the population. It's the leading cause of disability and morbidity in middle-aged persons, and is the
most expensive source of workers' compensation costs in North America. In the 30-50 age group, low back
pain is the single most expensive health care problem.

The escalating costs associated with low back pain have prompted legislators, policy makers and insurance
companies to investigate cost-containment strategies. As you will see in the following studies, chiropractic
care has been consistently identified as one of the most effective and cost effective treatments for the
management of many low back conditions, in addition to a number of other neuromusculoskeletal disorders.
Moreover, the volume of scientific evidence now being compiled makes a compelling case for the use of
chiropractic as a means of controlling the escalating costs of our overburdened health care system.

Prevalence of Selected Impairments. United States - 1971. National Center for Health Statistics, Hyattsville,
Maryland - 1975, DHHS Publication No. (PHS)75-1526 (Series 10, No. 9) and 1981 DHHS Publication No.
(PHS) 87-1587 (Series 10, No. 159)

Back Injuries in Industry: A Retrospective Study Part I Overview and Cost Analysis. Spengler et al. Spine,
1986 - 11(3):241-245.



THE MANGA REPORT

The following excerpts from the Canadian government commissioned study clearly indicates the cost
effectiveness of chiropractic treatment over standard medical treatment:

· "The overwhelming body of evidence shows that chiropractic management of low-back pain is more cost
effective than medical management, and that many medical therapies are of questionable validity or are
clearly inadequate ... Chiropractic manipulation is safer than medical management of low-back pain."

· "There would be highly significant cost savings if more management of low-back pain was transferred from
physicians to chiropractors... Users of chiropractic care have substantially lower health care costs,
especially inpatient costs, than those who use medical care only."

The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga
Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.



THE UTAH STUDY

In 1988 a Utah Workers' Compensation Board study found the total treatment costs for back-related injuries
cost an average of $775.30 per case when treated by a doctor of chiropractic. When injured workers
received standard medical treatment as opposed to chiropractic treatment, the average cost per case was
$1,665.43.

They also found the mean compensation cost paid out by the Utah Worker's Compensation Board for
patients treated by medical doctors was $668.39, while the mean compensation cost paid for patients
treated by chiropractic doctors was only $68.38.

Cost per Case Analysis of Utah Industrial Back Injury Claims: Chiropractic Management vs. Medical
Management for Diagnostically Equivalent Conditions. D.C. Tracts - 1989.

Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions
with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine - 1991;33:847-852.



THE OAKLAND UNIVERSITY STUDY

After reviewing the health insurance claims for 395,641 chiropractic and medical care patients, Miron Stano,
Ph.D., lead researcher, concluded:

Those patients who receive chiropractic care, either solely or in conjunction with medical care, experienced
"significantly lower health care costs... on the order of $1,000 each over the two-year period" compared with
those who received only medical care. Specifically, total insurance payments were $1,138 (30% higher) for
those who elected medical care only. The lower costs for chiropractic patients were attributable both to lower
inpatient and outpatient costs and indicated that "chiropractic treatment substitutes for other forms of
outpatient care."

Stano/Medstat Research. Miron Stano, Ph.D. Oakland University.



THE VIRGINIA RESEARCH STUDY

An economic analysis conducted in Richmond, Virginia in 1992 found chiropractic care to be a lower cost
option for back-related ailments. The researchers concluded that if chiropractic care was insured to the
extent of other medical specialties, it would likely emerge as a first option for many patients with certain
medical conditions. They also believed this could result in a decrease in the overall treatment costs for
these conditions.

Additional research conducted by The College of William and Mary and the Medical College of Virginia in
1992 on mandated health insurance coverage and the economic impact of chiropractic coverage revealed:

· The low cost of chiropractic is due not to its low rate of use, but to its apparently offsetting impacts on costs
in the face of high rates of utilization. Chiropractic is a growing component of the health care sector, and it is
widely used by the population.

· Formal studies of the cost, effectiveness, or both of chiropractic, usually measured against other forms of
treatment, show it to compare favorably with them.

· By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide
important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with
apparently minimal, even negligible, impacts on the costs of health insurance.

· The conclusion of this analysis is that chiropractic mandates help make available health care that is widely
used by the American public and has proven to be cost-effective.

A Comparison of the Costs of Chiropractors versus Alternative Medical Practitioners. Dean DH, Schmidt RM.
University of Richmond, Richmond, Virginia - January 13, 1992.

Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, with
Implications for the Commonwealth of Virginia. Schifrin LG. The College of William and Mary, Williamsburg,
Virginia, and Medical College of Virginia, Richmond, Virginia - January 1992.



THE FLORIDA STUDY

This large State of Florida study examined 10,652 patients who sustained back-related injuries on the job.
Their findings revealed that individuals who received chiropractic care compared with standard medical care
for similar diagnoses experienced had a (i) 51.3 percent shorter temporary total disability duration (ii) lower
treatment cost by 58.8 percent ($558 vs. $1,100 per case) (iii) 20.3 percent hospitalization rate in the
chiropractic care group vs. 52.2 percent rate in the medical care group.

An Analysis of Florida Workers' Compensation Medical Claims for Back Related Injuries. Wolk S. Foundation
for Chiropractic Education and Research, Arlington, VA. - 1988.



THE AV-MED STUDY

In this study, 80 patients who previously received medical treatment were subsequently referred to the
Silverman Chiropractic Center. Of the 80 patients, 21 percent had just been diagnosed with spinal disc
problems, 12 percent had been diagnosed as requiring surgery and 5 percent had received emergency
room treatment. Following chiropractic treatment, none of the patients were required to have surgery, 86
percent of the patients needed no further care, and the estimated health care savings in the group of 80
was estimated to be $250,000.

The Av-Med Study - 1993.



THE AUSTRALIAN STUDY

In this Australian study, 1,996 workers' compensation cases were evaluated in patients who experienced
work-related mechanical low back pain. It was found that those individuals who received chiropractic care for
their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4
times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those
patients who received chiropractic care there was a significantly lower incidence of progression to a chronic
low back pain status.

Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian
Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia - 1992;22:47-53.