Use and Costs of Chiropractic Care in a Community-Based Sample of the United States. Executive Summary

摘要

This thesis analyzes data from the RAND Health Insurance Experiment (HIE) to answer significant research questions about chiropractic health services. The HIE was a population-based, randomized controlled trial that tracked the use of medical services and the health status of enrolles over a 3-5 year period. Participating families were assigned to insurance plans that had different levels of cost-sharing. All plans covered chiropractic services. Claims forms and baseline demographic and health status data were used for the analysis. The chiropractic use rate was 41 visits per 100 person-year. About 7.5% of the population saw a chiropractor at least once during their three or five year period of enrollment. Back pain accounted for 42% of all visits, and spinal manipulation accounted for 60% of all services. Seven-fold differences in use rate were seen between geographic sites. Cost-sharing decreased annual chiropractic expenditures by about half. HIE site, male sex, white race, and high school education were all independent predictors of choosing a chiropractor as the primary provider of care. Chiropractors were the primary provider for 40% of all episodes. Chiropractic episodes of care were among the lowest in total cost (along with general practitioner episodes), but among the highest in outpatient costs.