This study compares health insurance payments and patient utilization patterns for episodes of care for common lumbar and low back conditions treated by chiropractic and medical providers. Using 2 years of insurance claims data, this study examines 6,183 patients who had episodes with medical or chiropractic first-contact providers.
Multiple regression analysis, to control for differences in patient, clinical, and insurance characteristics, indicates that total insurance payments were substantially greater for episodes with a medical first-contact provider. Most of the cost differences were because of higher inpatient payments for such cases. Analysis of recurrent episodes indicates that chiropractic providers retain more patients for subsequent episodes and that patient exposure to a different provider type during early episodes significantly affects retention rates for later episodes. Patients choosing chiropractic and medical care were comparable on measures of severity and in lapse time between episodes.
The lower costs for episodes in which chiropractors serve as initial contact providers along with the favorable satisfaction and quality indicators for patients suggest that chiropractic deserves careful consideration in gatekeeper strategies adopted by employers and third-party payers to control health care spending. More research is needed, especially in developing alternative measures of health status and outcomes.
*From the School of Business Administration, Oakland University, Rochester, Michigan.
†From the Health Services Research Program, School of Public Health, St. Louis University, and Health Services Research and Development, St. Louis VA Medical Center, St. Louis, Missouri.
Portions of a previous version were presented at a poster session of the Association of Health Services Research, Chicago, Illinois, June 5-6, 1995.
This study was supported by a grant from the American Chiropractic Association and a faculty fellowship from Oakland University's School of Business Administration, Rochester, Michigan.
Address correspondence to: Miron Stano, PhD, School of Business Administration, Oakland University, Rochester, MI 48309.