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Where the United States Spends Its Spine Dollars: Expenditures on Different Ambulatory Services for the Management of Back and Neck Conditions

Davis, Matthew A. DC, MPH*,†; Onega, Tracy PhD*,†,‡,§; Weeks, William B. MD, MBA*,‡; Lurie, Jon D. MD, MS*,¶,‖

doi: 10.1097/BRS.0b013e3182541f45
Health Services Research

Study Design. Serial, cross-sectional, nationally representative surveys of noninstitutionalized US adults.

Objective. To examine expenditures on common ambulatory health services for the management of back and neck conditions.

Summary of Background Data. Although it is well recognized that national costs associated with back and neck conditions have grown considerably in recent years, little is known about the costs of care for specific ambulatory health services that are used to manage this population.

Methods. We used the Medical Expenditure Panel Survey to examine adult (aged 18 yr or older) respondents from 1999 to 2008 who sought ambulatory health services for the management of back and neck conditions. We used complex survey design methods to make national estimates of mean inflation-adjusted annual expenditures on medical care, chiropractic care, and physical therapy per user for back and neck conditions.

Results. Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. During the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; although physical therapy was the most costly service overall, in recent years those costs have contracted.

Conclusion. Although this study did not explore the relative effectiveness of different ambulatory services, recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions.

We used the Medical Expenditure Panel Survey to examine expenditures on health services that managed back and neck conditions from 1999 to 2008. Recent increasing costs associated with providing medical care for back and neck conditions (particularly subspecialty care) are contributing to the growing economic burden of managing these conditions.

*The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH

Institute for Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH

Department of Community and Family Medicine, Dartmouth College, Hanover, NH

§Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Department of Orthopaedics, Geisel School of Medicine at Dartmouth, Hanover, NH

Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH.

Address correspondence and reprint requests to Matthew A. Davis, DC, MPH, The Dartmouth Institute, 35 Centerra Parkway, Lebanon, NH 03766; E-mail: matthew.a.davis@dartmouth.edu.

Acknowledgment date: September 27, 2011. First revision date: February 9, 2012. Acceptance date: March 3, 2012.

The manuscript submitted does not contain information about medical device(s)/drugs(s).

NIH grant funds were received to support this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.